swallowflight

i really haven’t been writing much about my experiences at work over the past couple of months. in some sense it feels like a loss – it’s been such a rich experience (actually that’s an understatement – it’s been a complete overload on every level…. rich seems to suggest some element of enjoyment but it’s been too much too fast to enjoy!) and seems like it would have so much material for reflection. in another sense, it feels like writing about the experiences i’m having will just make me re-enter them, something that seems just too tiring at times.

but then i realized – sometimes when i am sitting at the computer at work, composing my narrative notes that what is happening with the patients starts coming together. as i write, i realize what i forgot to ask or start to see a pattern or direction forming. of course for time management and documentation purposes, i need to focus on being very to the point and getting just the relevant stuff in.

yesterday i walked in and got the impression that the ED wasn’t all that busy. there weren’t many people in the waiting room, but once i got inside i saw that my preceptor already had plenty of patients, with some quite-sick folks. it turned out to be a busy day. i learned so much.

we got a notification that there was a patient coming in on the ambulance who was already in cardiac arrest. when he arrived, he was intubated and had no pulse. the EMTs had given him meds on the ambulance, with no response. we hooked him up to the monitor, did a bedside ultrasound and saw no activity in the heart, and called it.

he was a tiny, frail man. i’d taken care of him a week or two ago. in fact, he was still wearing his hospital bracelets. when he was with us then, he got stuck in the ED for more than 24 hours, waiting for a bed upstairs. though obviously in extremely poor health, he was stable then, just waiting quietly. he refused all his meals. his veins were terrible and i hadn’t been able to draw blood from him. i think i gave him some IV antibiotics, did vital signs a few times. the following day, i came back and he was still there.

there wasn’t much to do but take care of his body. another nurse, one of the techs (who is phenomenal and from whom i have already learned many things) and i finished up after everyone else had left the room. we took off his clothes, put him in a gown, removed his soiled diaper, put a clean sheet underneath, removed the leads from the cardiac monitor, unhooked the fluids from his iv, closed his eyes, crossed his hands and feet and tied them, put a plastic sheet around his body, covered him with a bedsheet, straightened his head. the tube stayed in his mouth, the ivs in his arm. instinctively, i still eased his body from side to side, as if i could hurt him if i weren’t careful.

i was gone before his family arrived.

there isn’t a lot more to say. his moment of death had already passed; still, there was a quality of last rites. there is a strangeness to an ending that comes among strangers, however compassionate they may be.

we ended the day with another patient, a woman who came from a nursing home with severe sepsis. the treatment she needed was simple: IV antibiotics and fluids. but not so simple if we had no IV access. her arms and hands were swollen and her veins were terrible… it took three physicians an hour and a half to get a good line. the whole time her blood pressure was low, low, low… dropping into the 50s over teens. they tried everything – neck, femoral, neck again, both sides of both, couldn’t find anything for so long… the whole time she was awake and totally oriented and aware of what was going on. once we finally had access, we started everything…. fluids, antibiotics, and levophed, a drug that raises blood pressure. her blood pressure came up and she started looking a little better.

she said she’d been feeling bad for three or four days. i asked her afterwards why she hadn’t come sooner. she just said, “i fought it.” after seeing her make it through all of that, i wasn’t surprised that she’d gotten her way.

do these stories mean anything? i write them and feel so far away from them. i was there, i did things, but i still have a sense of distance from this work. i try to keep engaged, try to keep present, but my mind is always full of so many things. ironically, though i often feel scattered, i also feel like i get tunnel vision. that’s what i became conscious of today – the sense sometimes of going blindly through a task, thinking of nothing but finishing it. there are flashes of flow, but things still feel pretty piecemeal. there’s so much further to go…