Archive for August, 2005

I don’t think I would admit this to my colleagues, but I find some of the expressions used in the ICU to be kind of heartwarming, if not downright charming.

For example, when someone is about to be extubated and the nurse might say, “I really don’t think he’s gonna fly.” The vision of a coughing, sputtering extubated patient turns into this:

Or when someone is “bucking the vent” (which means the patient is breathing over the ventilator) the sick, struggling patient turns becomes this:

Or my absolute favorite, “The Renal Player.” This simply means a patient who has kidney problems. Whenever I hear this, I picture a bunch of dialysis patients sitting around playing poker in Las Vegas.

For more interesting ICU imaginative stimuli, check out Bob’s Dreams. This patient actually recorded his dreams after being vented and sedated with ARDS.

I dreamt that my patient went into V-tach, or something like it. As commotion ensued, I was trying to remember everything I could about ACLS (which isn’t a lot). What kept going through my head was that you have to shock V-tack, but for almost everything else you start with drugs (atropine, epinephrine, etc.) So the essential theme was: Shock? Or drugs? Shock or drugs? Shock or drugs? WHICH IS IT??? Then my patient got up and ran away before we had a chance to do anything.

In real life, I got to work and in morning report heard that the patient I had previously admitted did, in fact, go into V-tach, then received amiodarone, and synchronized cardioversion, and was stable now. And it gets better.

The docs were about to round on my patient when the resident from the previous night told me what had happened. She was trying to insert a central line in him and as the catheter got close to his heart, he started in with this crazy arrhythmia. The residents collectively decided it was Supraventricular Tachycardia and decided to give amiodarone. Meanwhile the charge nurse was yelling at her “You have to shock him! It’s V-tach!” The resident was very upset with the nurse for yelling at her, particularly because the patient at the time had a pulse.

So it was a lot like my dream, except that my patient never got up and ran away. Instead he flew away. More on that later. Meanwhile I think it’s time to go out and get my ACLS certification.

If you haven’t already, you might want to read A Baby Story, first.

I just happened to be 20 minutes early going to work when I got the phone call that the baby was born. I was so excited; I mean, what are the chances that I would actually be early for work on that particular day? So I was able to visit with them in the morning and during lunch and share their first joyful moments as a family together. They are both very close friends of mine; you could actually say I was instrumental in getting them together, so I was very grateful to be able to share these moments with them. I went back to work, absolutely beaming with happiness.

Then the second set of troubles started. Before you read further, please don’t anticipate that there was any trouble with my friend’s baby. He is healthy and thriving. No, the trouble was with me. It is after all, my blog.

I will preface this by saying that my husband and I have been trying to conceive a child for the past year and a half, without success. It’s a very frustrating situation, but I guess I didn’t know just how frustrated I was until the afternoon I was deluged by a mob of pregnant women at work.

To set the scene: It was a half hour before shift change and I was receiving a new patient. Picture 5-7 people in a tiny ICU room, each person doing a different task in an amazing display of teamwork, in order to get the new patient settled in. It was my admission, but everyone was so competent and quick and more experienced than I, that they kind of took over. I tried to absorb everything and contribute what I could. It was so second nature to them that they immediately fell into this animated conversation that had nothing to do with the patient. It in fact had everything to do with…pregnancy.

One of the senior nurses has this odd psychic habit of dreaming of fishes each time a nurse on the unit finds out she is pregnant. She had recently dreamt of fish and the charge nurse was telling us that she believed the dream was about her. Squeals of delight ensued, everyone was ecstatic. I looked around the room and realized that out of the group of nurses that were helping me, two of them were already pregnant, another one had just given birth a month ago, and the charge nurse was announcing that she was pregnant.

Well. That was just a bit too much for me. I could feel the tears about to come, the flood gates were about to open. But like Tom Hanks says, “There’s no crying in baseball.” Thank god for the face shields that we wear when our patient is on isolation. No one could see that my eyes were welling up.

So I swallowed it down and continued about my business. Eventually the patient got settled in and everyone left to go get ready for shift change. Now that I was alone I couldn’t stop thinking about what had ensued. The events from the past few days flashed through my mind: the brain dead mother with the expelled fetus, my friend’s baby downstairs, and now this. The floodgates broke. At that exact moment, the charge nurse (who is a wonderful person, by the way, and I felt horrible for inwardly raining on her parade) came back around to see if I was okay. She saw my tears and immediately handed me some tissues and sent me to the back office to let it all out. Then she set about tying up my loose ends for me.

So let it all out I did, wiping my eyes down with the sandpaper-like hospital tissues. The charge nurse came back and I explained the whole awkward situation to her. Coincidentally, she just happened to be the one who guided me through the whole deceased pregnant woman situation, and she was very understanding.

Later that night, I had a premonitory dream about the patient that I had just admitted.