Welcome To The Jungle

**VivaLasViejas**, ASN, RN

I've been out of acute care for many years now, but I'll never forget the experience of being a float nurse. It was the best of all possible worlds: I was cross-trained to all the different nursing departments instead of remaing stuck in Med/Surg, which even then was a thankless, backbreaking job. I got to learn how to 'catch' babies and take care of sick neonates; saw some grisly traumas in the emergency room; worked with respiratory therapy and served as the IV nurse.

But it was critical care which both fascinated---and intimidated---me the most. When I first cross-trained to The Unit, as we called it, I was expected to be nothing more than a glorified unit secretary, answering the phone, inputting physician orders, and assisting the "real" CCU nurses with turns and minor tasks like vital sign monitoring and perhaps the occasional discharge to the floors. But as I found myself floating to The Unit more and more frequently, the more I was accepted by the nurses there, and the more often I was permitted to participate in patient care.

One evening, I was actually given a patient of my own. She had been admitted with a blood glucose of 800 and was on an insulin drip, which required frequent adjustments per standing orders. It was fascinating to watch her progress from an almost coma-like state to conscious and confused, then to alert and oriented in the course of the 12-hour shift. Now, how rewarding is that?? To know that my interventions had saved a life, even though I was working under established protocols, was one of the most incredible feelings I'd ever had as a nurse.......and after that night, I was hooked.

I began to request shifts in The Unit whenever they were short-staffed, which was often. Even OB, which was my first love, took a backseat to all the excitement I found in critical care: the DKAs, the cardiac drips, the enormous gaping wounds, the sepsis. Ventilators were scary, so I rarely took those patients, but I was willing and eager to tackle other challenges, such as the patients on pressors. It was amazing to see what happened when the drips were titrated up or down; I'd start out with an unresponsive, grey-faced patient with a blood pressure of 40/20 and see him pink up and become alert within minutes as his pressure climbed back to normal levels.

There were also patients who stayed in The Unit too long and began to experience "ICU psychosis". I remember in particular a woman who weighed somewhere in the neighborhood of 450 lbs. and whose surgical wound had dehisced to the point where she had an eight-inch gap between the edges of the wound, which stretched from her umbilicus to her pubic bone. She'd been in The Unit for weeks, and then one night she pulled out her central line and her Foley and began to scream hysterically. She thought we were demons, and fought us with surprising strength as we tried to cover the CVC insertion site and get her into four-points.

If there is anything more physically exhausting than wrestling with a morbidly obese patient in the throes of a psychotic episode, I'm not sure what it is. I was still tired and sore the next time I was sent to The Unit a couple of nights later. Sad to say, the aforementioned patient had gone septic and was in the process of actively dying, so she was placed on comfort care and passed away early the following morning as we were giving report.

Then, there were the tragedies like "Bob", a middle-aged husband and father who had been brought in for complaints of chest pain. I was on Med/Surg admitting him after the ER had determined he was appropriate to be out on the floor with telemetry. What none of us knew was that he had the same congenital heart condition that had killed his father at age 46 and his older brother at age 38. This gentleman had just turned 40. As I helped him get settled in bed, his color began to change from pink and freckled, to pale, to grey.

I called The Unit at pale; they arrived at grey, and by the time we got him down to The Unit he was purple and beginning to mottle. At that point I became his nurse and stayed throughout the code.....and what haunts me to this day was the look of terror in his eyes as he clutched at my hand and begged me not to let him die. But the battle was over before it had begun, and we all knew it, though we coded him for what seemed like a long time. His wife and two young daughters were in the waiting room as we worked on him, and I'll never forget hearing her scream when the doctor went out there to give her the bad news.

That was the awful part of working in The Unit. But critical care had become my passion, and that's the only regret I have about leaving the hospital---I still miss the adrenaline rush of trying to save a patient who's crashing, the rewards of seeing someone walk out of The Unit after barely surviving an MI, and the camaraderie between nurses and doctors who have borne the battle together.

Welcome To The Jungle

About VivaLasViejas, ASN, RN