...are the ones that make the biggest difference


Last week was hard/weird

The semester is finally over. Last Tuesday I took my final and managed to squeak through the class with an 'A'. Which is no mean feat when 93% is an 'A' and your teacher, bless her heart and her obvious devotion to preparing good nurses, writes what can generously be described as only mildly-horrible tests. At least 10% of the questions on every test have two right answers. Not one answer is better than the other, which I'm told is a frequent occurrence on the RN licensing exam - you know, which is the first, best thing you should do when your patient is coding or something. No, these are questions like "A common symptom of liver failure is?" and jaundice and elevated serum liver enzymes are offered as separate answers (both are right, by the way). Normally we can argue these questions when we get our tests back and she will occasionally see our point, or the book's point, or her lecture note's point, and allow both answers. But there is no chance for that on the final since we don't ever come back to class. I was borderline going into the final, knew there would be at least a few questions that were just a blind guess and thought there was a good chance I would guess incorrectly between two correct answers, thus scoring poorly enough to drop my grade. I didn't find out what my final grade was until Thursday, so it was a somewhat tense couple of days.

So that was Tuesday, but the week actually started out on a much less promising note. We've been looking for a church here for some time now, and we decided to try a new one that is part of the denomination the wife grew up in (and for which the father-in-law still works). This church was also highly recommended to me by a nurse I work with. So we went. It was nice. Good music, good mix of ages and family situations in the congregation, casual but not too casual, people were friendly - all those little things that are nice to see on your first visit. Until the pastor got up to speak. In reality, there was absolutely nothing wrong with this pastor. He was finishing up a series on parenting and made some really good points about the role of parents in the family - setting up boundaries, consistency, fairness, communication. He was energetic, passionate, engaging and had the unfortunate quality of sounding, and even looked a little, like the pastor that fired me 2 years ago to the day. Bizarre coincidence. And a rather upsetting one. I know that whole situation wounded me pretty deeply and for reasons that are not always easy to articulate, but I honestly thought I had gotten mostly past that. I feel like I've dealt with it. I can generally think about it without getting angry or sad, and I frequently don't think about it for weeks at a time. The wife and I are in a pretty good place in our lives right now and I'm thankful to be here, doing what I'm doing. No, its not my absolute ideal, but it feels right. So I was caught completely off guard by the range of negative emotions just listening to this pastor speak brought up in me; anger, sadness, frustration, anxiety - all the tumult I felt back then was right back, center-stage. It wasn't like picking a scab off of a wound; it was like getting shot in the same place again. It kind of put a funk on the whole afternoon and left me and the wife feeling just wrong. Needless to say, I don't think that is where we'll end up.

So I go from the unpleasantness of Sunday morning, to an entire Monday of cramming for finals on Tuesday. Tuesday comes and goes, which is a relief, but I'm left the tension of not knowing my final grade for the class. I'm mostly an 'A' student and potentially missing one by a few points is very frustrating to me. I'm scheduled to work Wednesday-Friday because I had to juggle my school schedule to accommodate studying for finals. I show up Wednesday morning, everything is going fine until lunch time, when a code-blue is announced overhead. The way things work in my hospital is that when someone codes (ie, dies or gets well along in the process of dying), the floor nurse calls the operator, who makes an announcement overhead, which sends a designated ICU nurse, a respiratory therapist (RT) and a pharmacist scrambling for their respective supplies as they make a mad-dash for the elevator. Once on scene, the ICU nurse takes charge of the code until a doctor arrives. My nurse was assigned codes for that day, so when the call came in, we went running. Another ICU nurse and 2 student techs also came along to assist & observe (participating in a certain number of codes is required for a few different professional accreditations). We get to the room, which quickly becomes crowded by the 7 of us, another RT, at least 3 nurses from the floor and a number of doctors. One of the other students begins compressions, but she is a rather slight thing and we're working on a larger patient (a woman in her early 40's), so I am put in to take over for her. This is the first time I've ever done compressions, first time I've ever seen a code. And it is nothing like you see on TV.

The CPR is fast and furious, with RT's alternately bagging and trying to intubate while we compress like mad. No 1-2-3-4-5, breathe - they're forcing it in as we're pushing on the chest. Monitoring patches are put on, an automatic defibrillator set up and still the compressions continue. I could feel/hear her ribs crack under my hands, but no matter, you keep pushing, pushing, pushing. Ribs will heal but her body needs the blood. I compressed for probably 10 minutes straight, pausing only long enough for them to shock her or try to get the breathing tube in. The shocks were not dramatic - no exaggerated arching of the back, no loud thump or sound of electricity. Just a whine from the defibrillator indicating it had charged, followed by a "Clear!" and then the lady's arms twitching when the shock was applied. And then back to compressions. I was drenched in sweat when another student stepped in to take my place. We rotated through the three of us then, every couple of minutes, though by the end, none of us were lasting more than 30 seconds. My arms burned, my shoulder felt like jello and my whole body was drained. Still, you push. The entire episode turned into nothing more than pushing, shocking and injecting drugs in a kind of organized chaos - all heads turned toward the monitor, hoping, praying for a rhythm, anything other than the horrible, small wavy line that indicated nothing but random electrical activity in the heart. We worked for 35 minutes before the doctor finally called it.

And then it was over. The room cleared. We gathered our equipment and left. For 35 minutes every person in that room was focused on doing anything and everything to bring that lady back. People were handing up supplies, pushing drugs through her IV, adjusting the equipment, asking & answering questions, relaying information to people in the hall - just a hundred different things going on at once. And in the time it took a single man to utter a single sentence, it stopped. It was done and she was gone. The whole drama of life and death and all of eternity opening up for this person was over in less than a second. The quiet that ensued was such a stark contrast that you'd almost think nothing had happened, that we had all gathered in this small room around this metal bed for no apparent reason and now, realizing that our presence served no purpose, were leaving, back to our jobs and daily routines, befuddled by our pointless presence.

In my less-than-2-years in the medical field, I have handled at least a dozen dead bodies. I have washed them, removed IV lines, catheters and readied them for transfer to the morgue. I have put them in body bags, affixed toe-tags, packed up their belongings and carted them down to a large walk-in cooler in the basement. Most of these deaths were expected, even planned in a way. The families had decided to remove life support and on a set day and time, the machines were unplugged, the tubes removed and the person died. Sometimes quickly, sometimes they lingered for hours or days. But everyone knew death was coming soon and there would be no announcement overhead, no mad scramble for supplies or sprints to the elevator. That was the key difference - this lady still had hope, or at least there was hope to be had. It was a struggle to walk away from that bed, to renounce that hope. I came out of that room a changed man; now, more than ever, will I fight to keep that hope alive in those entrusted into my care by their families and Creator. I will push until all hope is gone.


Benedict Seraphim said...

Whew. Prayers, bro.

D. Ian Dalrymple said...

Yikes, Nathan. Thanks for sharing this. It's timely for me, since my wife's auny is presently on what we all expect to be her deathbed (cancer). Thanks for the reminder to hope.