from Heather McHugh, "Intensive Care"
As if intensity were a virtue we say
good and. Good and drunk. Good and dead.
What plural means is everything
that multiplying greatens, as if two
were more like ninetynine than one,
or one were more like zero than
like anything. As if
you loved me, you will leave me.
As if friends were to be saved
we are friends. We talk to ourselves,
go home at the same time.
As if beds were to be made
not born in, as if love
were just heredity
we know the worst, we fear
the known. Today we were bad
and together; tonight
we’ll be good and alone.
tales from the ICU
I find rarely talk about my work. Not in my blog, not in person, not to my family or friends, not really ever. Which ultimately makes my URL (as in nursey) pretty redundant.
Of course there is always the occasional story about the bizarre or hilarious admission (because someone ‘accidentally fell’, which often requires immediate surgery to remove various items from various cavities) or the really amazing people with such courage that survive the most horrific events. I enjoy that part. A lot. Oh the stories I could tell you - and I’d probably tell you the most revolting story I could whilst I shared a meal with you….”oh you can’t finish your meal after that story…? No worries ill help you!” (Stef, regularly)
But i guess its different working in the intensive care than in other parts of the hospital. We see the sickest of the sick, we see untreatable and unexpected injuries, disease, death, grief and loss in unimaginable quantities.
It’s difficult to talk about it, because if I didn’t leave the stories I hear and the patients I encounter at work behind, I wouldn’t survive. I have learnt to emotionally unattach myself and i have found blocking it out and forgetting about it, or making an inappropriate joke out of terrible and traumatic situations to be my best coping mechanism. Shoot me if you must, but that is the only way I am able to do what I do.
But last Sunday I looked after a patient that I can’t forget. Ever. It’s funny how you can encounter someone that you know will impact on your nursing practice, but more your life, forever.
A 21 year old girl, lets call her Emma, was admitted into my ICU just before midnight after drinking a small dose of weed killer earlier that afternoon - a suicide attempt. Her boyfriend of 2 months had broken up with her that day. She also had a past medical history of depression.
She arrived in the ICU and she was a little bit drowsy but speaking, and had on no intravenous support. She kept sobbing and repeating ‘I’m sorry’ to her dad as he sat crying by her bedside, holding her hand. And it was in this brief moment I think she had some insight into what she had done, and how sick she was about to get. And how much of a mistake she had just made.
By 2am, she was unconscious, ventilated, on a ridiculous amount of support for every organ, (ventilation, intropes, dialysis, vassopressors, blood products, plasma exchange, electrolytes, sedation, isolipids) incredibly sick, and ultimately, she was dying.
I will spare you the gory details, but it was physically the single most traumatic experience of my life. The small amount of toxin she drank had caused her to have huge volumes of internal bleeding, had put her into multi-organ failure and Disseminated Intravascular Coagulation (DIC) - whereby she ultimately was bleeding uncontrollably. Her blood results came back more and more deranged - and there seemed to be nothing we could do to stop this spiral.
Despite our best efforts (5 intensive care nurses and 4 intensive care doctors working non-stop) and having exhausted every single treatment option, by 5:40am she was dead.
This beautiful 21 year old girl who had her entire life ahead of her. And in one stupid decision, she lost it all.
I haven’t stopped thinking about her all week. I have never had a patient affect me so terribly - and i have seen some terrible terrible things. I think there needs to be more TALK about mental health and depression. Because its such a hush hush topic. Everyone seems so afraid to talk about it. The media rarely report on it. And there is such a stigma for those who suffer from these medical illnesses.
But we need to. We are losing too many people far too frequently.
The staff involved in her care had a debrief yesterday at work - and I think that everyone has been affected similarly by this young girl. Are we so affected by her because we care? Or because she was so young? Or because in one split second decision, she made a poor choice because of a sad circumstance? Or because hardly anyone talks about it, and therefore no one will learn from her mistake?
I believe when something bad happens you have three choices - you can either let it define you, you can let it destroy you, or you can let it strengthen you.
I feel for her family and friends and those left behind. And I feel for her. And the life she is missing out on. Because I know that regardless of how dark it all may have seemed, tomorrow is a new day, and there is endless possibility waiting for you. And there is always someone who will help you, if you let them.
Intensive Care by The SoniXx ft. Laura Newman (Dubstep Mix)
Intensive Care - The SoniXx ft. Laura Newman
"I wish I were dead, I'm in so much pain."
Those are the words that came out of my mom’s friend’s mouth when she found out that her husband never woke up after the accident.
We visited her at the hospital today and my mom told my sister and I to stay in the waiting room cause she felt like it would be too crowded. After an hour, my mom and her two best friends came down from her friend’s room and all of their eyes were red and they were sniffling. It was obvious that they had been crying.
What made the whole situation worse was that I knew who these people were, not personally on a close level, but I knew of them. They were such a wonderful couple, so loving and carefree. The car that swerved into my mom’s friend’s car was speeding and since he was on the other side of the ride, it caused a head-on collision which killed both drivers instantly. Luckily, one woman survived which was the driver’s wife, my mom’s close friend/co-worker.
The driver (husband) was a loving man. He attended Fonzie’s birthday, they went to bars to watch Football together, partied in Vegas together, and they basically were family to one another.
His wife, who is currently under intensive care with a 24 hour nurse, is depressed and in pain. After the accident, they found out that her body had split in two. Her back is broken, her intestines fell out of her body, her bones are sticking out of her body, she has stitches all over, huge pieces of glass pierced into her organs, and they know for a fact that she will not be able to walk again. My Momma and I cried when my Momma was telling me the story of how her close friend wanted to die after she found out that her husband was dead.
“I want to die and be with him. I’m in so much pain, from the injury and by the emotional state that I’m in. I wish I were dead. I regret wasting so much time, I never should have yelled at him so much or fought with him so much. Now that he’s gone, I can’t live without him, but I need to be strong for my 3 children.”
Their children are my age and if my parents were in this same situation, I cannot and will not imagine a life without my mom.
To everyone, I know you already know, but still… Take advantage of the time you have with your loved ones. You never know when their time will be cut short. My Mom never wasted any time and she lost one of her closest friends after an hour of talking to them. Be safe, be cautious, don’t play hard on the road cause you never know what could happen. You think you’re a skilled driver after driving for a certain amount of time, but someone else thinks otherwise. Be careful, please.
PICU: First Clinical Shift
18 month year old female. 24 weeks deliver c-section.
Chronic lung disease/injury. 4-5 re admissions since birth.
Nearest approximate weight: 8.9 kg.
Little J is very temperamental. Does not act like a PICU baby should.
Hates intervention, thus ‘cluster care’ ethos is taken during the shift. Meaning, that when you need to suction, or do eye care, or pressure care or anything - do it all at the same time. Then let her settle.
- Noradrenaline (variable dose)
- Dopexamine (5mcg/kg/min)
- CVP + ART flush
So today was about me getting to know the units’ routine and way of working. I have started on the unit with 3 others, one lady whom I worked on LITU with, the other two have paediatric backgrounds but not intensive care backgrounds. So myself and A’ think they have a huge advantage and they think we do. Different perspectives aye?
Everything on this unit is paperless. Everything is linked to the computer at the bedside. Works great. The pumps (almost typed pimps, woops!), the vent, the sats probe, the main monitor etc, all translates and gets sent to the computer. You verify that you’ve seen the numbers, and input some values (such as urine output) yourself, cos not even a smart computer can calculate u/o based on a wireless catheter! ;)
The morning checks are mad. The list goes on and on. Having said that, it probably took me ages, as its computer based and I don’t really know my way around the software yet. It’ll come.
Bagging is a daily, if not hourly occurance depending on the patients state & diagnosis, and bagging a child is pretty different to bagging an adult. There isn’t a PEEP valve as such, merely a hole in the end of the waters circuit, which you pinch/occlude.
All the infusions (regardless of route or simplicity [or lack of simplicity most usually]) is mcg/kg/min as they’re all really small.
That’s a vague tired run down of the daunting things so far.
More about little J:
Neurologically: held the atricurium (paralysing agent) for 90 minutes, as a hold. Started to be non compliant with the tube, fighting the ventilator and desaturating as a result. So, findings documented: back on the atricurium went! PEARL 2 2. Showed no signs of distress other than whilst intentionally holding. - Almost all assessment tool for pain, when a patient is fully paralysed and sedated is pointless.
Cardiovascular: Supported on minimal inotropes. MAP >50 throughout shift. Ignoring systolic pressures, mainly focusing on MAP (mean arterial pressures). Electrolytes within range. SR/ST depending on intervention. Apyrexial.
Respiratory: Tube size 4.5 | 12cm at lips. Proned. Unpredictable temperament Saturations remained >88% throughout the day. But for unknown reasons to us, she would swing from 88% to 98% quite randomly. Given her chronic lung disease saturations of 88% were deemed satisfactory. Clear secretions on suction, more secretions evident on oral and nasal suction. Crackles and wheezing bilaterally.
GI: Feeding 18mls/hr. Receiving optimum calories for BW (body weight). Bowels sounds present, not open for 24 hours (?Fentanyl induced). Aiming neutral by end of shift. Blood sugars stable.
Renal: Urinary catheter in situ. Aiming 1ml/kg/hr - Passing between 0.5-2mls/kg/hr. Catheter care given. On TDS 3mg furosemide. Lactate and other buffers within range.
Skin: Pressure areas intact, old marking on back (? pressure from cable/line). Dermatitis around buttocks/peri-anal area. Warm wash given - clean sheets applied.
Next of kin: Mother phoned, sang to little J. Will be visiting during the week. (Other dependants).
That is the first day guys! - They’ll be more! Promise.
Churchill's Pocketbook of Intensive Care by Whiteley, Bodenham & Bellamy
A handy yet surprisingly engaging practical guide which covers how to repair and refurbish your kitchen sifter, strainer or colander whilst on a camping holiday, written by that talking dog off the adverts.
Due to an unforeseen spasm whilst using adhesive, I simply couldn’t put it down.