Let me just start out by saying I did not sleep very well yesterday in-between shifts. Had trouble going to sleep, had trouble staying asleep and just plain gave up after waking up for the millionth time about 2:30pm. I was zoning out while getting ready for work and praying to God for an easy work night. "You know I'm tired God, can I please have a pleasant evening at work?"
As Clinical Coordinator (i.e. Charge Nurse) I'm not supposed to take a patient load so I can "manage the flow of the ER". I usually do what we call "SWAT", which boils down to "EVERYTHING". I know for a fact I run more and work harder in this position than if I were to have a room assignment, but it really is the best way to keep track of everything in the ER. But, sometimes I want a room assignment. Sometimes I want more than just 5minutes face time with a patient. Sometimes I don't want to know everything that is going on everywhere. So that sometimes was last night, and I was hoping for a relatively good night...but God laughed.
Well to be perfectly fair to God, I kinda did it to myself. I KNOW that every single time I assign myself the Code Room (which we keep mainly empty for that specific occasion) I am going to get a critical patient. I KNOW this, yet I gave myself that room. In all fairness I was hoping that I would be like the majority of other people and have an off night where that room mainly stayed empty...but then God laughed.
So my first patient was a 79-yr old man with complaint of difficulty breathing that I had initially assigned another room, but by the time her arrived in the ambulance he was in severe respiratory distress and had a critically high blood pressure. I was thinking we might have to intubate him and put him on a ventilator, but within 30minutes of arrival he did a remarkable turn around and ended up being very stable. He got diagnosed with a new onset of congestive heart failure (too much flood on the heart/lungs) and went to a regular cardiac monitored hospital bed.
I really had barely gotten my first patient admitted and had the room cleaned when we got the call about another elderly man having difficulty breathing. My first question was is he in distress. Oh no, he has an asthma history and we are giving him a couple of breathing treatments and we’ll be right in. So in they come and what do you think? Yep…back into my room in severe, critical respiratory distress. Now this 73yr old man was really much, much worse than my first patient. He was breathing so hard and his heart was working so hard that we immediately prepared to intubate him. We got the medications all pulled out and drawn up, had the intubation equipment all laid out, had the ventilator machine at the ready, when my little man began improving slowly but surely. Now he went to the ICU but what a different picture he presented. When he arrived, the patient was pale, diaphoretic (sweaty to you and me), and abdomen heaving just to push air into his lungs, eyes rolled back into his head and only able to grunt. Now it took about an hour for the tide to change, but it really was nothing short of a miracle that this man did not get intubated or die. But you want to hear something funny? After the patient was better and resting quietly, I was helping him with some ice chips and he kept asking me a question I couldn’t understand so I lifted the mask off his face ever so slightly and he said “where is your accent from?” Now I really had to laugh because seriously this man almost died and he wants to know where I am from? So that is what I told him... and then said…Texas.
Now, despite the fact that I spent over half my shift in this one room with two different severely ill patients, I did have three other rooms. Several of which had patients that needed a bunch of orders completed, whether it was drawing blood, starting IVs, giving medications, helping splint broken bones, making sure one more drunk doesn’t die of alcohol poisoning, etc…I had three other rooms. Yep, I thought it would be an okay night considering the fact we saw over 100 patients the night before (I mean who was left to check in, right?)…but then God laughed.
You know I’ve often thought about why I always get the critically ill patients when I have the Code Room. In the past I’ve crossed my fingers and help my breath hoping NOT to get that assignment when I wasn’t the one in charge making that decision. I’ve even been a bit irritated when others have an easier night because of that assignment and I didn’t. But then I really, deep down, know why I always get these types of patients…God isn’t really laughing at me, He is giving me these patients and placing them in my hands because He KNOWS I can handle their crises and help them in their hour of need. So I know that God isn’t laughing at me, He is helping me…help them.
Have a great Sunday!
Ciao! De ;)
PS: "We Plan, God Laughs" is a novel by Sherre Hirsch