Holy toledo, what a night!
I was first tipped off that it was going to be a memorable evening when one of the local doctors (who's wife is also a Dr) called to say they were bringing in their 5 year-old son. If two doctors are going to bring in their son to see another doctor, something's up. There was vomiting. There was pain. There was an ambulance trip to another hospital for air ambulance to another province for surgery.
Meanwhile, in my corner, elderly man with severe pain to neck, right shoulder, right arm, back, and right abdomen with shortness of breath and a history of cardiac problems. I got to see what a pacemaker looks like on a chest xray! I wrestled with the EKG machine. (Tis a good thing i learned how to use it last night because i had to do one on every one of my patients tonight and my mentor was busy with the child to be air-lifted out for surgery.) Oh, and the IV. This is how it went:
me: i am going to start an IV (there's no one else available. i need this. i have to do this. )
patient: ok. but i have no veins left. I had vasculitis and an embolism and deep vein thrombosis and surgery and now i have no veins left. They're all gone. Kaput. blah blah blah NO VEINS.
me: i am going to start an IV.
result: KAPOW! That's me NAILING it on the first try! The patient was stunned! I was stunned as i realized he was bleeding all over the place and i had no tape (damn!). The nurse who came to my rescue with the tape said it wouldnt hold because i hadnt done something and i said, oh it will hold. And it held! HUZZAH! The patient looks down at me crouched on the floor, nursing his new IV and says: high five to the nurse! And so i got a high five from my disbelieving 80 yearold patient. What a high! The doctor was totally impressed too. He had seen the patient and didnt think i would get it! I got another high five! Later my mentor, the doctor and i were talking about it and i was explaining what i hadnt done (that's different than standard nursing procedure) and why and they both agreed i was right to have done so! Woohoo! See my head, its getting bigger.
Next scene. I'm in the middle of admitting the guy with the lovely new IV to the ward for overnight observation when the ambulance calls to say they're bringing in a new guy with shortness of breath. Déjà vu! My mentor took over the old patient and i got to follow through with the ambulance transfer. He was having moderate respiratory distress but had no history of cardiac problems. What was ordered? An EKG! What else? An IV. I got the EKG ok. It had a lot of artefact (background noise) but it was clear enough for the doctor to see that the guy was experiencing some ischemia (precursor to an MI. recall MI = heart attack). I think it would be scary to be a patient, laying in wait for an impending heart attack. What happened with his IV? At first it seemed i had some time to play with it. But then the doctor realized it was becoming urgent. I had a bad feeling about it. I tried once. Twice. On the third time, the doctor set it up for me and guided me through it and was stunned when it failed. I was rather crushed. It brought me down hard after my winning IV high.Fitting result for letting Pride get the best of me? And of course the doctor got it on his first try. But then again, he's been doing this for awhile. I've really only been trying since yesterday. I dont think its an excuse. I think its a valid point. My mom says its ok that i keep missing. Arent moms always right?
It was busy. There was winning. There was failing (though we didnt lose anyone. A friend told me before me shift to tell my patients they were not allowed to code on me. I guess they heard because none of them did). But it was exciting to take charge and do things while waiting for the doctor to be able to exam the patient and give orders. And it was good for me (says my mentor) to have seen and tried so many things. Sure she's right, but i'm beat. When we made it down to the unit around 4am to hang out with the other nurses, i was so tired i was nauseated and giddy. And when one of the nurses asked my mentor what she was reading and she said The Beaver, i couldnt stop laughing. And it made another nurse laugh. And there we were, laughing like nuts until we couldnt hold up our heads and our eyes were tearing.
I thought it would be a nice way to end the night. Giddy, drinking overly-sweetened energy tea, reading my book. Then the phone rang. 5:55am. Aw, peas. All the nurses were guessing it was someone calling in sick. No way. They can call in sick all they like as long as its not the ambulance calling.
It was the ambulance.
My mentor was so annoyed. Cant they keep the person until 8am? What do they think we can do with them? And its true. It was almost shift change. The doctor had only been gone home to bed less than 3 hours ago. There was no way we were going to call and wake him up for a patient who had fallen in the bathroom at the senior's lodge. I sat around for 40mins waiting for the ambulance to arrive. I took my blood pressure. I think it was a little high. At least the systolic was. And my heartrate was on the high side of normal, but lower than when i was a nursing student! I took my mentor's BP. I started offering to take the blood pressure of the cleaning staff and someone who was randomly walking through the ER. When the ambulance finally arrived, they asked if i wanted the patient left on the clamshell. Uh...?! I dont know, what do you guys think? Hey, they said, you're in charge. What? I'M NEW. Too bad, you're Hospital, you're a higher rank, you decide. Dang! Can we just send her home and go back to eating timbits (brought by the ambulance guys, bless them, upon their return from taking the boy to the big city hospital) and trying to get back to the high from the successful IV?
The ER tried to get the better of me and it looked for awhile like it might win. But even though it tripped me up in the IV department, i'm still alive, my patients are all still alive. I think the title belt goes to ME!
Now its time for bed. Oh how sweet it is (oh Women's choir!) to crawl into my bed at the end of a 12hr night, knowing that i dont have to get up tomorrow until i want to because i have five days off! And yesterday was payday! And i rocked the casbah on the first IV! And i was useful! And there are chocolate chip cookie-wanna-bes awaiting consumption. It's a new day!
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