A Nurse with a Gun

Wednesday, May 06, 2009

A Light Rain

Beep beep beep beep beep beep. Internal bleed. ER1. The night is quiet as I return to the hospital. My dinner sits on the stove at home. I walk through the ER to assess the patient. Inside the ER, a lone nurse is working in the first trauma room. A man lies on the gurney with a unit of blood infusing on a pump. He is unresponsive and clammy. His BP on the monitor, 36/17. "What's his hemoglobin?"

"5.2"

"Get some trauma tubing, a pressure bag and four more units. Now." Ding ding ding ding ding. Damn. No pulse. I start chest compressions. "Get the doc in here!"

The other half of my call team walks in. "Bust open the crash cart. Get atropine" My partner, although not a nurse, responds well. He assumes compressions, I push the atropine and grab an ambu-bag. While I check for a pulse, he slaps pads on the patient's chest. Chest compressions. Bicarb. The rest is a blur. Bicarb. Art line. Dopamine. Levophed. Femoral line. Pulse. 94/44. Hang the blood. Pressure bag. More blood. Ding ding ding ding ding ding ding Damn. Chest compressions. Tube him. Vent. 150 joules "Clear!" Bam! Epi. Chest compressions. Sweat on our backs, blood on the floor.

It's strange what you remember during a code. A nurse not knowing how to put blood in a pressure bag. Someone saying "He's not going to make it" and another responding "She's got a sickle in her back pocket." We coded the patient three times. Later, two and a half hours later as I leave, a family sobs in the parking lot. I walk past another ambulance with the rear doors yawning open, an elderly man with an oxygen mask on a gurney inside. It is raining a light rain. I have pork chops on the stove at home.

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10 Comments:

Blogger Rachel said...

Flawlessly written post.

I have a humble question: what line of nursing are you in where you get called to come in and deal with this kind of thing? Or is this a usual thing for all nurses? I have wondered this since I started reading your blog a year or so ago.

12:13 AM  
Blogger Xavier said...

I now do surgery and endoscopy.

i wasn't called to deal with it, just to help stop the bleed. I just found a train wreck when I got there.

12:42 AM  
Anonymous Bruce S. said...

As an anesthesiologist (now retired), this sounds all too familiar. All too often the bleed was not the first for a alcoholic patient with esophageal variceal erosions and a niggling sense of futility was mixed with the adrenaline fueled heroics. Still, you do what you can--and go on. Great writing, thanks.

7:43 AM  
Blogger Ed Skinner said...

The variety is what makes your blog interesting. It is intriguing to see the latest "ugly gun", read about an ER incident, follow your latest visit to the pawn shops and then see/read your photographic work.

8:07 AM  
Blogger Dave said...

Well written and sorry for another hard fought loss.

I have never understood why nurses forget the basics sometimes.Like it sounds happened to someone on the team.

stay safe..

9:01 AM  
Anonymous Dulie said...

Very well written. My youngest brother is starting school this fall to be a nurse. He earned his EMT certification and has been doing that since November and is continuing to get his IV and other certs before he starts school this fall. His goal is to be a trauma nurse. I have passed this blog along to him. I think he will learn quite a bit.

9:49 AM  
Anonymous Anonymous said...

The other thing that seemed surreal when I first started residency was being on call, having the code pager go off, waking out of a dead sleep, running down the hall, coding a patient, them not making it, telling the family of the patient whom you had never meant that their loved one just died, trying ineptly to comfort them as best you could, then trudging back down to the callroom to try and go back to sleep and waking up the next morning wondering if that really happened or whether it was just a dream. If you woke up at the hospital, it was usually real. If you woke up at home, likely not.

But I got used to it.

-Ben

10:12 AM  
Blogger DouginSalcha said...

Your 'stream-of-conscienceness' way of describing your night in the ER makes it much more real and immediate for us who don't normally live/work in an Emergency Room. Thank you for saving lives (or at least for trying to when you can't)...

12:07 PM  
Blogger Bob said...

And this is why I read your blog, Xavier. Beautifully written.

2:42 PM  
Anonymous Anonymous said...

This post is why I keep coming back. In your resume you forgot "poet". Thanks!

3:47 PM  

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