Over the weekend I had a pt. who came in with atrial flutter and heart rate in the 160s and on a cardizem drip from a long term care facility. Obese, 2 colostomy bags, cerebral palsy in legs, slightly MR, very needy and impatient. But, I have kids, I know how to talk calmly and sweetly enough so he doesn't get too upset. Often, all he wants is his nasal cannula adjusted or a pillow under his ankle anyway. Maybe some toast and a sip of water. So basically, when he's my patient, I'm the only one who goes in there when he calls because the aides just have no clue how to handle him. Fine, whatever.
When I got him back yesterday, found out his heart rate plummeted into the 30s that afternoon and they d/cd the cardizem drip and started him on a dobutamine drip. I recall during my ICU rotation a few of my pts running dobutamine, but I couldn't remember anything at all about the drug (honestly I didn't think we were allowed to run dobutamine on our floor). All I knew was if his heart rate went over 100 I was to shut it off. (no titrating, just turn it off) Alrighty then. So I'm doing my assessment and thinking, you know, if anything happens to that site, I'm fucked. I better try to get another peripheral site into him. I tried and I couldn't get him. Called the charge nurse, he couldn't get him. Grabbed a Dr. and told him we need a PICC line placed in him by the PICC team. Dr. put in for the PICC team consult and they will be in to place the line tomorrow am. Perfect! Now all I had to do was protect that site with some extra gauze and cross my fingers nothing happens to it.
45 minutes later he hits the call light and says, "I think my IV site is out"
FUCK.
Go in the room, sure enough the site is out. While I'm assessing the site, a priest walks in to give him communion and I'm thinking to myself "well good thing you're here, we may be needing last rites, too.."
Page the Dr. and tell him the site is out and the pt. is not getting his dobutamine. He tells me to page general surgery and have a central line placed (a little riskier than a PICC insertion but he needs the medicine and it's well known he's a tough stick). Get in touch with general surgery and the Sr. resident says, "Have you exhausted all your other resources? Called ICU units to get a peripheral site put into him? A central line should be a LAST RESORT and it sounds to me like the only reason you are asking for a central line is because you don't have the skill set necessary for this patient's needs. Keep calling other floors and if no one can get a line in the next 2 hours we will come and place the line."*slam*
I stood there stunned for about a minute and ran though about 5 scenarios in my head.. most of which ended up with my patient coding because I wasn't able to get him the help he needed in time... and I cried. I stood there right in front of the printer by the front desk and cried. Charge nurse (G) saw me and said, "WHAT DID HE SAY TO YOU? What's his number? I am calling him now.." I begged G to just help me get a the pt's dobutamine into him and we can talk about the resident's communication techniques later. I was more worried about my patient than my pride. In the midst of my crying, the priest came over and asked me if it's ok if the pt. received communion and I said yes, it's fine. (The priest looked kindly concerned for me and told me he's sorry I'm upset and he will pray for me, that was very sweet of him.) One of the nurses from our floor was able to get a line in him after all and the dobutamine was back up and running. Who knows, if not for the priest maybe things wouldn't have resolved so quickly.
Anyway, the better part of today was spent in tears, partially from exhaustion, partially from stress, partially from sheer loneliness. I hate that I internalize everything and things affect me so deeply. I can feel my healthy life perspective slipping away from me, it's getting more and more difficult for me to process all the complex scenarios (this story one simply one of MANY). All I feel left with is raw emotions and an inability to cope with them. Giving all you have to complete strangers for 12 hours a day 3 days in a row is exhausting emotionally and physically. The odd thing is, while I'm at work, for the most part, I feel invigorated. I kind of view my patients as a gift, I'm so lucky I get paid to do what I do. The downside to that is, allowing my heart into the nursing equation I think will eventually become my greatest mistake. When you give so much of yourself, you risk losing much of yourself. I hope time teaches me how to balance my emotions because if I continue on like this I'm going to suffer tremendous consequences.
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