In my prayers
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- 4 Published May 31, '08In Emergency Medicine we don’t get the lovey dovey stuff so often with patients. We see patients at their worst. We try to get a big picture as to what’s going on with them, stabilize them and then ship them off. Sometimes before we even get to even know them, they’re out to another room or holding area so we can get another one in. All the stuff they teach in nursing school about getting to know your patients is for floor nurses. But I have alot of respect for them. We’re hard in the ER. Our skins are tough, probably from all the sweat from running around.
We do the best for our patients and then we don’t try not to take the job home or let it bother us. But I give credit for those floor nurses who are busy taking care of our grandma’s, grandpa’s, mom’s, dad’s, siblings and friends, because in a way, they become their own family. Their work family. For the most part they see them everyday, day by day. All the things nursing school focuses on care plans and stuff actually matter up there. In the ER not so much.
But today, I felt like I connected with a patient. It was’nt a bad night in the ER. We had my first cardiac arrest at Crouse tonight which was defintely different the way it is run at the Brook. But that’s a whole other story. I was working at the Acute end of the ER tonight but I thought I’d go help one of the nurses who was drowning with patients. I went to go check on her patient who was hypotensive.
I walked into the room and the small frail lady in her 80’s sat there in her bed with her son and her daughter at her bedside. I took her BP and asked her how she felt. She said I feel like “crap”. Laughing I looked at her BP and it was 70/40. Low. Her son made a comment about saying mom you could’ve said you felt like ****. And the woman laughed and yelled at her son for cursing in my presence. So we bolused her and I went on my merry way.
About 20 minutes later they rush her to the Acute end. Apparently she went into rapid A-Fib and her pressure kept dropping. She had a positive troponin. Pretty much whatever was bothering her was becoming systemic. The doctor wanted to cardiovert her. All the sudden this frail old lady who laughed and joked looked lke a scared child. She kept saying how scared she was. She told me one of her grandson’s names were Andrew and that he did’nt like being called Andy. I told her she could call me whatever she wanted. We tried to calm her down, had the family step out and gave her some propofol. Once she went out we cardioverted her 3 times. We could’nt get her back into a sinus rhythm. She slowly came around and looked at me and said to me. “Andrew I’m scared. You see, I did’nt call you Andy.” I felt horrible for the poor old lady who was being shocked over and over.
I kneeled on her side and held her hand. I told her exactly what the doctor was doing through each step of the central line. She squeezed my hand and said “I trust you Andrew. I’m scared… but I trust you.” I kept reassuring her that it was going to be ok, we did the central line and I explained each step telling her how great of a job she was doing. I tried to talk to her about her family to get her mind of things. She was a mother of 8 children oldest in his 50’s and youngest in his 40’s. She had 15 grandchildren and 3 great grandchildren. She just kept smiling when we talked about them. We started her on pressors to bring her BP up. When the doctor was done, I left the room to attend to another patient.
A few minutes later I figured I needed to get something from the room and check on her and she’s in the room and the doctor is doing chest compressions and intubating her. I don’t know what it was. I’ve been doing this for so long and I’ve seen people crash before but I felt like I was connected to her. As if that was a family member on that stretcher. We got her back and she started waking up from the sedation. She had a ET tube in and she just looked at me and tried to mouth words. I just tried to comfort her and tell her it would be ok. She looked at me and I could tell she recognized me.
So tonight I pray for her. I hope she get’s better. I try not to get too attached but I am only human. So even though I don’t know her and probably will never see her again, I hope that I’ve made all the difference in my hour with her.
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1Jun 7, '08 by Babs0512I worked in the ER for 8 years, and your right, we don't often get the "Lovey dovey" stuff that floor nurses get, but I tried to connect in some way with each patient whom I took care of. I found sitting the patients while taking a history, always gave the impression that you spent more time with them than you actually did, and that you cared. Their press GAneys support my belief.
I met a women who came in with near syncope. When she arrived, she was absolutely stable. Sinus rhythm, near perfect VS, vague complaints of "uneasiness". Lungs clear, no edema, heart sounds S1, S2. She held my hand and look into my eyes, and said "please, don't let me die tonight" My hair stood on end, I've learned to take patients very seriously when they say that.
Although her lungs sounded clear and her pulse ox was 98% on RA, I put her on O2 "just in case". We did a ROMI (Rule out MI). As part of that, she had a Chest x-ray, which showed mild CHF. So we gave her some lasix, and she began to c/o "a rubber band around my chest". I decided at this point to move her to a front line bead. All the while she held my hand and patted it saying "please, take good care of me, don't let me die" I assured her, I would do every thing possible NOT to let her die, as it would ruin my shift and cause me to have to stay late to do mountains of paperwork! That made her chuckle. Long story short. Her initial cardiac enzymes were negative, they often are. But we hung a NTG gtt, for her CP and it would help her CHF. She had a foley by this point as well. When the NTG gtt helped, but not completely, I gave her some Morphine, which seemed to do the trick.
Her family was by her side pretty much the entire time. I encourage her to rest, and the family to allow her to rest. Her EKG still showed no signs of an MI. I decided to do a right sided EKG - don't know why, just a hunch, and there it was, ST elevation and all. Due to lenght of time and her hx of GI bleed, it was decided not to Retavase her. I did start a heparin gtt.
I told her jokes, and made her smile. Chided her for not resting, and generally tried to keep up her spirits.
Before she went to ICU, her family called me in the room, this patient said "Thank you so much for keeping your word, and making me feel so comfortable - I knew you wouldn't let me die."
I felt really good going home that evening. I found out the next day that overnigh, she arrested and died, I felt better having held up my end of the agreement.0Jun 8, '08 by Nursebarebari"I try not to get too attached but I'm only human". Yes, I can relate to your feelings. I always try not to get too close, but it does not always work. So in the end I say to myself that I'm only human and my heart is not made of concrete.
Nice and sweet article.redpinkhe0Aug 20, '08 by melleo16I worked as a ward nurse once and I encounter so many things and situation with patients.I get closed to them but to my disadvantage end up crying when they die.Its really painful for me letting them go knowing even the family will not see them again. The painful part is when I am doing the post mortem care really pour my heart out