Wednesday, January 12, 2011

my empire of dirt

Patient came to us about a month ago. He suffered from the ICU FunPak of cardiopulmonary diseases----80 pack-years' worth of smoking, emphysema, multivessel disease, and a newly acquired septal defect that took away his heart's "lub-dub" and replaced it with a pathetic "whooooshwhooooshwhoooosh". He was also unable to hear, leaving all of the staff to use his worried family as interpreters. When they weren't available, we wrote short technical manuals for him in Sharpie pen, explaining test results, procedures, and the fact that if he didn't have surgery to correct his defect, he would surely die within weeks. If he did have surgery, he had a great chance of dying on the OR table, but a slim chance of surviving and returning home eventually. The physicians on different (one could say opposing) teams argued with each other, then got passive-aggressive. Send him out to a larger facility? No. Cut him now? No. Recommend palliation and give him a bunch of drugs and an opportunity to live with his family at the end of his life? Oh, hell no.

Precious time passed, and Patient finally went to surgery. After much debate, he decided he was willing to roll the dice on dying because for him, it was worth it to try to survive until his grandchild's first birthday, a short two months from this point.

Patient spent the rest of his life after surgery on an air mattress, stoned to the gills and terminally air hungry. He couldn't be assessed for neural function because he was sedated. He couldn't have sedation lifted because he would fight the vent. He couldn't respond to commands anyway because he couldn't hear us. All he could do was occasionally open his eyes, writhe, and get bolused with more sedative, to keep him manageable.

I use the word "manageable" loosely.

The last time I took care of Patient, I could have sworn I heard more of a whoosh at his apex than I had previously.  I frowned at the find, and chastised myself for not paying more attention during my previous assessments. I couldn't think about that sound being a new development. I talked to his children, his wife; I refused to say "better" or "worse", and just stuck to the facts. I honestly didn't know what to say otherwise. The Surgeon brushed off concerns, and would only say that we needed to give Patient more time. That night, over drinks, I decided to swear Patient off. I couldn't care for him anymore. I was dreaming about him, thinking about what else I might have missed, wondering what I could change, and dreading further arguments with Surgeon. It was time to stop.

A few days later, Patient tanked and died. It was one of those TV Hospital-style deaths, with everyone being heroic, and every measure taken. A horrible, horrible death. He didn't live any longer than he would have without the surgery.

I can't quit thinking. I can't quit thinking.

let me give you the nickel tour.

There have been a few questions about what this blog is.

It is:
  • all true, with some story editing for flow and readability. That includes the bit with the "Taco Bell" patient...that one seems popular with you guys.
  • complete with all names and some genders changed to protect the employed.
  • a way for me to vent, on behalf of all nurses who wish they could share the amazing, dismaying things they see, hear and have to do.
  • if you wish, a place for you to vent as well. I don't have the market cornered on the insanity that is nursing. (As a matter of fact, I have a new entry I'm working on editing for "Haldol, NP"---an advanced practice mental health nurse who last year began his work in the private sector).
  • A display acknowledging how much we know and give in the course of providing care. I don't care what my mom says, I don't get paid well enough. And neither do you. 
  • not intentionally a forum to mock anyone. It just works out that way sometimes. Okay, frequently.
  • me trying to wrap my head around why we do what we do; not only within the profession, but within American health care.