Blog 8: Angels, Eyes, and Last Goodbyes

   Hello! This blog is coming to you live from the balmy Florida panhandle on a beautiful Saturday afternoon... It's been quite awhile since I posted an update on my life as an ER nurse and there has been a lot of water under the bridge. I graduated the LPN-to-RN nursing program in December, took my state boards on January 29, and have been on "orientation" as a registered nurse since then. My preceptor is a nurse that I have worked with since I've been at Baptist, so we work together well. As good as orientation has gone so far, I am a bit of a nervous wreck... There has been a steep learning curve where charting is concerned,... so much to remember and so much more responsibility! I've also been pretty nervous caring for critical patients. It's so different literally being the nurse responsible for a patient that is "borderline dead," with critical titrating IV drips regulating their heart rate and blood pressure. I've had a couple patients that needed conscious sedation to reduce dislocated and broken bones, which is a nerve-wracking nursing experience... and then, last week, I had my first stroke patient that needed TPA, the high-powered clot-busting drug that is given IV. So, yes, I am back to praying every day on my way to work that I don't kill anyone! Having said that, I LOVE IT!!!... even in the face of a "global pandemic." Every day on the job brings something new and exciting... especially in these crazy times! I've had a lot of interesting experiences since the last blog, but only a few really stand out. For some reason, the experiences that have really stuck with me lately are rather dismal, so apologies for that! 

   There is a quote somewhere about nurses caring for patients during birth and death, but ER nurses see a lot more death than birth. Usually, we are fairly callous to death,... we pull off the monitors, clean the equipment, and throw a sheet over the body... And usually, the patient is actively coding when they come to us, so we don't really have time to look them in the face and associate a life with that person. We just do what we are trained to do... A couple weeks ago, we had a patient come by EMS, an older male accompanied with his wife... He was having severe shortness of breath but was still able to talk to us in short sentences. His wife was very worried and stood stroking his head and encouraging him to breath... We put him on a non-rebreather mask with the oxygen turned up high, and he seemed to improve for minute, but he was still visibly struggling and his oxygen saturation was slowly dropping. A nurse called the respiratory therapist while I went in to try for a second IV because it looked like we were probably going to need it if the patient kept deteriorating. As I went in and stood beside him, I noticed that he was looking pretty gray and that his heart rate was slowing...at that moment, I also noticed that he turned his head to look at his wife and was obviously trying to say something to her. She told him to stop talking and concentrate on breathing, but when he turned his head back towards me, I could see that his eyes had changed... they had that "look" and I knew this wasn't going to turn out well! We got a doc in there in a few seconds, and by then, his heart rate was in the 30's. By the time we got a crash cart and extra hands, he was in asystole. We coded the poor man for 20 minutes but never got a pulse back. Bedside ultrasound showed a heart full of coagulated blood and we found out later that the patient knew that he had a heart blockage and opted out of open-heart bypass surgery. I am convinced that in those seconds that I stood by his bed, I witnessed his soul leave his body... I think he knew he was dying and turned to say his goodbye to his wife, and then turned away from her in that final moment to keep her from seeing... It's a strange thing about eyes! They truly are windows to the soul! 

   A few days later, we had a 2-month old Code Blue that came from the area close by the hospital, my first ever infant code. Normally an infant would be sent to our neighboring hospital that has a specialized pediatric ER, but since we were the closest hospital and the infant was in cardiac arrest, she came to us. EMS report stated that the infant had an unknown "down" time and had been found in her bed unresponsive. By the time she got to us, we had a room FULL of people ready to go... A pediatric code is very different than an adult code! A pediatrician is called in... Pharmacy comes to the code to draw the medications since they have to be precise and weight-based for an infant. L&D nurses respond to the ER and the infant warmer is dusted off and powered on. Chest compressions are done with the thumbs instead of with two hands... The work space is so tiny and there are so many hands working within that tiny space. IV's are tiny and really hard to get. I noticed that the doc's hands were shaking as he tried to intubate with the tiniest ET tube I've ever seen. I tried for an IV along with several other nurses, but the poor little thing had no circulation. We tried for an IO (IntraOsseous or in the bone) line but that was also unsuccessful. At that point, the code had been going at least for 30 minutes with no sign of cardiac activity and the doc asked if everyone was OK with calling the code. Quietly, everyone stopped their activities and we all looked at the little girl lying there... She was the cutest little thing with lots of dark brown curls and perfect little eyebrows... Except for the dusky gray of her skin, she could have been lying there sleeping. I suppose we'll never know the exact reason for her death,... the whole situation seeming a bit shady according to law enforcement. The rest of the staff involved in the code were a bit shook up afterward, but for me personally, as hard as it was to see a little baby lying there and not be able to fix her, I was comforted knowing that innocent children have a place in heaven. Who knows what she would have faced in this life? Most likely a lot of heart ache and pain and grief...  

   That same week, LifeFlight brought us a 28-year old female who had shot herself in the head with a hunting rifle. She was technically beyond our care, but was 21 weeks pregnant and still had a pulse, so once again, the infant warmer was powered on and the L&D team came down to the ER. I wasn't involved much with this code, but I did go in for a second, and was amazed at how well so many people were able to work together! Even though the scene was grisly and both mother and baby ended up passing away, the two departments came together for a short while like a well-oiled machine! 

   While there have been other memorable patients in the last few weeks, including an inmate who tried to hide a paperclip in a rather unfortunate orifice and was unable to retrieve it, a wife who accidentally ate some grill brush bristles when her husband grilled bacon for supper, and a gentleman whose football-sized abdominal hernia ruptured in the fruit aisle at Walmart, these days, the question I get asked the most is how we are dealing with corona virus in the ER. Honestly, the answer is... we are dealing with it like we deal with everything else! We just roll with the punches! Almost a month ago, the hospital hired some company to come in and set up a larger isolation unit within the ER... We now have an entire section of the ER that is taped off with plastic walls and zipper doors and is supposed to be "negative pressure." We call it "Covid Camp," or "Tent City," and try not to take the whole situation too seriously...(Although, after this, we'll probably all have PTSD when we hear a tent zipper go down!) Usually we have two nurses assigned to Covid Camp and I would say on average, maybe 5 to 6 people that end up going into isolation per day. Most of these people are discharged home to self-quarantine while they wait for their results. Thankfully, all the testing going on in the community has cut down on the testing we have to do in the ER. As of 04/04, our hospital has only 3 positive patients in the upstairs critical care units, however, the total count that has been seen in the ER is unknown to most of the staff. We are notified by management if we have been exposed to a positive case, but so far, thankfully, I haven't gotten that email! We have long since been reusing N95 masks and surgical masks, and thanks to our many wonderful sewing circle ladies, we now have cotton "Menno" masks to go over top of our surgical masks to help them last longer... we have taken to wearing masks most of the day, because, honestly, every other person that walks into the ER could be a positive case and we don't test nearly all of them, so we just try to protect ourselves the best we can, not just from CV19, but from all the other nasty things that "splash" that we no longer have protection from. Gloves, the remaining masks and gowns, and cleaning supplies are under lock and key as they kept disappearing at a high rate of speed. The entire hospital is on lockdown except for 3 entrances, where everyone coming in is screened for symptoms. No visitors are allowed except for family of trauma patients and dying patients. This has cut down on a lot of the unnecessary ER traffic quite a bit! No more dental pains or ingrown toenails! From what I understand, the hospital administration still expects the situation to get more dire, but we'll see how the rest of April goes! One very silver lining is the abundance of staff we have every day! During this time, management makes sure we have a full staff at all times! Another lovely little byproduct of this global pandemic is the effect on early morning traffic! No more annoying school buses and backed-up stop lights! I can get used to that! 

   Thanks for reading and for the support that I feel from all of you! If you think about it, just say a prayer for all of your local nurses during this time! I feel pretty fortunate to have a healthy immune system and a strong faith in God. I know He is in control and knows the future, but a lot of my coworkers don't share that faith. They are very anxious about the virus, the economy, and the future of our country. 

   And, once again, I would like to say thanks to all of you out there who spent time sewing "Menno" masks! The ER staff put together a collage of photos to share with you, and I will post it here! Earlier in the blog, I talked about eyes truly being the window into the soul... It's been interesting looking at these photos. You can literally tell they are all smiling, even though you can't see most of their face! You can tell it by their eyes!