Wednesday, March 2, 2011

my first day

Even though it's been six months, i think my first post should still be about my first day. This is an email I sent my parents the next day:
As for my job, my first day was kind of baptism by fire. The first thing the previous nurse said when giving us report was, "I can't believe this patient is still alive." And after report and assessing the patient, I couldn't believe he was either. Even in the middle of report his blood pressure dropped to 60/40, so we upped our norepinephrine until it we had maxed out the dosage. That meant he was maxed out on norepinephrine, vasopressin, and phenylephrine. As soon as report was over, we and the doctors explained to the family that the patient was not doing very well and that it would be wise to consider just comfort measures. However, they said if there was even the slightest chance of the patient living, they wanted to do everything possible. It was hard to be in on that conversation--understanding how much the family must hope for him to live, but seeing how unlikely that was. So, we knew in order to help him, we needed to get him started on continuous dialysis. But we didn't have a vas cath to do so. Our intensivist came to put another one in. About half way through putting in the vas cath, the patient's pressure started dropping again so we started a fourth pressor, epinephrine. That held for a bit. So we scrambled--my preceptor, Lourdes, was setting up the continuous dialysis while I got antibiotics (the patient was badly septic), diuretics, albumin, etc. going. In the midst of all this, he was holding his pressure 60/40, not ideal but we were ok with it. Then all the sudden, after not looking at the monitor for about fiveminutes, I looked and his pressure was 39/31, maxed out on every pressor we coould give. We got the doctor and the family there. Just as we were about to start the code, the family said they did not want compressions, just a "chemical code". So we began pushing bicarb and Ca gluconate. But the pressure kept dropping and we watched the heart rate go from 150's to 40's. Finally the doctor called it, it was done. The family broke down, Lourdes and I broke down, even the doctor had tears in his eyes. We had worked so hard all morning, just to see this! And to see the family have to watch him go in such a frantic, desperate way. It was really sad and really hard to watch. As a tech, I knew this happened, but I was always spread out over eight-sixteen different patients and wasn't as involved in each. So I was emotional. Then the rest of the family came in. One son was slightly handicapped. He came in and as soon as he saw his dad, he fainted and fell to the floor. Things turned frantic again, waking him up and making sure he was ok. He woke up and went hysterical, screaming and thrashing, etc. It, again, was hard to watch and be so close to that. I broke down again, and sobbed for a while. Not helpful to the family, I'm sure but I couldn't help it! Lourdes told me this was almost as bad as it gets and would probably be uphill from here for me. I was glad to hear that! We stayed with the family, trying to comfort them for another hour or so. Then had a couple of hours of paperwork and getting the patient to the mortuary. Finally, about 3:30 we had a break and caught some lunch. When we got back, we got two new post-op patients, one with a AAA, the other with a bile duct obstruction (he was the color of a squash). So we flew, getting them admitted and getting their pain under control. I went home so tired, physically, mentally and emotionally! I hope I build up some stamina for this! (The next day they blessed me with two telemetry patients, both awake, alert, pleasant and uncomplicated. I still was overwhelmed with how much I needed to learn, but it was a very nice break after the previous day!)

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