Easy as Blood Gases from a Dead Lady

Ruby Vee, BSN

In 1984, however, or thereabouts, there was a class of residents that stands out for stupid, arrogant behavior. One of those residents was a guy with the unlikely name of zippy. (ok, his name wasn't really zippy -- but it was just as unlikely a name and even funnier if you said it really fast three times in a row while drinking.) there's one in every class who will try to tell you his first name is "doctor", and I almost didn't blame zippy once I called the paging operator, spelled his last name and asked for his first name. But the guy was such an arrogant donkey that I got over feeling sorry for him really quickly.

My patient that night was a lovely little old lady with multi-system failure. She was on a balloon pump, a ventilator and had a pacemaker. Earlier that day, the radial art line had failed, so we were forced to stick her for all blood draws. (hospital policy forbade drawing from the aortic line). When the family decided to make her a dnar, we asked zippy to please d/c the lab orders so we wouldn't have to stick the poor lady. Zippy declined. Thinking that either I misunderstood or zippy had I approached him again at the start of my 12 hour night shift. His response was to snatch the chart out of my hand, and in bright red ink write the following order across an entire page of the chart:

"Yes, I do want 1-hour blood gases just like I ordered yesterday and again this morning."

OK. I felt like a jerk, but I went and stuck her for a radial blood gas. And then, because he'd ordered the gases, I called the results to zippy. This was ok at 2000, 2100, irritating him by 2200 and clearly ******* him off completely by 2300. At midnight, I couldn't find an artery in her arms that would yield up a specimen and neither could anyone else who tried. So I called zippy and once again asked him if he'd please d/c the order for every hour blood gases.

The resulting tirade was so loud that the charge nurse on the other side of the desk learned some new curse words. He ended with "try harder, you incompetent nincompoop" or something a little more colorful. So we called respiratory to try -- also to no avail. By this time, I knew my patient was essentially gone. She had a pacemaker stimulating pacer artifact which triggered the balloon pump, and that 42cc balloon inflating and deflating in her aorta gave her a pulsatile pressure of about 42/20. The ventilator gave her a nice, even respiratory rate of 12 and the fever she'd had made her nice and warm, still. She was gone, she was a dnar and all that remained was to call the resident to pronounce her.

My friend was in charge, so I approached her and told her what I had in mind. "Tell me if you don't think I should do it," I said. "You're in charge and we're both going to have to explain it to the bosses."

With her blessing, I called zippy once again and said, "Listen we've all tried to get blood gases, so if you really want them, you're going to have to come and draw them from a femoral artery. I know how badly you want them, so we're all set up for you." ranting and raving, he nevertheless emerged from the call room and stalked into the patient's room. He was in there for about half an hour while the charge and I (and everyone else working that night including a resident from another specialty who knew what was going on) hovered outside the room trying to peek through the curtains and listen at the doorway. Finally, he stalked out of the room in a fury. "you bi$%^es win," he spat out. "you can d/c the hourly blood gases." and he flung the partially full glass blood gas syringe at the wall where it shattered into a hundred pieces. How he'd managed to get even that much blood might have impressed me, but he'd spent half an hour getting it without noticing that the patient had expired!

"Thank you, doctor," I said as sweetly as I could. "Now would you mind going back in and pronouncing her?"

I could end the story here, and just mention that the micu of that hospital is still famous as the unit that woke a resident up at "0-dark-thirty" to draw blood gases on a dead lady and that the residents know better than to ever mess with a micu nurse again. But a few months later on a very slow night, we'd had an agency nurse come in to cover staffing while micu staff went to a wedding or a funeral of a former patient. (common practice there.) it was late, we were all tired, and we were sitting around the nurse's station watching the monitors and trading stories.

"So tell me," the agency nurse said. "Did you guys really wake a resident up in the middle of the night to draw blood gases on a dead lady?"

"Guilty," I said and went on to tell her the whole story, with special emphasis on what a butt that resident had been.

"Well good for you," she said. "I just wanted to tell you that I'm married to zippy." as my jaw hit the floor, she continued "I was about ready to divorce his $$$, but ever since you guys did that to him he's been so much easier to live with! So thank you!"

Easy as Blood Gases from a Dead Lady

About Ruby Vee, BSN

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