He rose again-a lesson learned

cav5

My second year working in the ICU brought about changes, both good and bad. I was becoming more competent, more independent, and more secure in my knowledge base as not only a nurse but an ICU nurse. However, with this level of confidence and skill came with it something close to impudence, a firm belief that if I hadn't seen it all then maybe i had seen enough. I find that in life, at least mine, that whenever I tend to get to this point, the universe makes sure that I learn that there is never "enough". Every day is a learning day. Every day is a day when you might know "enough"-enough but not all.

It was 10:00 p.m., the night before Easter Sunday. A 70-year-old patient was being transferred straight from surgery into the ICU because he was not doing well and his no-code status could not be honored in the recovery room. He had come out of surgery with his pupils fixed and dilated, respirations were shallow with very little air flow, and he was not responsive neurologically. Everyone thought it best to transfer him to the ICU where he could get care if he should recover while at the same time honor his no-code status. That is, until a very young and new physician decided that we should intubate.

I was mad.

I was upset that this patient's wishes were not being honored. I was furious that yet another family would have to make the decision to "pull the plug" after three days of waiting and hoping, only for it to be fruitless. I was enraged they would have to suffer needless guilt and sorrow for ending their father or grandfather's life because a young doctor didn't want to make "the hard call", particularly when this man had made sure that that would never happen.

I was mad.

However, despite all protests, the young doctor called the family and urged them to intubate "just until the anesthesia wears off". So, we did. During the next hour I gave him IV's, got him settled, and talked to him.

"Bud, I am thinking she should be voted off."

You see, bud was an affectation that I took to calling most of my male patients, I had run out of many other subjects to talk about, and survivor was very big at the time.

It was then that he turned his head. Yes, he turned his head and looked straight at me. My patient had literally come back from the dead...on Easter Sunday.

After an hour bud was sitting up and asking for ice chips via hand gestures. It turns out, all he needed was respiratory help until the anesthesia had worn off. In fact, after he was fully awake with a normal CO2 level he was so fine that the tube came out the next morning and he was free to go home in less than a week.

Come to find out, the pre-op paperwork failed to mention that he had a pre-existing eye disease that made his pupils always fixed and dilated. Oh, and that the primary name that the patient responded to was his nickname..."Bud".

I learned a lot that night. I learned that survivor was one of bud's favorite shows. I learned he agreed with my choice of who should be voted off-something he watched first hand and tube free the next night. I learned that paperwork, while very tedious and time consuming, really is that important-the smallest things could literally mean life or death.

I learned that if it had been up to me and my "enough" that Bud would have never gone home to his home, his family, and his favorite tv show.

I learned that that you can never know "enough".

He rose again-a lesson learned

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