Wednesday, September 08, 2010

Living in the present

The fascinating (well, one of the fascinating) things about working in the CCU is that it teaches you to live in the present.

The moment when my car about ended up in the lake today? Was not unfamilliar. I've had the same feeling when I've tried to suction an inch-long mucus plug out of a patient's lung, or when I've tried to start an impossible IV, or when somebody's coded for the sixth fucking time in a day.

The universe collapses to what you're doing right then, all emotion disappears, and your thinking is incredibly clear and precise. It's as though a road map of what's about to happen is laid out in front of you, and you simply manage the situation, with all the diverse things that entails coming naturally to you.

I used to have that feeling in micro class. One of the prerequisites for my nursing degree was a combined micro and patho class, with a hugely complex three-hour lab twice a week. I loved that lab; I'd show up early and leave late and blast through the assigned stuff, to the point that the instructor would give me contaminated cultures or shit he'd found living on a deerhide to analyze. Everything in the world would stop. All I could see was whatever was in the field in front of me, and the lack of emotion and judgement was clean and cold, like snow. Either something got stained with methylene or it didn't; there was no sorta-staining going on.

It's the same with nursing. Nine times out of ten I have to page the doc if a patient codes; more than once they've called me back with no clue as to what's happening. I've had to break it to them non-gently, as in "Mrs. Whittaker is coding right now. She has no rhythm except for compressions" as soon as they identify themselves. There is no room for comfort at those times.

But that, in a way, is freeing. You either die or you don't; we get you a stable rhythm or we call the code (or I suck that glob of snot out of your lung/I don't, and you code, or I get that IV/I don't, and you code, or I manage this crisis/I don't). There is no "a little bit dead" or "a little bit alive". Even on pressors, maxed out and on a vent, you're technically alive.

And that? Is what I love about critical-care nursing. I spent more than a decade, counting what I did as a paraprofessional, being warm and fuzzy. I like the fact that right here, right now, what I see is concrete. Even in my unit, where we're much more human than they are down in the surgical CCU, there are absolutes. I go to work, and all the emotional drama of being human recedes. You're either alive or you're not; you're either injured or you're not. There's still plenty of space for the warm fuzzies; I do gobs of educating and encouraging and rehabbing in my job, but it still comes down to the cold, hard facts: are you fucked up or are you not?

If you're all jacked up, I'll help your ass out. If you're not, I'm kicking you out to go to rehab.

I wonder sometimes if I could qualify as being somewhere on the Asperger's spectrum, as I'm certain my pal Jo (yes, there are two of us) on nights certainly does. I wonder sometimes if my folks saw the social anxiety I'm still plagued with and shoved me into music and acting as a way to combat that--to learn to act like normal folks. I wonder, amazed, at the gift I maybe have? of being able to combine the snow-clean, cold, emotionless scientist with the warm-huggy-loving education-crazy, comfort-giving snuggly nurse.

All I know is this: the times when I yearn for microscopy are the times that something like a flooded highway or a coding patient are likely to come up to save me. And the times when I'm feeling as sensitive as a bashed thumb, all purple bruised nerve endings and swollen, taut skin, are the times when somebody will suddenly be human to me, and I can reciprocate.

I am so, so, so damn lucky.


woolywoman said...

Yup. I am addicted to the feeling of the world narrowing down to that tiny space with a very, very clear path.

Even though, when the view opens back up, I generally have a stiff neck.

Phiddy said...

Wow! Though I have been out of the ICC/CCU for over 10 years you brought feelings back for me which are still intense. You speak of the narrow field of vision when all else recedes. The here and only this now. I remember....

Matt said...

Amazing post, your an inspiration.

messymimi said...

Blessed, to have the best of both worlds; well balanced.

Nursing is blessed to have you, too.

shrimplate said...

You get three strikes. On your third code for the day. you get to ba DNR.

bobbie said...

I remember too ~ and I miss it much!

Anonymous said...

That's when you're in the zone. Same with athletes, like a pitcher who is pitching a perfect game.