Codes don’t make us super

I need to talk about my first real code. I’d watched codes and rapid responses before and they were exciting. I walked away feeling empowered, like a goofy superhero. “We did it!” racing through my heart, I would go home and tell my mommy what I had accomplished. I did compressions, I started an IV – the little things. Naturally, I assumed my first real code as a real nurse would be so much more empowering. To know that I have the intelligence, education, and speed to make a difference. I was so wrong. I was focused on the whole “bringing them back” and forgot you have to see them die first.

We were understaffed. I was getting threatened with an 8th patient. Some floors are quiet enough to give a nurse 8. There are 22 rooms and 3 nurses. One tech. My floor should only have 5 or 6 patients per nurse and two techs. Two patients needed their H&H watched with a possibility of stat PRBCs. I had Foleys, PCAs, PICCS, centrals, a gastric decompression tube, 4 wounds, 3 isolations, a brand new C Diff diagnosis needing teaching, a chest pain, a drug seeker, and withdrawing alcoholic, and the list goes on. I hadn’t slept before getting asked to take this extra shift.

At 0345 I walked into his room to help the lab pull blood from his PICC and found him limp with blood pouring from his mouth. I called out his name and grated my knuckles across his chest. He gurgled as he slumped over, eyes rolling in opposite directions and my stomach twisted. Ripping the cord from the wall I called for my charge nurse and our “nurse on a stick.” As soon as charge got in she called rapid response. I told lab to stay nearby because we needed her soon. I grabbed a pair of gloves immediately, something I learned the hard way in my first code my senior year of nursing school. Charge shoved me out of the room to go grab all my paperwork on him and his chart, warning me the doctor would want to know everything. 30 seconds later with my prewritten SBAR and computer I returned and wove my way to the doctor past so many people. They handed me leads to the AED and suddenly, I forgot where to put them. RA, LA, RL, LL. Those are the limbs right? Or is that Right Atrium, Left Atrium? No, definitely limbs. Damn it, which side’s right? Put the shock pads on first, then it will come to me. Snapped them in. The monitor screams on and my feelings finally fade out. My mind is numb and clear. I filled in the doctor. He was AxOx3 at 0230. Surgical repair of perforated gastric ulcer on xx/xx/15, continuous gastric bleed from unknown source, last 2 Hgb 7.1. We can’t get a BP. I tried both lumens of his PICC and the line on his central and I could only get 1ml of blood. His type and cross expired 4 hours ago. Then the beepbeep on the monitor flattened. Compressions. Epi. Levophed. 2units O- stat. 2L NS bolus. I finally take a good look at who’s here. My favorite ER nurse. My favorite pharmacist is here. That’s good. Focus. We only have one pressure bag so I became the other. I felt afterwards like I broke my hands holding onto that bag for the next hour. My right hand and wrist is visibly bruised the next day.

I watched helplessly as everybody buzzed around my patient. What did I do wrong? I analyzed my entire night looking for what happened. Maybe I should have checked on him earlier. Maybe I missed some lung sounds. I should have done my ACLS before now. Looks like I’m studying when I get home. My hand hurts. I readjusted my grip to increase pressure. I watched them intubate him and contemplated the gracefulness of it all. Hear the sarcasm? For all my non-medical friends, hold onto your chairs. In order to intubate, we stick a very long L-shaped piece of metal into your mouth, pin your tongue down to your throat and pull UP to stick a tube the size of your thumb into your airway. For all practical purposes it looks like hooking and holding up a fish. His head started floating up off the bed, his jaw jutting forward, rosey-gray tongue sticking out the side. I could see the lighted speculum outline through his throat.You know when you find a dead animal on the side of the road and the swollen tongue is sticking out? The wide-eyed gaping of the bass you pulled in?

I can’t hear what RT is asking for. Oh a smaller suction cannula. There is already over 400ml of blood they suctioned from his lungs sitting next to his bed. In fact, now that I look, there is blood everywhere. The amount is unnerving and this is a GI floor. I’m used to GI bleeds filling the commodes. There has to be a couple pints in here. His Hgb came back: 4.something low. How did he drop so fast?

All dignity has been stripped, there are 4 hands checking for a femoral pulse, a doppler crackles in a search for any kind of blood movement. Tubes everywhere, needles and wrappers, 6 IV lines, Telemetry and AED leads, 2 oximeters, a blood pressure cuff and a lab tech desperately trying to get an ABG.

RT finishes up their suctioning. Suddenly, a rhythm. 69bpm and it’s decently regular. O2 99% with RT bagging. It takes 7 of us to transfer him to the ICU where my two favorite ICU nurses take over. It’s still a mess, and I’m still clueless. I stand in a corner and wait to be asked questions. I’m trying to soak it in, trying to remember everything, hoping the paperwork won’t be bad. Trying to think of my other 6 patients and what they might need, hoping someone is watching them. I take and sign orders. I answered all their questions and left my name and extension. I stopped to see the family and answered their questions.

I ran back to the unit. It’s a little after 0500. He will be DNR. I know in my heart he will never wake up. He’s done this too many times. I watched my patient die today. I helped bring back his body, but I did not save him. I did not go home a bloody hero, I am not proud of myself, I am not a superhero. I returned to his room for his family’s belongings. Blood, chaos, oddly Instagram-worthy. I handed out the rest of my medications, helped restock the crash cart, finished the code sheet, passed off my patients, did all my paperwork, and went home. Being a nurse is never about saving lives in a dramatic fashion. That thought was foolish. That day, it was about losing someone and still having the strength to fight for the others.

I lost him. His heart restarted but he will never speak to his wife and children again. He will never crack a joke. He will never push his call light and ask for another blanket. He is gone. His death was void of grace and ease. He drowned in his own blood.

They say war heroes rarely completely agree with their honors. They say medal of honor recipients struggle with feeling they didn’t do enough to deserve it. I never could understand it. But now that someone’s life is in my shaky little hands, I can begin to understand.

My favorite security guard swung by afterwards. I call him cowboy. You would too if you walked behind him. He looks like Clint Eastwood walking into the sunset. Except he smiles. I didn’t say much, but I guess most nurses try to blame themselves because that’s what he told me not to do. He told me not to beat myself up over it, but I have to wonder if I could have done something more.

There is no such thing as a clean victory. I will never have done enough. I will try to save you, I can keep it together, but please.

I’m just a nurse.

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Montgomery

This is a very difficult post to write. I don’t want pity, it’s almost over. However, I do have to wade past so much fear. Fear of my abusers, fear that no one will believe me, fear that my abuser will lie and you will believe. But I promised him I would never stop fighting his bad decisions. Fear that maybe it will never stop if I confront it. Fear that I will lose my brothers as a consequence.

Among the valuable lessons I have learned over the last 2 months, one hit me particularly closely. There is chocolate at the end of the food line. Moving from Greenville to Montgomery has been traumatic to say the least. I found myself no longer truly welcome in my home around Thanksgiving. My parents would say it’s because I refused to submit to my father’s authority. I would say it’s because I refused to turn a blind eye to the way he treats his children, especially his autistic son. I had called the police, it got so bad. I simply consulted the police officers though, I didn’t want them going into the house. I didn’t want a huge mess. I want to keep my family intact. I want to keep hoping everything will get better. Nothing came of it except my “leaving the house.” I refused to turn a blind eye. I was given a choice: stay and stop challenging my authority or leave and don’t come back. I had packed up and left within 2 hours. I knew this day was coming. I had been engaged for a week. I had been slowly packing and storing my boxes.

I was now homeless for a little over 2 months, taken in and given a bed in my friend’s house. Working a job that couldn’t even pay all my bills, I couldn’t get an apartment. Jeremy and I had chosen to have a small wedding quickly so I could have a home. While still in Greenville, I began job hunting in Montgomery, since it usually take a couple months to get the ball rolling. I got a call the next day and was hired within 5 days. Uh-oh.

There was no way I could afford my own apartment and wait 6 weeks until my wedding ceremony. I couldn’t afford my bills or food. I was being given food by my friend’s family. I was not going to move in with my fiancée and live together before the ceremony. I had no choice. Jeremy and I got a legal marriage Feb 11, with the ceremony March 28th. Now I had my very own mattress on the floor and food and a way to pay my bills.

My parents were furious. Someone at work had snitched to my mother and told her before I got to. I hadn’t married Jeremy at that point, but the plans were in the making and I wanted to tell Mom myself. I was not going to NOT tell her. Some gossip got to it first, so she was not open. I don’t understand how I had any other choice, but she was too hurt and angry to listen. I hadn’t thought that maybe she would want to come and watch the courthouse wedding. I didn’t think it was a big deal, the March 28 ceremony was the big deal. I didn’t mean to hurt them. I wish I would have gotten to her first. My dad didn’t really want to go anyway.

Because I was orienting in AL, I was not in SC. I got a call from pastor.

Your parents told me you left and got married. Since you have moved and are already married, we are canceling your church shower. I’m sure you understand.

I just said “sure” and hung up.

No, I don’t understand. I don’t understand how they manipulated you like that. How you couldn’t be bothered to ask me why. How you could just yank the support of my church out from underneath me when I needed it most. How after 13 years of attendance, I could be abandoned so quickly. I would still make trips to Greenville for the next 4 weeks. I wasn’t done going to church. Well I was now. I attempted to explain to my Sunday school group. I don’t think they really believed me.

It should make sense though. Abusers don’t fit a mold. They look like nice, good people. My mother loves him, and denies any of my points. So of course a pastor with little experience with abuse would trust a parent over a child. Anyone can make that mistake. When I went to him in October to talk about my father, he wanted to hear both sides of the story. He told me to get my father and meet him. One never brings an abuser and a victim into the same room and tells them to work it out. That should have been my first clue that pastor didn’t believe me. I asked my mother to not say anything until I found a good time to bring it up. She did not, and in a typical power-play, my father made the first move just days later and had me meet with himself and pastor. I was outnumbered for one, outplayed, and in the same room as my father, whom I am accusing. I was terrified. I offered a few points, but it turned into both my parents telling pastor that I’m just rebellious and ungrateful. He bought it.

So I shouldn’t be surprised when he treated me like a runaway rebel.

Jeremy and I made ends meet, paid all our bills, and were starting a happy life. I finally had enough peace and mysteriously stopped biting my nails. We filed our taxes early February and used the money for the wedding. We had a sweet and simple wedding, a smooth honeymoon with just a couple hundred dollars and returned home. We used the last $50 for groceries and waited for our next paychecks. Then, 3 days before taxes were due my father told me he would be filing me as a dependent no matter what I thought. I reasoned with him, but I didn’t beg. Maybe he wanted me to beg. I barely didn’t qualify as a dependent, but we doubted we could win. We lost $2400.

I tried not to panic.

My coworker had told me about the food bank, and told me to go. I did. They gave me a good-sized box of food and the number for the rescue mission; told me they had a food pantry on Thursday morning. I sobbed in the lady’s office. I sobbed like a child. I felt so helpless and ugly. I should be able to provide for my husband. He took this whole thing personally as well. It made him feel like a terrible husband. I assure you, he is not a terrible husband. He eats peanut butter sandwiches for breakfast and lunch. He makes pancakes for dinner.

On Thursday I found myself standing in line for food at the rescue mission after my 3rd 13-hr shift, and among about 200 people I was the only white person I could see. I still had my scrubs on. Some of these folks had wagons filled with boxes behind them. There were some older folks who looked like Social Security had let them down. Some very young women with babies. Everyone looked hungry. Maybe you’ve been here too. I can’t possibly be the only one.

I don’t belong here. I have a good job. I grew up on a well-off family. I have a husband with a good job. I’m not starving, maybe I should go home. I sat on the curb and watched the people mill around with their numbers. I didn’t get a number, so I had to wait for 1-136 to go, then I could go. Everybody looked at my scrubs, but to my relief, no one looked like they were judging. I was judging myself enough. I waited two hours and then I got to go through the line with my two bags. One said Bob Jones University and the other said USAF. A little ironic I think. The lady in front of me was tall and large and talked a lot. She was like the mother of the entire group, and loaded me up with vegetables and told me how to cook them-what was I to do with three bags of green onions? She was instructing everyone else and holding all the babies. I helped carry a box for the girl behind me. She asked me if I had a job. “Yes, I do, I’m a nurse. I’m new here and I just need a little help now. I’ll get back on my feet soon.” She hugged me. She said, “Yeah you’ll get back up on your feet. Only two people to feed is a blessing. You’ll be just fine.” I think she assumed I have a child.

A bright red, brand new sports car roared up. A well dressed man covered in gold and diamonds stepped out. He walked up to the front of the line, grabbed a box and started going. Maybe he was a pimp and didn’t want to buy food for his girls. I don’t know, but I suddenly felt justified in being here. I wish I knew though. I wish I knew if there were other people suffering. I walked away with my food and thought about what I’d experienced. There is more pain and suffering in this world than I have experienced. I will in no wise minimize what has happened to me and my family, but I will be grateful that it is not more than it is. There is more than I have written about, but nothing documentary worthy. I will not let bad things give me a bad attitude. God knew about all of this and He let it happen and He will be there for me when it overwhelms me. There is always grace at the end of a trial.

There was chocolate at the end of the food line.

I think that sums up what I learned on Thursday.

I’m restarting C25K

So I’ve gained a couple pounds back, and I’m over two hundred again, but I know that being discouraged isn’t going to help me fight back. So, I restarted this program called Couch to 5K (C25K), as an app on my phone. I really want to stick with this the whole way through. I think I’m going to be getting married sooner than later and it’s imperative I lose enough weight to not look like Jabba the Hut’s granddaughter pretending to be Princess Leia. I know, I know, enough with the Star Wars. Never!

I weighed 202.5 this morning while on my cycle (I’m a nurse, remember?) so I haven’t lost too much ground. I’ve really gotta push though. Two years ago, I started liking myself around 170. 30 pounds to go. I will try.

Do. Or do not. There is no try.

It’s been a while and I’ve been lazy

Alright my friends, I have a confession. It’s been several weeks since I’ve posted and that is likely because I haven’t really been able to work out lately. I got *very* sick Aug 23 and my white count, in essence my immune system, decided to imitate a chemo patient. Since then, I have been trying to find out what exactly is wrong with me. While my WBC count is no longer 2.3, it is still on the low end of normal and finally explains why I’ve been consistently sick and “fragile” the last few years. However, I do not know why my immune system is doing this. I am overweight, so I might be more susceptible to illness and fatigue, but seemingly nothing wiping me out? My doctor and I have a meeting on Wednesday to talk about it. I gained about 7 pounds this last month. I am determined to continue to lose weight, I just can’t push like I was. Maybe I was pushing too hard anyway. All that to say:

I’ve had to start over.

I’m going to try not to be discouraged about the fact I won’t be my goal weight when I get married. But I can at least not be obese? I want to get married at maybe 165. Pray for me, I don’t want to give up.

ER Nurses and Military Men

So I’m not an ER nurse, but here’s why I think I can say I could be. I want to be. I didn’t see my textbooks or diagrams. I remembered my teacher’s voices. I remember the maps in my head and the way the physiology felt. Like a river with waterfalls and side passages. I did what made sense to me, not because I read it in a book, but because I knew it. It was part of me and I needed to trust it.

I needed to not feel. Conceal, don’t feel, don’t let them know.

You’re about to wet yourself.

 

I did not save this man’s life. While it was serious, it would have taken some serious botching for him to have died.

——————————————

Watching Guardians of the Galaxy yesterday, the boyfriend elbows me. “Hey, he’s having a seizure”

“Hi, I’m a nurse, can I help you?”

 

OH MY GOD YES PLEASE HE’S DIABETIC AND I DON’T KNOW WHAT TO DOOOOOOOOO!!!

 

She is holding sprite to his mouth, which is simply heaving out with each seize. Eyes rolled back. She is shaking so hard the row is trembling. Or maybe that’s him. I’m afraid of him choking on it. Aspirating. Why is he seizing? Not quite grand mal, but eyes rolled back, muscles locked, definitely something up. Tall, average size, late 20’s, Tshirt, jeans, pale, clammy, cold. Oh darn. His blood sugar is likely equal to the amount of digits in rigor.

“Alright ma’am. I need you to stop trying to make him drink soda. He’s seizing right now and cannot swallow. He will be still in a moment.”

 

To him: “Honey, I’m Rebecca, I am a nurse and you are going to be okay. Just hold my hand, let me know you’re there. *simultaneous pulse check. mid 70s regular* Seizure lasted about 2 minutes. “Honey, I’m Becca. I’m going to help you. Squeeze Oh good you’re there. Here’s a straw for some sugary juice. Okay. I’m going to look for your pump, so I need to unbuckle your pants. I need to you try to swallow this (juice). Mom, I need you to take a deep breath and see if you brought a glucometer. I’d like to know what we’re working with.”

I’d forgotten how panic and helplessness removes people’s bubbles. Grown men cling to me like children. They love to hold a hand that isn’t shaking and promises to help them.

His mother babbles in terror about how he’s had this for 18 years and he’s always controlled it on his own and she didn’t see this coming.

“Type 1 can be unpredictable” And unforgiving.

 *lights come on and movie pauses* First cold draft of fear. It hits me what I’ve done. Mental hesitation. 2 seconds in my head. What on earth do I think I’m doing? I haven’t taken my NCLEX yet. What if I’m not competent? I don’t know if I am because I haven’t passed it yet. Did I inadvertently lie to these people? They needed to trust me. Should I allow them to trust me? I have no clue what I’m doing, do I? What if I screw this up? I have no experience. Diabetes lectures were not my strong point. I should have taken better notes and listened more to Mrs. Jones. I should just make them call 911 even though Mom doesn’t want it because I. Am. So. Afraid. Don’t overthink it Becca, you know what to do. Just do it. Deep breath. It’s too low. Get it back up. Fast sugar, slow carbs. Candy, peanut butter. You got this.

 

Instinctual pupil check. All good. Seizures apparently over.

 

“You are going to have one hell of a headache when this is over” Language has necessary icebreaker effect. He smiles. We learned he skipped lunch bc he didn’t want to eat before the movie. Oops. He can hold his head up now and move his digits. Improvement. He and I have a conversation but the only thing I now recall is that he’s 26. I wanted to introduce Airman but I can’t remember if that thought made it out my mouth.

 

I had to pull one side of his jeans down and decided to pull his boxers up to pull out both needles to the pump. It’s actively pumping. Wow there’s two. Well we don’t need that at this moment. I pushed them into each other so they wouldn’t stick him. Checked his insulin container, plenty. Cover him back up Becca, he’ll soon be aware enough to be embarrassed. What if this was your boyfriend. Make him feel better. “I have the opposite problem. I have hypoglycemia. I went down in the middle of nutrition class once.” (See? You are not alone-Mother petting his head.)

 

The military half of this deal stood by handing me things, helping to figure out the glucometer, keeping crowd control, explaining the situation to managers, getting things off my hands so I could work, and bringing a certain silent strength to the situation. And keeping everyone sane. I should mention here how quiet it was. Everyone but him was terrified (I was secretly shaking). The entire room was silent, wide-eyed, frozen in their seats, but not my Airman. He stood beside me, relaxed, softly smiling while I talked out loud about not skipping meals, explaining everything I was doing, asked for an empty water bottle to use as a sharps and blood container, and recommending seeking advanced care. I think he knew I was nervous. It had been almost 10 minutes by the time our panicked mother got the glucometer together. SQBS 30. (after 10 minutes of soda, juice and candy, what had it been?!?) Don’t think about it Becca. Just don’t. Airman would have helped you do CPR.

Every time I don’t know where to look or what to think I find his eyes. He trusts me. It helps. I’m racking my brain for something I’m missing. I don’t want to make him worse. I want to help him. I’m scraping my memories of lectures and notes, knowledge I’ve collected and I feel my fear like talons raking my gray matter. It actually hurts. I need to calm down, I’m not missing anything. I wish I had an instructor. I am a nurse. I am doing a good job. These people need me to quit doubting myself and just do my job. Right now, I just need to stay with the people and make sure he continues to get better. There is nothing left to do.

 

He’s alert. I am extremely comfortable now that he’s responsive and all I’m doing is feeding him. I have asked for peanut butter, and mother pulls out Reeses pieces M&Ms. Not real peanut butter, only more candy, but I should let her feel helpful. Thankfully I had real peanut butter with me. I asked my strong and steady to grab it for me. I explained to her the reasoning behind candy first and follow up with something delayed to avoid crashing. She seems to understand. He is now making eye contact and blushing.

 

“Let us restore some dignity” –> I heard this in Mrs. Valarie Petersen’s voice in my head. *pull his pants back up and button, zip, buckle* Thank you nursing faculty. Nursing is about the whole person, not just the diagnosis.

 

Recheck SQBS. 40. He barely stood up on his own. Mother asks me where I’d like a job. I said ER, realizing how cheezy it must sound at this moment. She begs me to do diabetes. I smile, the anxiety of realization making it dangerous to speak. Then the Airman and the Manager walked him out to his car. Manager told Airman he’s never had a situation there so well under control. Manager also told me his wife is a nurse. I explained that I just graduated, lest we spread some ridiculous notion that I’m soooo experienced and felt like I had everything under control. I remember distinctly feeling like I had somehow patched a crashed helicopter with spider webs in the middle of the Olympics because everyone needed me to know what I was doing. It was so quiet. They needed me to know what I was doing.

 

Movie started back up, lights off. Airman joined in a minute or so. They had rewound the film for us, so he didn’t miss anything.

 

Commence post-traumatic delayed adrenaline release. Airman just puts his arm around me and kisses my forehead.

 

 

To be honest, I did a good job. In the end, I did know what I was doing, it was just instinct not textbook recall. But I was so afraid. I guess that’s normal. It took only seconds to stave off my fear but in my head it felt like longer. I’m told I was the picture of control and serenity. I’m told the only person who could sense I might be anything other than comfortable was Airman. Airman calls it my “nurse face” – that unreadable face I pull when I’m bottling up my emotions to deal with something that makes other people freeze. That look I get when I’m numb and the blanket of nurse knowledge inhibits any thoughts other than that pertaining to the situation. Incidentally that look I get when I’m trying to drive and he’s being too adorable to resist. Manager told us we are quite a good couple. I’d tend to agree.