Tuesday, August 02, 2011

Nothin' like blood up to your elbows.

The neuro CCU didn't have any patients, so I took myself down to the surgical CCU to be a general dogsbody and bottle-washer. And got my ass run off for three days straight.

It wasn't so much the lack of staffing as it was the acuity of the patients. And it wasn't so much the acuity of the patients as it was the cluelessness of the residents. And it wasn't so much the cluelessness of the residents as it was that every single damn thing that could go wrong, *did*, usually all at the same time, which was of course right around lunch.

Elizabeth called me into one of her rooms to ask if the leaking from around a JP drain was normal. Yeah, sometimes it is. . .but that drain site was leaking a little more than I would strictly consider okay. So, as Deidre packed Surgi-Cel around the area, trying to stanch the worst of the leaking, and Elizabeth called the resident, I tried to figure out where the blood was coming from. No go. There were enough holes in the poor patient to make any of them a contender, and no obvious source of blood.

Which means that the blood was coming from *inside* the patient, not from the hole the drain came out of. This is always bad, because it means that you have to re-open the surgical site and see what the heck is going on.

In came the resident. He looked at the drain site and said, "Walp, looks like the bleeding's stopped for now." I looked at him from across the bed and said, "On the outside, maybe."

And just then the patient turned his head and coughed out a fountain of bright red arterial blood from his trache.

Which is how I got blood up to my elbows. The patient is fine, by the way: a quick re-exploration of the area showed a small artery hadn't been properly dealt with during the surgery and had reopened--nothing that a few stitches, or something, and about six units of blood couldn't fix. When I saw him the next day he was relatively pink-cheeked and cheery.

What I've not mentioned until now is that, as all of that was going on in the room (and you know how it is, with Get me a suture kit please and Can somebody please call the fellow and Hold this there and tape that here), there was a person just next door whose head suddenly blew up like a beach ball for no apparent reason, and a person down the hall whose MAP (mean arterial pressure, a measure of how well you're perfusing) dropped into the 20's (bad), and another person who leapt out of bed over the bedrails despite having a dense right hemiparesis, and the fire alarm went off.

Just then the helicopter crew showed up, bagging a person who'd fallen off of something tall and hit his head and been transferred to us.

Run that tape back and play it over and over for two more shifts. This is why I took a five-hour nap today and will order a pizza tonight.


Silliyak said...

I think I saw that scene on Rescue Me!

Jo said...

Well, then. Life imitated art, I guess.

What's Rescue Me?

clairesmum said...

i'm exhausted just reading it! wow, i'd sure want you around if I were the one in the bed who decided to dive toward the drain instead of just circling it!

Anonymous said...

You're my hero.

Anonymous said...

How much longer can we keep this up? I'm TIRED! Plus no techs, no unit secretaries,no supplies and no respect.

terri c said...

Sweet JESUS what a day... "nothing that a few stitches, or something, and about six units of blood couldn't fix..." has got to be the understatement of the year.

bobbie said...

I remember those days... they make a desk job sound attractive!

WV ~ brutl (as in 'brutal')

messymimi said...

Some days, as Bugs Bunny put it, you "just shoulda stood in bed!"

Don't want to think about what might have happened had you not been there to lend a hand.

Rosanna said...

Through the past 3 1/2+ decades, my other half has acquired----(by direct observation and marital osmosis, I think, haha!!)----a wide-eyed, yet helluva *empathetic appreciation* for the.... grueling.... gut-busting.... and (professional/criminal/civil) liability-laden.... days that nurses ROUTINELY go through.

So, after Jack quietly and intently read your *shinin' fine*, kickin'-it-down-the-street blogpost here, Jo, he---(in his own usual guy way)---said, "Man, if I EVER get hurt real bad and I'm in ICU, SKIP the priest, i.e., I wanna see ............ JO'S FACE when I wake up!!!"

(By the way, my dear maternal uncle IS a priest; and----with his current health problems----he very well might say the *same* thing, too, haha!!)

shrimplate said...

Pets can help.

Just My 2¢ said...

Just wanted to tell ya that I had surgery last week to remove my rare tumor (dermatofibrosarcoma protruberans) from my arm. It looks like we have pretty similar outlooks. Both of our cancer flavors are pretty slow developing with pretty good outcomes and low risk of metastasis. Doesn't make me feel any better, though.

I've just re-read a bunch of your posts from last September and October. Thanks for chronicling your journey. At least now I know that my feeling like crap isn't just me.

Dave Doyle
Pinedale, WY

Anonymous said...

Just another day at the office