Optimistic
My heartbeat’s rhythm is a lonesome sound Just like the rubber turning on the ground Always lost and nowhere bound
~Chris Stapleton
I can’t count how many times I have been in this situation. But, I know it’s been hundreds . Maybe, if I am really digging deep... thousands.
She was a cardiac arrest with a long down time and multiple subsequent cardiac arrests. My optimism for recovery was a zero. She had periorbital edema and her pupils were questionable to respond. A breathing tube, temperature probe and gastric tube all crowded her mouth and pushed her swollen tongue listlessly to the side. A central line hung out of her groin and allowed the IV pumps to carry lifesaving anti-arrhythmics and blood pressure medications to her blood stream. Her body was swollen with fluids meant to save her life. Her kidneys, that had been tenuous on a good day, were no longer functioning to get rid of all the medicine and fluid we dumped into her.
I wrote report in the same short hand that I used for everyone. Another experienced nurse would understand, but many would not. A few steps from where I blankly absorbed a litany of information, my orientee stood scribbling madly. His eyes were alight with interest and his posture was one of barely contained energy.
The day before we had decided to give up our continuous renal replacement patient (CRRT) and take something more acute. He had said multiple times throughout the day, “I want a code. I need a sick patient.”
So, as I took report I looked at him and shook my head. The patient had been coded for 35minutes in a sister hospital before transferring to us where she got shocked 12 times during the night. By 7 am she was pseudo-stable and we were supposed to fix whatever mayhem was remaining. I was less than thrilled.
After 8 years in an ICU, I like to have the same patients for days. And, I may be shunned for saying it, but I like the sedated intubated ones. I like the control I have over them. I like that no matter what is happening with them- I am 100% in charge. Awake patients can muddy the water with meaningless complaints that are benign. A sedated, intubated patient can’t. If their body does something- it is a true blue symptom needs to be addressed.
Instead of the stable patient we had the day before, we found ourselves knee deep in this cardiac arrest patient. We talked about pressors and doing thorough neuro exams. We talked paralytics and vent dysynchrony. We talked... we talked. As the day went on, though the patient did not cardiac arrest, I was less than optimistic. My orientee surprised me though... As sure as I was that she wouldn’t wake up, he was just as sure she would.
“She turned a corner” he said many times through the day as we turned, cleaned and treated her. I smirked at his sweet naivete and shook my head. I had seen my share of surprises in this job. But, an elderly individual with multiple co-morbidities and multiple arrests? That was something that was usually a direct recipe for anoxic brain injury.
At 1600, when we went to turn her, we both jumped when she turned her head to our voices. A few moments of talking to her elicited a slight but very present nod of her head. We exchanged a look and walked from the room. I looked at the young new grad before me and felt a sense of sadness. I missed those days. The days of endless hope and optimism for every patient that came through. The feeling that you saved people and made a true difference. The feeling that death wasn’t a given.
These days I distance myself from patients. It is almost like I see them as time-bombs waiting to go off. They may not die this minute... but they will die. Patient’s like the one we had, in my experience, rarely wake up... let alone leave the ICU alive.
But, there was a time when I believed it could happen. A time before death after death hammered my soft heart into something unrecognizable. Something hard and yet brittle. Something I keep hidden from my patients now. Something I feel jolt when a new nurse with wide expressive eyes and an earnest heart reminds me of how I used to feel.
I don’t know if the patient will leave the ICU. I don’t know if she will survive this horrific ordeal her body has been subject to. But, I do know, if she does it isn’t because of me.
It’s because of the optimism and hope of a new grad.