Nursing Intuition, Part 1: "The Visitor is . . . Dying!"
"How much damage to the car?" We're in the ER. EMS has just dropped off a young female driver following a motor vehicle crash.
"I'd say moderate. It was partly head-on, but more left front to left front. No airbags went off. Everybody was ambulatory at the scene. They all denied any injuries. Even this one originally refused transport, but she decided to get checked out because she's eight-months pregnant. Her cousin here was a front seat passenger, but she just came to be with her. She's not a patient." Tom is nonchalant. He's a good medic, generally concise and accurate in his assessment. "Any other questions?"
"No, thank you. We'll take it from here." I turn to assess the young girl strapped to the backboard. She confirms Tom's story. She's 21, in good health, denies any pain, and states she feels the baby moving normally. Her vital signs are good. "I'll get some help in here and we'll get you off this hard backboard."
"Can I get some water? I'm really thirsty." I glance across the protruding abdomen at the patient's nineteen-year-old cousin sitting in a visitor's chair on the far side of the stretcher. She smiles and shakes her head. "I don't know why I'm so thirsty."
This is where the big intuitive moment begins. All nurses have intuition; it's a hallmark of healers. Subconsciously, we listen beyond the words, pulling in nonverbal clues and relevant tidbits from previous experiences and a broad knowledge base. Sometimes, there may even be shades of clairvoyance, and our intuition acts more like faith or an energy that takes us to the right answer well beyond reason. Maybe it was the way she shook her head or her stated surprise at the sudden onset of her intense thirst. Maybe it was knowing that moderate front damage can cause serious injuries.
Inexplicably, I flash to a single line from a story I'd heard years ago: "The cry of the dying is for water." Three teenage boys were drinking when their car careened out of control, slamming into an old gumtree in the front yard of the person who told the story. He rushed out to find that all three of the boys had been thrown from the car. Two were not moving, but one was writhing slowing in the middle of the street. He ran to the boy and listened as he moaned one word over and over with his dying breath. "Water." The storyteller shared this experience to make point out that in the face of death there is a realignment of our values. He observed that the bottle of vodka was lying in the street beside the dying teenager, but the boy wasn't asking for that now. "The cry of the dying is for water. Just water."
I look at the young girl simply asking for a drink of water. She's clearly unconcerned about injury, but I can't ignore the "water" words flooding my consciousness now. "Are you sure you are okay? Does anything hurt?"
"I'm fine." She pats herself down and lifts her arms as turns her head side to side. "Nothing hurts. I'm just super thirsty. I don't need soda or anything--just water."
"Even though you feel like you're okay, do you mind if I check a few things really quick before I get you a drink?" I motion to an empty stretcher on the opposite side of the trauma bay. She agrees and lies on her back on the stretcher so I can check her abdomen. I pull the curtain, slide her shirt up, and see that her abdomen is smooth and flat. There's no seat-belt abrasion or discoloration. "Were you wearing a seat-belt?"
"Yes, but it was bothering my neck so I had it tucked under my armpit. I'm really okay."
I'm tempted to let this quest go, but "the cry of the dying is for water" words won't go away. I apply moderate pressure, palpating the lower quadrants. She denies any tenderness. When we get to the right upper quadrant, she winces. "Does that hurt?" I ask, adjusting the position and pushing a little deeper.
"Oh. Okay. That's a little sore there. Um, I guess it really does hurt right there." She suddenly looks worried for the first time since she casually walked into the department. Her radial pulse is thready, and the rate is about 120. Her BP is 96/48. Her palms are sweaty, and there's a hint of perspiration on her face. She looks a little pale now. Objective findings are piling on in support of my gut feeling.
The next few hours turn into a blur of lifesaving interventions. I physically drag the attending ER doc to the bedside where he supports my suspicion. We start two large bore IVs, draw labs, band her for a type and screen, and hang normal saline. We have her in CT in less than ten minutes, confirming a large intra-abdominal bleed from a lacerated liver, likely from her improperly placed seatbelt sliding under her ribcage on impact. Only one OR is available, and they ask me to scrub in because they don't have enough staff to handle the emergent surgery. For nearly forty-five minutes, I function as a human rapid infuser, standing at the head of the table to the right of the anesthesiologist, hanging unit after unit of blood and manually squeezing in several of them when her pressure drops precipitously. Additional OR staff finally replace me, and the surgery drags on for several hours.
I come to work early the next day to stop by ICU. She's on a vent, extremely edematous, looking like she is nearly twice the size of her slight build when she walked into the ER the day before. I'm told she received a total of 18 units of blood, but she is relatively stable now. Her puffy face looks peaceful. A tear rolls down my cheek as a surge of emotion reminds me just how close she came to dying. She eventually recovers and is discharged home.
We never know how many lives we save. Our intuitive moments are not always profound or memorable, but, for me, this one was unforgettable. Even though it happened years ago, any complaints of thirst in potentially hypovolemic trauma patients still grab may attention. This girl was minutes from death, and no one knew until a flash of intuition intervened. "The cry of the dying is for water."
EDITED BY ALLNURSES TO ADD
This two-part series includes a giveaway as one of the contests allnurses.com will be having in celebration of Nurses Week coming up next week. You are invited to share your own intuitive "save" story as a response here. The story with the top 10 "Likes" shared by the readers will receive a paperback copy of "Anonymous Complaint: A Nurse's Story." Those who share a story in response to either article will be included.
For Part 2 and details about a special Nurses Week Giveaway, see Nursing Intuition, Part 2: The Seizure Girl
