I had that instinct they always talk about....

A cute 60 something woman came over from the CV/ICU mid-afternoon. She looked good, post operative day 2 . . No major issues to be reported. I settled her in, did a thorough assessment, oriented her and her sister and then continued my afternoon as usual. A few hours later I was in her room talking with them and she just seemed a tad different. I couldn't put my finger on it but it was her eyes that told the story. They had this glazed look to them and were not focusing quite right. I did a rapid neuro assessment and she checked out fine. I just didn't feel right about her so I called my charge nurse in to do a neuro assessment herself. The woman checked out but seemed a little drowsy and the family agreed that this was abnormal for her. We thought about her being a dialysis patient and having received Percocet prior to coming to us. Was this influencing her metabolism of the pain medicine and maybe contributing to her drowsiness?

About 5-10 minutes later the monitor room called to tell me her heart rate had dropped from the 70's Sinus Rhythm to 49 and was now riding in the 60's. I had just left the room and she was unchanged. I checked it out on our monitor and she was Sinus Brady. She had had no rhythm issues prior to this. I reviewed the past rhythm strips and they looked good, so I concluded this was abnormal for her and something was changing. I told my charge nurse and asked if she wanted to put the monitor and pacing pads in the room. She said " let me call the ICU nurse who previously took care of her and ask some questions and we'll watch her close".

I walked back into the room and found she was not arousable, her eyes were wide open and she was barely breathing. I called for a rapid response while the other nurses grabbed the code cart. Her respirations were agonal at this point so we started bagging her. We hooked her up to the monitor and put the pacing pads on her. She was in Sinus Bradycardia. We tried to get a blood pressure and couldn't , they called it "Code Blue". We accessed a strong femoral pulse as people started pouring in to help. The code team , ICU nurses, medical residents, anesthesia and their students , respiratory, the AOD and chaplain. We had plenty of hands, as always in a code.

Still couldn't get a pressure as I tried to explain to her attending physician what was going on. Of course he was frustrated and demanding more information than I had at the time. Eventually he got the picture. I think part of it is that he knows I'm a new nurse and thinks I am incapable in some way. At least that's how I feel when they get all stressed out with me on the phone. Oh well that really wasn't important, my patient was. He ordered her be intubated and taken back to the ICU. Eventually, we got a pressure, a really crappy one and she was headed for the ventilator and some pressors. Days later I talked to one of the nurses about it and it turns out the patient had Sick Sinus Syndrome and needed a pacemaker. So... It was a good assessment on my part and we had done nothing wrong. She received the right treatment in time and is doing quite well now. Another learning experience on my part. TRUST YOUR GUT!

Thank You Sister Sheila

Nursing has served me well! For all it's ...trials & tribulations, schedules that look like a strip of Atrial Fib, exhausting documentation, impossible personalities , untold pathogens and fluids, mornings when I can still feel my pulse in my feet from yesterdays shift, yes nursing...has served me well. It has provide life experiences and rewards that most people will never have.

When I realized I was entering my 30th yr of nursing in 2006 I decided to track down Sr Sheila and thank her. In the fall of 1973 Sr Sheila called each gal into her office to ask our plans for college. I had to tell her that I didn't know what I was going to do. You see, my father had just recently been hit by a "down-sizing" in his corporate world and was let go. There would be no money for college.

Sr Sheila didn't miss a beat. She picked up my transcripts and said "Your very good in sciences. Why don't you get a diploma in nursing, go to work and then decide what you want to do." And that started the ball rolling. In 1976 a diploma in nursing cost $2400 dollars and 2 yrs study with no time off. I did it and over the next 12 yrs had my children, went through some life changes, and finished my degree. Regardless of changing economic climates I never once worried about finding a job.

I tried to find Sr Sheila using a classmate web networking site without success. I called High School acquaintances, without success. I tried contacting the order of Nuns she belonged to, again without success. I tried a few more ideas and then gave up. I said "OK God, I tried. If you want me to do this then give me the way"

A year later I happened to be at work one day when a favorite ER volunteer was sharing how she had helped each of her four adopted children find their birth mothers using the web. Bingo? I explained to her my quest. She requested the name of my high school, the year I graduated and how old I thought Sr Sheila was in 1973. One week later she walked in and handed me...Sr Sheila's phone number!

I couldn't wait to make the call. When she answered I explained "I don't expect you to remember me but you were my high school guidance counselor in 1973. I continued my story and finished by saying... You steered me onto a path that gave me a sense of purpose, supported me and kept me challenged for 30 years. I want to say thank you. You made a huge difference in my life". Her voice cracked, she said "You will never know how much I needed this call today! "

You see, God didn't give me her phone number when I wanted it, he gave it to me when she needed my call. I love how that works.

FROM THEIR SHOES

I answered the EMS incoming call. They were bringing a transfer from a small hospital 30 minutes away. The story: 33 yr old female patient with a history of Paranoid Schizophrenia involved in a vehicle-tree accident. Evaluated and treated for abrasions at the smaller hospital. During this time the patient was actively combative and hallucinating. Arrangements were made for the admission to our Psychiatric Unit and the patient was given an injection of Geodon prior to leaving. Enroute the patient stopped being combative, no longer required restraints and was cooperative.

When I entered the room she was sitting on the stretcher sobbing. Obviously fearful and overwhelmed she was telling her husband "You don't understand!! God hung up on me!! Now they can get me! I have no protection, he hung up on me!" She was shaking and praying. "I tried calling him over and over but he wouldn't answer!"

It dawned on me. We in healthcare experienced the successful effect of medication intervening and curbing hallucinations, voices, and combativeness. But the patient? She experienced this same scenario as God abandoning her when the voices left. Now, in her "unprotectedness" she was terrified. Vulnerable to the demons that had been chasing her,
a sitting duck.

I went in and calmly said to her "I know your scared but we will take care of you. We will keep you safe." True, we would. She stopped crying, looked up at me and said "Will you pray with me"? I said "Yes"... held her hand and we said the Our Father together. She remained cooperative the rest of her time with us until she went to the psych ward. In nursing we take care of people where they are at, not where we think they should be.

Holiday Hearts

For some of us the term "Holiday Hearts" may bring visions of Salvation Army bell ringers, Toys for Tots and Community Meals for the homeless. For the ER nurse it means a crowded waiting room of upper respiratory infections peppered with the flurry of new onset Atrial Fibrillation.

Ahhh, "Holiday Heart." The susceptible heart carried by the 50ish age group of heavy drinkers gets pushed into an AFib rhythm by a week of drinking "holiday" quantities of booze and chain smoking. They show up in the already crammed full ER waiting room with family in tow or are brought in by EMS complaining of "feeling weak, poorly, not myself", or "my hearts just not right". Poor Souls" as my Irish Mother would say. It may be their first brush with their mortality. The first tangible message that they have been "rode hard and put away wet" one too many times.

They'll be OK, but are now the proud owner of a Coumadin regime including lab draws for bleeding times over and over, safety considerations for falls and accidents, and a lifestyle that requires following strict instructions...... here on out. Not every Atrial Fib patient is the result of hard living, just the ones who spent years standing naked in the snow singing Ted Nugent.
You know who you are...........