Tuesday, February 09, 2010

Live in a swamp and be three-dimensional.

Good advice at any time, but particularly now, when "be oblong and have your knees removed" sounds really, really good.

The original title of this post was "*thud* POP! AarghFUCKFUCKFUCKAARGH", but I decided not to go with that, as it didn't get to the real heart of the matter: the fact that I sprained my right knee during my workout with Attila last night.

Yeah. Sprained knee. Not badly sprained, as I can walk on it, provided I keep it wrapped up tightly with an ACE bandage, but sprained. It's not exactly painful, but it's a weird feeling, not being sure whether or not the lower half of your right leg is going to shoot off in some random direction without warning. I'm walking like I'm eighty and taking my own weight in naproxen sodium at the moment. If things don't improve markedly by tomorrow, it's off to the Doc-In-A-Box I go, for better bracing and a note that says that yes, I can work, really and truly.

Friend Suzie, who seems to have lots of time while wrangling rats and pigs to think up bons mots, asked me in a concerned tone, since I'm reaching "that age," if I was sure I hadn't broken a hip. I would kick her, but I can't manage that much movement with the bum leg.

For the first time, I am truly grateful I'm still on the night shift and in the CCU to boot. Were I still on the floor, I would have to chase around five or six rooms, move people, help them out of bed, and generally be active. With any luck, my assignment this week won't involve a lot of gymnastics.

Before I sprained the knee, I had plenty of gymnastics going on. One of my patients, who has the deep misfortune to have a number of bacterial and fungal infections going on in about six different places at once, suddenly became unresponsive the other morning, just before the docs started rounding. (I suppose that's more convenient than three ack emma, but not by much.)

She had been fine all night. Ten minutes before, she had been fine. Then, as I was walking past her room on the way to pick up some drugs from the pharmacy, I heard her snoring. My first thought was, "Thank God she's finally getting some sleep". My second thought was, "Um....that doesn't sound right. At ALL."

I went into the room to find her blowing spit bubbles, eyes rolled back in her head, and not moving anything, even to pain. Her pupils were uneven and oval--and that's a bad, awful, panic, horrible, hair-on-fire, Jesus Christ you stupid lazy nurse you missed an earlier neuro change sign.

Somebody called the resident. Somebody else called the radiology guy and woke him up from his nap (sorry, Scott!). I had the fun job of calling the family, and of having an audible code called while I was on the phone with them. We never lost a pulse, but we did end up intubating her, as we couldn't trust her to protect her own airway.

Thirty minutes later, she was back to neurological baseline. Was it a seizure? I have no idea. A cardiac issue, caused by heretofore unknown vegetations on her heart? I would think so, but her enzymes stayed fine all day. Hydrocephalus? Pneumocephalus? Maybe, but neither one of those do what whatever-it-was-she-had did. Plus, her CT was totally clean, totally unchanged.

The upshot of the whole trauma-drama was this: both the intensivist and the neurosurgical attending agreed that I had not missed anything prior to The Event. (This was a huge comfort; I had broken my own rule earlier in the day and had stayed up worrying about her rather than going to bed.) The attending confessed with a shrug that he had no clue what had happened. The intensivist opined, in his heavily-accented way, that sometimes strange things happen. Coming from a fellow nurse, that's nice, but coming from a six-foot-four Sikh with a blue turban, it's comfort.

We'll probably never know what really happened in her brain to make her go bad like that. We'll probably never know what happened to make her come back, just fine, and be extubated a bare six hours after she was intubated. All I know is that, the next night, when I asked her to show me two fingers and she grinned and flipped me off, it was the best feeling ever.


Anonymous said...

I would warn against too much Naprox.
I just spent 3 days in MICU and got 4 units of somebody elses red stuff pumped in because of a GI bleed that the gastro man said was caused by Aleve. I only took 2 tabs a day for a couple of weeks. I'll stick to Tylenol, thanks.


Evy @Aria Medical said...

That was a great story...I loved the end.

My grandmother died of complications of a stroke many years ago. She died in the hospital in the middle of the night--alone.

What I wouldn't give to have walked into her room seeing her "give me the finger!"

Life is funny. Sometimes no matter how hard we try, we can't change what's meant to be.

danielle said...

Thank goodness that you recognized the snoring did not sound right and that you acted upon it!!!!!
Experience is such a plus in nursing!!!

coulrophobic agnostic said...

Wow. Not being a doctor I obviously couldn't begin to guess what would cause that, but my god, just the idea is completely bewildering to me. Especially the pupil changes...that's just so WEIRD. Glad she's doing better now, though.

gramme said...

I am new to your site and I enjoy it very much! I've been a nurse for 30 + years and laugh so much at your experiences. I just wanted to tell you I had very much the same experience with a 1 year old on a vent. He was on paralytics and sedation. I was by his side every minute and all at once, after being very stable all night, he smiled around his ET tube. I thought he was coming out of sedation, so I checked everything- no changes in meds, IV was a central line so it was functioning. My little guy was seeing his angel. I went to check his pupils and found hippus and then they blew- right in front of me. I hadn't missed anything- there are just things we can't tell from the outside sometimes. No matter how hard we try, we can't predict every death.

I am thankful you were there to do the right thing at the right time. You rescued your patient for more of life. My little guy had experienced an overdose of a medication because of a bad physician, and we were trying to right the wrong, but to no avail. Heaven became a brighter place, and I learned about hippus and blown pupils.

Your sister in the soul.

Anonymous said...

I'm guessing a pretty heavy duty TIA --- had a very similar patient last week who was going along tickity boo, then I found her slumped over and unresponsive with a snail trail of drool down her gown. An hour later she was awake and asking what the fuss was about and why she needed the CT.

And yeah, there's snoring and then there's snoring. Good call.

I gave up a long time ago second-guessing myself. Sometimes, shit happens and patients go south.