ICU: Finding the Best Way to Care

Liddle Noodnik

Nursing is a daunting task for many of us, even when we have time under our belt. Call bells, charting, phones ringing, family members needing time and reassurance, doctors returning calls; and then there is the patient, if you have time.

At least, that's how it seems.

Multiply that by 8, 10, sometimes 12 patients, and it is unbelievable that we have decided to carry the responsibility for so many lives. What if we miss something? What if we give the wrong med, or fail to get scheduled treatments done? What if there is some critical lab value, or some assessment detail, that we overlooked?

Enter critical care.

As a fairly new nurse, I worked in about a 150 bed mid-level hospital. Oh, we did surgeries, had a nursery, and a good emergency room. We had medical residents available to us 24/7 (some of whom we were able to train pretty well). But I was always overwhelmed. I think the turning point was when the LPN on my team came to tell me my patient's IV had infiltrated. What he didn't say was that the patient's arm was now as big as his thigh. And the man's thigh could have easily fed a family of ten.

You get the idea.

It was then that I realized that for me medical surgical nursing was not all it was cracked up to be, primarily because I could not be everywhere. The old adage, "if you want something done right, do it yourself," became my motto, but where to go with it?

In comes the intensive care unit. I was "accidentally" floated to our 9 bed ICU one night, and it was a dream come true. Labs? Not just under a stack of papers but on the tip of my tongue. Assessments? Done just five minutes ago, and ongoing. Patient allergies? I didn't have to look them up. I was as intimately familiar with each patient as I was with my mother. Ok, much more familiar. And it was heaven.

Not only did I have a chance to really know my patient - or, at most, two - but I also got to know new details about them. Internal pressures and outputs, in the heart! In the artery! I could see the numbers and the visual. These patients' lives were more fragile than those of the ones on the general medical and surgical floors, but at least I felt like I was the one responsible for them. I reported to me. How wonderful.

Then there were the medications. IV versions of medications we gave orally on the regular floors. Immediate responses that were immediately measured.

Speaking of responsive - the doctors were much more responsive as well - they took these patients' problems much more seriously.

Then there were the relationships I had with these patients. Most were terrified simply by virtue of being in an intensive care unit. It meant that their lives were precarious, at best. And to have at their disposal a nurse essentially at bedside 24/7 - now that is a relationship. You get to know their concerns, from what they should have changed in their will, to what they miss having on their plate. I was hooked, and I transferred to the unit as soon as I was able.

I remember one lady, Alice, who was about the same size as my mother - 5 feet tall, six inches around, ok I am exaggerating but you know what I mean - she was TINY! She had end stage COPD, and she kept having to go on the ventilator. She was terrified of it. Every time her numbers showed that she could not continue to breathe for herself, she would have the debate: should I go back on the vent, or should I just let nature take its course? It was agonizing to go along with her on this journey of decision, over and over and over again. Obviously this was not a realm in which a nurse could venture an opinion - but that was what she wanted: someone to make the decision for her.

Then there was Ralph. Ralph was a chronic alcoholic with the tell-tale bulge where his liver was supposed to be. I'm not sure what had taken its place - I think some kind of alien. His coloring was not too bad, he was more florid than cirrhotic. His EKG showed a massive myocardial infarction. His hands showed major delirium tremens. He was jonesing in a bad way, and ugly about it. My challenge was to try to make him laugh a little, and try to help him forget that drink that he needed so badly. And also, to provide that delicate nursing care that would keep his heart going and his temper even.

There was another woman, Dorothy, who was my first ever code. I was able to see her cardiac rhythm gradually deteriorate, bring the code cart near, warn the doctor, and essentially wait to be able to intervene. Her rhythm grew progressively worse. The code team drew near.

Once CPR was initiated and the back board placed under her, I was the one to jump on the bed and start compressions. I had a wad of gum in my mouth and spit it out towards the left hand corner of the room. I began to emit a series of unintelligible sounds. The doctor placed his hand on my arm. "Are you oKAY?"

"Yeah," I said, confidently, as I continued compressions. "I'm just trying to remember her name so I can tell her to come back!"

By some miracle, Dorothy (as I later remembered her name to be) survived. So too did I.

There were of course those we couldn't save. I remember a youngish guy (he was then the age I am now) who went from casually conversing with me, to turning purple. He died almost instantly and there was nothing that anyone could do. I was so upset that I attended his autopsy, just to find out what had happened to him, just to see if I could have kept it from happening. I cried as I watched the medical examiner pry out the immense blood clot from his lung. "There was nothing you could have done," the doctor said, trying to reassure me.

But there was nothing the doctor could have done to change how I felt - that death will always stay with me. But so will Dorothy, Alice, and Ralph. I will treasure them always.

I'm not saying ICU was easy, or free from stress, not at all. You still have call bells, charting, phones ringing, family members needing time and reassurance, doctors returning calls; and then there is the patient. But in ICU, you have time. For me, it gave me the opportunity to give good, quality, individualized care. And I never stopped learning. There are others who find medical-surgical nursing to be more manageable. Not me! I'd take ICU any day.

ICU: Finding the Best Way to Care

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