Brown - Critical care: a new nurse faces death, life, and everything in between

While all of the stories in this book are true, in an effort to protect patient confidentiality and privacy, descriptions of patients and staff, and many of their identifying characteristics, have been changed. This book is not a medical handbook and should not be used as such. All medical information is presented as correctly as possible and all errors, medical or otherwise, are mine alone.

You left teaching English for this ?

Ive been asked the question so many times by so many people that it no longer surprises me. After all, who in their right mind would give up being an English professor who taught writing at Tufts University to become a nurse?

Other versions of the question are no more complimentary. A favorite of mine is You couldnt get a job, right? And sometimes they really give me pause, like when another nurse asked me, Why? Because you hated having summers off? I hadnt looked at it quite that way before, and the question made me stop and wonder whether I really was crazy, since people ask when they hear my story, Are you crazy? Im not, but I made a midlife career change that many people, including a lot of nurses, do not understand, and certainly would not have made themselves. The why of my decision at times eluded even me. Nursing just felt right, but I dont think even I fully understood my career change until the last night of the very last shift I would ever work as a nursing student.

That night an eleven-year-old leukemia patient who had a fever arrived on my floor at our childrens hospital. I had decided to do my senior clinical at Childrens because I wasnt sure if I wanted to work with kids or adults. In some ways I loved it there, but caring for kids when my own children were still young was hard, and ultimately I only applied for jobs with adult patients. Still, there I was on my last night at Childrens with a new admission, a kid whod been in and out of the hospital many times, at ten oclock.

The patient, Sean, and his dad came up from the ED (emergency department). They talked and joked with each other, started watching movies on the TV in their room right away, and passed an enormous bag of potato chips back and forth. I got the impression they were trying to convince us, and more importantly themselves, that an impromptu hospital stay could be fun if you just had the right attitude.

Other nurses on the floor had warned me that this family was difficult, but they seemed OK. Seans dad had a bad back and asked a few times for more pillows since he would be sleeping on the chair in the room that folded out into a bed. Im not sure why, but pillows are a rare commodity in hospitals. I searched both wings of the floor until I found some for himeven with a healthy back, those chair beds are not too comfortable. Sean, testing out some preteen behaviors, could be rude, so I teased him about saying please and thank you as I handed over cartons of apple juice. I described him to the resident as cheeky, but I liked him.

Theyd ordered fluids for him and antibioticslots of antibioticsand Sean and his father were concerned I was going to wake them repeatedly during the night since I would need to administer one drug after another. I told them I would do my best to let them sleep undisturbedpeaceful sleep is another rare commodity in hospitals, and its important for healing as well as peace of mind.

Still, they finished the first movie and moved onto another, until finally around two oclock in the morning they both fell asleep. They had turned off the TV and the light. Seans father had fallen asleep first, and then Sean, whod been lying in the dark hospital room with his eyes wide open, keeping his thoughts to himself, dropped off to sleep, too. I went into the dark room and hung the drugs I needed to administer as quietly and quickly as I could without turning on a light. I had promised not to disturb them, and I meant to keep that promise.

Around 4:00 A.M. my preceptor, the nurse supervising me, told me Sean wanted a Tylenol. I went to see what was up. As soon as I walked into his room, he looked up at me in the darkness and said, It feels like I cant breathe. My chest hurts. Alarms went off in my head, and I truly pictured myself as Tom, the cat in the Tom and Jerry cartoons, with little mallets alternately striking on opposite sides of my head, which had become one big metal bell. Oh, gee, that sounds bad, I thought to myself. What am I going to do about that? But then I did the things I most needed to do: made sure he could breathe and called the resident to tell him about Seans change in status.

I told my preceptor, Paula, what was up, and she told me to get a set of vitals. Hearing that, I felt stupid. I had gotten so used to taking vital signsblood pressure, heart rate, respiratory rate, and temperaturethat I had forgotten they matter, that in a situation like this the patients vital signs could give us valuable information about just how bad off he was. A low blood pressure and high heart rate would tell me he was in danger of being septic and going into shock. If his oxygen level was low, I would know that his breathing difficulty had something to do with not getting enough oxygen into his lungs.

I grabbed the equipment to take a set of vitals, but when I got back to the room, I had to waitSean needed to go to the bathroom. I helped him walk around the bed with his IV (intravenous) pump, and halfway there, between the bed and the bathroom, his knees buckled. He cried out, I cant see! I cant see! I held him up, then picked him up and somehow got him into the bathroom and onto the toilet. While I was holding and carrying him, I wondered, a little angrily, why his dad wasnt helping me. Could he really sleep through all this? I wondered, because he did look asleep, even though we must have been loud in that small room.

Once I got Sean settled on the toilet, I took his blood pressure twice. I took it with the machines we have, and I took it manually, by pumping up the cuff myself and listening for the flow of blood. Taken both ways, on both arms, his pressure was 70 over 30, much too low. He wasnt complaining anymore about loss of vision or not being able to breathe, and by this time the resident and the internthe doctors in training who were taking care of himwere both in the room. The poor kid had to sit on the toilet while we all stood in the dark and talked about him. When I checked to make sure he was safe sitting on the toilet by himself, he yelled out, Cant a man take a crap in peace?

I most remember a swirl of activity. The resident, the more senior M.D. in the room, asked me to tell him exactly what happened when Sean said, I cant see, and fell to his knees. I told the resident the story. He seemed stressed, or maybe I was just projecting my own feelings onto him. Id seen sick people, sure, and sick kids, but never anyone who was this fragile, and the nighttime and the darkness of the room gave the whole situation a surreal feeling. We increased the rate of Seans IV fluids because upping the amount of fluid is usually the first course of action when patients are hypotensive. Putting more fluid in the veins is an easy way to increase blood pressure and cardiac output.

However, we couldnt get Seans pressure up, and the doctors were worried that he was going septic. The resident called in the fellow (an M.D. training in the hospitals fellowship program) from the PICU (pediatric intensive care unit), and they talked over Seans symptoms. The doctors asked me to keep taking blood pressures, but Sean never climbed much above his early low. I watched all this with only a vague understanding of what was going on. The resident and the fellow had a couple of huddled negotiations in the dark hallway; the fellow made a few phone calls, then they told me Sean would be sent to the PICU, that he needed the more intense technical support available there.