the last two hours: an average day at work
Screaming. I hear screaming.
I return my gaze to the patient in front of me.
“Do you ever have suicidal thoughts?” She whispered, eyes glazed over. In the background, upbeat music played as she waited to order dinner from the kitchen. I paused, choosing my response carefully. “Sometimes. Are you feeling that way right now?” She nodded.
Suddenly my phone rings. Ah shit, I think. Out of all the possible moments it could be ringing. “I’m in the middle of something, can you call back in 5 minutes?” “Well, the patient is already on the way, but sure.” Click.
More screams. The charge nurse pops her head into the room. “Your new patient is here, the one who coded in the psych unit. Just come when you’re done.”
I return my attention back to the patient in front of me, once again. The music stops, “Last name of the patient? What would you like to order?” She orders her food. I’m replaying her words in my head. How do I proceed? What did I learn in my psych rotation? An awkward amount of time has passed since she said that, do I bring it up again? Of course you do dummy.
“So about what you said earlier...can we talk about that?” She moved her head side to side, no. My window has closed.
Ahhhhh, what’s the right thing to do? Do I sit and listen and try to coax her thoughts out? No. I don’t really have time for that. Wow, did I just think that? That’s kind of fucked up, that I don’t have time to sit and help someone who is telling me they want to kill themselves. She said she doesn’t want to talk about it though. Okay, its common to have suicidal ideation, but its not normal to have it all thought out. I’ll just ask about that.
“Fair enough, but can I ask you one question?” She nodded her head yes. “You’re having suicidal thoughts, do you have a plan?” She looked me in the eyes, “No.” Relief flooded through my body, though the hairs standing on the back of my neck revealed other emotions. “Okay. If you start feeling worse, or thoughts are too overwhelming, make sure you call me.” She acknowledged the statement with a small nod, or I’m pretty sure she did. I exited the room.
My feet carried me forward. I looked up and I was in front of the room with the new admit. Four or five nurses buzzed around, three doctors stood outside the room, two care partners ran around grabbing supplies. I took a deep breath and walked inside. “Alright, what do we got?”
“New onset afib with RVR, heart rate up to 170′s, hypotensive with systolic in the 50′s. Admitted originally for new psychotic episodes.” I visually assess her. Thrashing around on the bed, yelling things I can’t understand. A precarious IV sticking out, placed in her thumb. Interesting choice, she must be a hard stick. I walk up to the bed and see what my coworkers are doing, and what needs to be done. Need another IV placed. Need fluid. Wait she’s a dialysis patient. Does she have labs? No current labs. Need labs. Her airway seems okay, but where’s the ambu bag? And we need suction. Where’s the oxygen? Does she have pads on? Are the pads new? Lets replace them. Do we have the defibrillator? Lets plug it in.
The patient isn’t in the system because she came from the psych floor. Call admissions. We can’t pull any meds under name, she’s not showing up. We can’t see the orders. We need to give her something now, can we override the system?
Her blood pressure is dropping. Doctor, what do you want to do? We can’t give the metoprolol. What about levo? Can someone grab the levo?
A nurse walks away to create the levo mix, we don’t have time to go to the pharmacy.
More yelling. Everyone is trying to calm the patient. One nurse puts on some music, “What kind of music do you like? 70′s? 60′s?” She calms for a minute, hearing the tunes. Then starts yelling again. Another nurse tries, let’s count to five together. They count together. She calms. Then starts screaming again. One of the nurses makes a joke, “It’s hard to believe she has low blood pressure with all this screaming.” Everyone laughs, including the patient. Another nurse starts collecting labs. The patients sees the blood. “I DON’T WANT HOT SAUCE.” Okay dear okay, we won’t give you any hot sauce. Don’t worry.
Does she have a power of attorney? Did anyone call her family? Did anyone get consents? We need to cardiovert her.
She’s still awake, shouldn’t we give her something? Grab the versed and fentanyl.
Okay. Versed and fentanyl pulled up, attached to the IV. Push it. Okay. Everyone stand clear.
Clear? CLEAR. The patient lies motionless, the versed coursing through her body.
Everyone stands around, hands up to signal we’re clear. The upper half of the patient’s body jerks up a foot off the bed. She screams. It looks as if she has risen from the dead. We comfort her. We know, we’re so sorry. It’s okay. It’s okay.
Sinus tachycardia. It worked, but she’s still hypotensive. Lets start a central line since she’s requiring the levo. Hey doc, you have half an hour before shift change, the pressure is on, we joke. “I’ve done this at least 200 times, I think we’ll be good.”
The last half hour drones on and on. Slowly people leave, the only ones left in the room are the doctor, myself, and another nurse. Back and forth grabbing supplies. Pushing more versed. Trying to calm the patient. Counting to five over and over again. Telling the patient to focus on her breathing, in and out, while a drape is covering her entirety. The only exposed portion, a small hole over her neck where the doctor attempts to place a central line, three times. Unsuccessful. We’ll have to go through the groin, he says.
I look at the clock, 6:58PM. Fuck, the shift is over. I need to chart. My roommate is going to have to wait for me.
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