Sunday, June 1, 2008

"This is what you are meant to be doing and we will never forget you"

One night I picked up a patient from a fellow nurse and figured it would be a typical shift. We'll call this patient JJ. She was in her mid 40's and otherwise fairly healthy other than being a smoker. She came in after vomiting at home and having some respiratory distress. My coworker had gotten her all settled in and told me that she was doing fairly well and that she had pneumonia. We figured she would probably end up on a ventilator at some point in the next few days due to the way she was looking (she had a pretty bad pneumonia) but not imminentely. Ok, I say, no big deal right.........we see patients with pneumonia all the time. That's where I was wrong!!!!

I go in and say hello to JJ, do my assessment and she seems fairly stable. Out of breath with minimal exertion but I expect this really. I check her oxygen, iv fluids, etc. All looks well. Go out to the nurses station to check my labs and see what time she needs meds. I'm in the middle of this when I look over and she's attempting to get out of her bed!!! Ahhhh!! I run to her room to ask her what is the matter?? She states that she needs to get up. She is now clearly in severe respiratory distress and quite confused. This is NOT GOOD!!

I stat page the resp therapist (RT) and pulmonologist. RT comes right away but it takes 3 more calls to get the doc on the phone...Grrrr! He wants to try bipap (a tight mask that goes on the face that is sometimes successfully tried before the ventilator). He also tells me that he does not want to intubate this lady as he feels she won't have a good outcome but doesn't explain why. As she's not doing well I don't take the time to try and get him to explain I just take the orders and get back into the room.

At this point 3 people are holding her down to keep her in the bed. This is sometimes typical as people in this severe of respiratory distress for some reason want to get up and walk around!! We try the bipap which she promptly rips off so we have no choice but to intubate her and put her on the ventilator. Anesthesia is called and she is heavily sedated and intubated. Finally calm.........whew!!! Able to breathe with a secure airway. Crisis averted.........or so I thought as now she is coding and has no pulse...........OMG. This is NOT what I had expected. We start CPR and someone goes to call the doc again. Everyone shows up and we work on her for about 30 mins and get her heart going again.

I call the pulmonologist to tell him what happened and he says "well I'm not too surprised and next time when I tell you I don't want to intubate someone maybe you'll listen" WTF I think? What am I supposed to do? The woman cannot breathe. Just as I'm getting over that one though he tells me that he'll call me back in 30 min and not to call him as he's going out to dinner with his wife and another couple.......ummmm ok then. Jerk. As if I don't have enough going on I have to put up with his nonsense too!!! I hang up the phone, walk back into the room and she codes again. Luckily we get her back once again.

By then we have contacted her husband to let him know what is going on and he has come in. We get her all cleaned up and have him come in. The doctor and I update him and he visits with her. How sad to see his sadness. But luckily at this point she is still alive. He then tells me they have 2 teenage sons and I am even gladder that we saved her. Now, I'm just hoping that we did a good enough job and that she will pull through it. Only time will tell as I'm off for a few nights.

I come back a few nights later and there are her husband and sons at her side. He comes and says hi to me and tells me that he needs to thank me. I ask what for and he tells me that the day shift nurse from that day told him what actually happened that night and that if I wasn't there she wouldn't have made it. You are welcome I say but that it wasn't so much "me" and that any nurse that night would have saved her and he replies with "that's not what I was told". We leave it at that and he gives me a smile and goes back to her side. I have other patients that night.

She remains on the ventilator for almost 2 weeks to get over her pneumonia and sometimes I have her and sometimes I don't. I get to know her husband off and on. He always says hello though if I'm on. She finally is extubated successfully and remembers nothing. My heart sinks and I wonder what I did wrong that night several weeks ago. Did she go without oxygen too long and does she have brain damage now? Or is this just the lingering effects of the medications we use for sedation and amnesia when patients are on vents? Of course, I'm desperately hoping for the latter.

Fast forward another week and guess what...............JJ is back to her normal self!!!! She has no memory from the weeks that she was intubated but that's just dandy as that's what we want but she remembers everything else from her life. I'm so happy to hear this when I come in. I happened to be working the night she gets transferred out of CCU to the respiratory floor. As they are wheeling her out she says to me "my husband says I'm supposed to thank thank you so much for all you did for me." Your welcome I say!! Then her sons take their turns and thank me for all I did for their mom.......again I tell them it was my pleasure. Then over comes her husband who envelopes me in this huge hug. And then comes a moment I will never forget as long as I live....these were his words: "thank you so much for saving my wife. If you have ever wondered if you should have become a nurse then look over there at my sons. If it weren't for you they would be without their mother right now. This is what you are meant to be doing and we will never forget you."

Oh my gosh did it take everything I had not to cry at that point. Not that I haven't cried on the job before...I have. But that was just such a powerful moment for me. And, again, one I will never forget.


Anonymous said...

That brought tears to my eyes. Good work!!

Anonymous said...

that's the sweetest thing. my older bro is a nurse, he works in the burns unit. thanks for serving! xxx

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