The worst walk of his life...

I was taking care of a young CAB patient (coronary artery bypass)who was
Post-Operative day 5. Other than high cholesterol he had no prior cardiac history. He should have been off oxygen, walking around, and ready to go home. This guy just didnt look good. "Puney" is what we call them, they just look puney. His skin was yellowish pale, he was a bit anxious, still required a little oxygen and had been in and out of Atrial Fibrillation for days(not uncommon after this surgery).

What we tell many patients is " Once your up and walking around the whole hall you can go home". This guy really wanted to go, although I dont think he had a good understanding about his progress or lack there of. So I attempted to wean him off the oxygen and I got him off. He rested all day and we talked about him walking in the afternoon. He was ready, so we went. He was short of breath (SOB)as many of our patients are when they really begin to get up and move. I asked him to turn around about 1/4th of the way down the hall, I could tell he was pushing it. He said " NO, NO I'm going all the way around , I want to go home."

We made it back to his room and he was out of breath. I sat him down and got a pulse-ox to check his oxygen saturations. He was low (81%). Following protocol I put the oxygen on him by nasal cannula and let him sit for a few minutes. He was still low (84-86%). Suddenly he started saying " my leg is numb, I cant feel my foot!".
I asked him to flex and extend his foot but he couldn't. I grabbed a fellow nurse and we got him into his bed. We checked for a pulse. No pulse in that foot. He had a great pulse in the other foot. His oxygen was still low. I knew this was serious, his foot was looking bad. I requested the physicians assistant to examine him and he said we needed to call the doctor. I paged the doctor.
My patient was getting worse. He was anxious and breathing really hard. I placed a nonrebreather on him but and his saturations were still in the 80'S. We tried for a doppler pulse while his leg grew bluish and mottled. He was starting to grimace as the doctor came in. Then he started grunting and sweating in pain. The doctor examined him and decided he probably threw a clot that lodged in his leg
(blessed it wasn't his brain). He needed an emergency embolectomy and was rushed to surgery. The team really pulled in for me that day. I had four senior nurses at my side helping me do everything. They were awesome and I love them for it. I felt safe and on top of things. He left for surgery and I finally sat to chart the event and ponder the outcome.
A week later I inquired about him to one of the doctors. He said he was positive for HIT (Heparin Induced Thrombocytopenia)and threw clots to his heart and leg. Heparin is utilized during these surgeries and some people develop HIT. The fact that he was also in and out of atrial fibrillation didnt help. Basically he showered clots. He is blessed to be alive! A venous clot in his leg, an arterial clot to the right atrium . The leg was saved by the embolectomy. In addition, the patient qualified for an Argatroban drip and spent an additional week in the cardiovascular ICU. He is so blessed he didnt stroke , throw a PE ...die. I felt so blessed that I picked up on his condition and the team took great care of him.

WOW, I helped to save a life. This is what nursing is all about. I became a little less intimidated to call a doctor about an issue knowing it may save a life, and in this case it did. He recovered and told me later that he remembered me turning to his believing wife and saying " pray!" as we rolled out to the OR. The nurses helped, the doctors helped, medicine helped, and the prayers definately helped. THE ROOKIE-

WWII Vets

Every nurse has her favorites. My all time favorite patients without question are...WWII Veterans. I could quickly answer that it is because my father was in the Air Force during the war, but it's so much more than that.

When I walk into a room with an 80+ gentleman on the stretcher I slow down and my heart softens. While looking for a good vein, I ask "Where were you during WWII"? Regardless if dementia has taken parts of their life away from them today, it doesn't seem to touch those years. Without missing a beat they tell me how old they were when it started, which arm of the service they joined, how they told their families and where they were stationed.

I stop what I'm in the middle of, take his hand, look straight into his eyes and say "Thank you. Thank you for what you gave. It's because of men like you that I'm living the good life". They look back with such heart I can feel my own in my throat. They pat my hand with tears in their eyes then look off into a memory.

Once the heart of it has settled I look back up while taping the IV and say... "But you know...they just don't make men like you anymore. "It's true" I continue. "You put aside everything and gave yourself to a higher cause. You came home and somehow moved on past broken bodies, lost brothers and postponed dreams. Your family came first and you seemed driven by a sense of honor. It showed. That's how this daughter saw it anyway, I had one of the best".

By now even the little wife has tears rolling down her cheeks. But I'm Irish and on a roll, I'm not done. "Then we have to pick from a self-centered generation that believes a Porsche is the measure of a man and his inner-child comes first". Now he's laughing and starts telling stories.

I took care of a Norwegian WWII vet who was really joker. He told me "You know we helped the Allies out too. And when I came home I had to ride a train for two hours into the mountains. Then I had to put my ski's on and cross-country into my village"
I said to him "Wow, what was the first thing you did when you got home"? He answered "I made love to my wife of course" I was roaring. Imagine this little white haired man saying that. But then he got me...."Do you want to know what the second thing I did was"? Of course. He looked at me with his twinkling blue eyes and said "Took off my skiis"

The VET