Volume No. 2 Issue No. 62 - Monday, December 15, 2008|
Saving the young in the Emergency Room – A cultural experience
By FLORENCE - ER Nurse
It was a cold winter morning. I was just about to wrap up a mundane, boring shift with the usual alarm going off now and then in the ICU. I responded to the alarms, gave morning medications, tested the blood sugar, emptied the Foley catheter, finished charting the intake and output and the end of shift summary, and asked if my fellow nurses needed help to get caught up.
A patient in rushed to the Emergency Room.
Everyone seemed to be ahead in the tasks. The dreaded phone call from the nursing supervisor broke the silence of the moment as I savored the sophistication of my simple cup of foldgers coffee at the nursing station.
Trust me, no nurse likes a change of shift admission. Two reasons pressed on my mind. Firstly, I will not make it out on time to give report and go home in my comfortable bed that I dreamt of for 12 long cold hours and secondly, the patient must be very sick if they cannot wait in the ER until the change of shift. It turned out to be all of the above and more.
It was my admission. “All hands on deck….. Let’s do this!” I shouted as I felt a surge of adrenaline that only ICU and ER nurses and first responders know too well. The initial report just said, “21-year-old pregnant African-American female with sickle cell crises. HR 150’s.
Severe difficulty breathing. Iritractable pain 10/10. Prepare for possible intubation”. WOW! This was a loaded sentence. I knew that I was going to fight like hell for this young lady. She was just 21. The drama had just begun.
I started asking for help. There was no time to waste. Time is muscle. “ Set up the monitor, suction times 2 please, page the Respiratory Therapist to bring a vent, Page Anesthesia for intubation, Override Propofol and get succinocholine ready, Zero the bed and get an admission kit. I need an intubation tray now! Please get me a Foley catheter. We need a central line kit set up.” In the midst of all of this the patient rolled in on a gurney.
The look on the young lady’s face said it all. She was frightened. She knew she was in trouble. I introduced myself and said, “Don’t be afraid, we will take excellent care of you”. And that we did. I settled her in and gave bedside report to the dayshift nurse taking over from me.
I went home exhausted from that admission and I floated away into a blissful sleep knowing that I did everything I could to reassure that patient and keep her alive and safe during the short time I spent with her.
12 hours later I went back to work, and took over from the dayshift nurse who had a story to tell. Quite apart from the report of how many units of blood, vent settings, drips, blood pressure, Heart Rate, critical labs etc.
There was a psychosocial drama brewing that would put ER, House and Grey’s Anatomy to shame. Our patient was from a Nigerian family with deeply intrinsic cultural values. She was estranged from her family because they forbade her to date her Black American boyfriend. The entire Nigerian village was in the ICU that night.
Everyone asking the same questions. One Med-Surgical RN from the clan decided that she wanted to review the chart, asked for the labs and all the x-rays etc .
They wanted an explanation of every number on the monitor and why this number is red. I tried to be as tactful as I could but had to take control of the situation quickly to prevent an interruption in the care of my patient. I said simply and as a matter of fact, “Please don’t worry about these numbers on the monitor. It took me 4 years to learn the big picture here and I simply do not have time to explain all of that now.
I need to focus on the patient, so let me worry about these numbers.” By that time, the patient’s condition had deteriorated to the point where she needed 3 nurses to keep her alive. It was emotionally charged. The two other nurses were from the African mainland.
There was nothing too much to do for this young lady. We travelled to the radiology department to do a full body scan to isolate the source of her bleeding. We knew that we were fighting an uphill battle and the chances were slim.
But we fought valiantly. Our patient had gone into a dreaded condition called DIC (Disseminated Intercoagulopaty). This is when the body uses up all its clotting factors and can no longer clot its own blood. She was bleeding from everywhere. Her abdominal gearth was growing by the minute.
A sign of severe internal bleeding. The 12 week fetus of the baby she was carrying was suddenly in the bed. I carried it in a jar of formaldehyde to the pathology department. I said a prayer. There were machines all over the place and everyone was important to keep her alive.
We emptied 23 units of packed red blood cells, along with platelets, cryoprecipitate and plasma. She continued bleeding. The beautiful young lady that I admitted that morning was almost unrecognizable. In comes mum who was in the waiting room.
“How is she doing nurse?” I was honest but not brutal. “She is really critically ill, she is bleeding a lot. We will continue to do everything we can.” Mom looked like she had the weight of the world on her shoulders. In despair she thanked us and said “I don’t want to be in your way.” She went to the waiting room.
For the next 12 hours, we did literally everything for this young lady. She went into cardiopulmonary arrest 5 times. “Code blue CCU…. Code blue CCU” It was announced throughout the hospital. The drama continued. We went through the ACLS protocols and revived her four times. I went to the waiting room and told mom. We got her back. She hugged me and said thank you”.
But the last time, I could not say the same thing. I just looked at her and mom knew that her daughter had departed. She immediately went into shock and collapsed to the floor. She was hard as a plank of wood. “ I need a gurney” I said excitedly, We need to take her to the ER”.
And that we did. In the meantime, the brother was punching the walls, he had lost his mind. There was lots of weeping and wailing and gnashing of teeth. Incomprehensible grief unless one took times to understand the context of this whole situation.
It was the early hours of the morning By the time we finished disconnecting all the equipment and preparing the body to be taken to the morgue. I worked with a group of hard core critical care nurses. We all sat and wept around the nurses’ station like little babies.
We had worked extremely hard on that case, but our external façade was pulverized. I guess we all came to grips with our own relationships and how we manage them. I vowed to make amends where I needed to because life is just too short to sweat the small stuff.
Mom came back 2 weeks later to the unit to express her gratitude for our work. “Words cannot express what I feel, I am a broken woman. I never had the chance to say goodbye and to ask for my daughter’s forgiveness. I have learnt so much from this.
While I will never forgive myself for the stance that I took with my daughter dating an akata (black American) man, I can just advice everyone not to let anything or anyone come between them and their children. Hold on to your children oh…. Hug them and tell them how much you love them every day. Accept them no matter what”. That was life changing for me.
Editor’s note: This is the first in a fascinating series of articles surrounding the isses of life and death at America’s hospitals penned by a highly respected Dominican ER nurse working at a major hospital center in the Western United States.
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