Mrs J

Mrs J was one of those patients that you just never forget. I had been a nurse for a little under two years when she came into our unit (CCU) just after the new year. Only 42 years old, she had been having chest pain on and off since Thanksgiving. Her doctor had told her that it was due to her kids being out of the house, in college, and not to worry. By the time she came to us, she had massive cardiac damage requiring several IV drips, had to be put on inverse I:E ratio ventilation, which in turn required sedation and chemical paralization, and was having frequent runs of V-tach. We kept her on the inverse I:E ratio ventilation for about 10 days, and then were able to wean her to more standard ventilator settings and stop the paralyzing agent. She continued to require ventilator and cardiac drip support, however, and would have frequent runs of VT, which responded well to coughing. Unfortunately, she became very fearful of going to sleep, afraid that she would die because she wouldn't be awake to cough. Once we realized this, we talked to her, and let her know that we would still be monitoring her closely, and could wake her up if needed, and treat her ourselves if it came to that. She was finally able to relax a bit, and get some sleep, though she would always be somewhat fearful at night. The damage to her heart, however, was so severe that she continued to need a lot of support, both from the ventilator, and from cardiac drips. She required careful monitoring to keep her in balance- enough fluid and drug support to keep her blood pressure stable, but not too much since the drips are pro-arrhythmic, and she could go into heart failure fairly easily due to extensive damange to her myocardium and accompanying severely depressed ejection fraction.

She had been in CCU for about a month, and her birthday was only a few days away, so we decided to giver her a party, and selected the dayroom on the step-down unit as the ideal location. It was big enough to accomodate her family members, was close to the unit, and had enough electrical outlets for her various IV pumps as well as the ventilator. We were giving her something to look forward to, and she really needed that. We didn't tell her about some out of town family coming, and some off duty staff came in, so it ended up being a festive event. Unfortunately, however, that was the last birthday or holiday she had- a few days later she coded, and we weren't able to revive her. Many of the staff member from the nursing and respiratory care departments, including myself, attended the funeral, and there were many hugs and tears from both family and staff.

Slow Night

I'm not quite willing to say the Q word yet, as its only 0430 and we could get still a code from the floor, or even an ER admit, though nothing down there right now to concern us in in the ICU. We've only got 5 patients, three nurses, and I'm the one with only one patient- and she'll go out to the surgical floor on dayshift. I've got my empty room partially stocked- we're discarding everything in the room after each patient leaves, so we're trying hard not to overstock, but of course, we also need to be ready. I figure its kind of like carrying an umbrella- if my room is stocked and ready, I'm less likely to get a patient!



I started this blog to put down some of my memories, concerns, and other thoughts from my 20+ years as a nurse. Most of it has been spent taking care of patients in middle of the night, though I did a stint working in the corporate world in Disease Management for a few years. Night shift isn't less work, but it is quieter, and you don't have management hovering around. And sometimes, the quiet and darkness encourage confidences. I will never forget the night that one of my patients started talking about when she was a young girl- in WWII era Poland, in the Jewish section. She skipped over most of the concentration camp times, but talked about the time leading up to when her family got sent to the camps, and how she was the sole survivor in her family by the time the camp was freed. She showed me her tattoo, and tears were falling as she talked while I sat next to her and held her hand at 3 am-- there's just too much hustle and bustle during the day for that kind of talk.