Work Stories

Forget TLC's "Trauma: Life in the ER" show. These last three days have been crazy and exciting! I thought I would share, but as usual I spare details and use generalizations. Also, in telling a story, I in no way want to seem insensitive by the way things are said or the way they are termed. Day one: My patient (pt) was very young and was going to have their organs donated due to their unfortunate situation that left them no hope of survival. However, you need to be declared dead before you can donate, obviously, however this person wasnt quit brain dead so we had to declare her a cardiac death before we could harvest her organs. This is tricky because without a pumping heart your organs/body dies, making it difficult to harvest them for donation. This is a very well planned orchestrated event. The transplant team, me and the MD planned our actions out for hours before the event to make it smooth and the least traumatic for everyone. So, this is how it worked- again young person- intubated(breathing tube), on contnous IV meds to give her a blood pressure, in a coma. With family at bedside we pull all the support and allow her to die. It went very well. They died within minutes, with little extra pain meds, while the family played Amazing Grace. I'm certainly sad but well trained in not crying, but I notice the Respiratory Therapist (RT) is really crying. As soon as the pt is "declared" (dead) we usher the family out and I quickly detach and unhook all extra devices. We have 5minutes to get the patient to the Pre-preped OR for the organ removal surgery. The 5 minutes allows for what is called autoresuscitation, when people will die then spontaneously come back to life, it really does happen, I've seen it myself. Anyway, we all go into the OR (already prepped before hand in scrubs) to greet the OR team and surgeon. The pt is placed on the table, clock going, prepped, positioned, tools ready and then -5minutes up. First cut is made and the pt is opened up. I got to sit in for the whole surgery. SO COOL!!! The liver is way bigger than I remember. The whole process of preserving organs is very detailed and amazing. Tons of phone calls are being made inside the OR. There's a plane outside the hospital waiting to fly the organs to the appropriate places. The pt's family was so excited about being able to donate that they even wanted to know where to go so that they could watch the plane fly away! Day 2: Day was going realitivly normal. The RT that had been with the donor pt and I the day before came up to me and starts to tell me how much it meant for her to be in the surgery. She goes on to tell me that 10yrs ago her teenage son died and was able to donate his organs. It was the first time she had ever been able to be a part of the whole process. SO COOL! That's why she had been so emotional! Then toward change of shift, my podmate (RN working in the same area as me) yelled out "I need Atropine", knowing the tone and need for that drug, I drop everything and grab her Atropine. I standby, pt's ok, then I hear it again " I need Atropine!", I run off to get more and by the time I get back shes on top of the pt doing CPR. We had nursing student's that day on the unit and they were all in the room, really excited. The pt was in the process of being intubated so it was a very organized code blue, with the RN and MD already in the room. Some codes are CRAZY and chaotic, especially outside of the unit, the goal of course is to have a controlled chaos, where everyone plays their role. My role was to record, so I was mostly standing at the doorway. Anyway, we thought the pt was okay and then they coded again a few minutes later. Finally it all ends and we are giving report to the next shift. I get ready to leave and go home, I have my keys and bag in hand when this new RN being oriented says while in our pt's room "is that what his arm was doing before?" I look back and the pt is seizing. This is not "what his arm was doing before". So I threw my stuff down and ran to get some Ativan from our drug dispenser. What a way to end the day. Day 3: My seizure pt was fine. My other pt was not. We had talked about intubating him since yesterday, however he was riding a fine line, and it hadnt been done. He was kindof awake but had a snore-like breathing pattern (not good). Well morning starts off with him vomitting and because of his condition I know he was going to need to be intubated. I could safely assume that he aspirated, he did not even cough or move much when he threw up. So I call the pulmonologist and he comes by shorlty after and we intubate the guy. Later that afternoon the pt gets to the point, again riding a fine line, where he needs a "brain drain". His pressures in his head were building up so much that we needed a way to evacuate the extra blood that was not reabsorbing as planned. I was hoping the neurosurgeon would do this at the bedside since they often do, because I had a student again and she would have loved to watch! But instead we wheeled him to the OR. He came back with some minor seizures and a new brain drain! Then I find out that the lady that coded the day before came back positive for a very contagious and deadly bacteria. Everyone involved in the code had to go to the in-house pharmacy at work and get an antibiotic. Luckily I was only at the doorway! but still had to take the drug. Also while walking to lunch earlier that day I saw the transplant RN and she told me that all the transplants from our donor pt so far were a success, and in particular, one of the kidneys had gone to a 35 year guy who had been on the transplant list for 8years! The transplant was a huge success! I guess when the surgeon had called to tell the transplant RN this, she was in tears saying that they kidney reciever was such a nice deserving guy. None of these events are abnormal, but all in one week, day after day made for an exciting week! And I didnt even mention the week before when I ran into some sticky legal situations with suicide attempts, where security and hospital attorneys had to be called. It was one of the only times that I was pretty sure I was going to be taken to court! So far no subpoena!