Quiet

I’ve been quiet for a few days. The old saying that you can’t fill someone else’s cup if your own well is dry has been true for me this week. Let me explain:

As you all know, I work three days a week. Day one, I had four rooms and a parade of really sick patients in them. One of my patients had leukemia and didn’t know. The doctor and I had to tell her. Still other patients had a host of problems- one guy had a 100% blockage in two cardiac arteries, another had lost so many fluids from a week of diarrhea that his blood pressure was only 70/42. A long day.

The second day saw me treat two coworkers: one a doctor who had a seizure at work. The second, a fellow nurse with SVT and a heart rate of over 200.

The third day was by far the worst. We had a critical incident. Let me explain. EMS brought in a woman who was in cardiac arrest. She was also 38 weeks pregnant, and had been down for about 40 minutes when she came in. I was the team leader.

When you work a cardiac arrest in the emergency department, what we call a “Code,” there are numerous jobs.

• There is the recorder, whose job it is to write down every single lifesaving act we take, drugs given, etc. That person also is the time keeper. Things like “Two minutes to the next pulse check, three minutes to the next dose of epi,” things like that. This is always an RN.
• There is at least two compressors. Their job is to perform chest compressions, and there are two so they can switch places when they get tired. Literally anyone who works in the ED can do this job.
• A Respiratory therapist, who is in charge of ventilating the patient and maintaining the patient’s patent airway.
• One nurse or paramedic who is in charge of IV access.
• A doctor, who is in charge of making all decisions.
• The team leader, who runs the defibrillator and handles all of the drugs. This is always an RN, and usually a well experienced, senior one. They work with the doctor to ensure that the patient gets the proper treatment.

One of the sights that I will never forget is what that lifeless baby looked like when they cut her mother open to rescue her. Another sight that I won’t forget is looking across the patient and seeing the nurse who was the compressor continuing to do her job as tears poured down her face. It was heart wrenching.

In total, we worked on that mother and her baby for over an hour.

We wound up getting mom’s pulse back. We lost the baby. We still had six more hours to go in our shift, and we still had patients to take care of. The most jarring thing about it was that you would walk out of a room where you just spent an hour trying to save a dead baby, only to hear your patient demand a turkey sandwich. Codes involving the death of a child are always hard. In fact, it was one such call years ago that had me seeing a shrink for a couple of years.

Emergency nurses are some of the most jaded people I have ever known. They are used to seeing tragedy on a daily basis. It isn’t unusual for us to work several codes in a shift. What is unusual is to work a code on a child or on a pregnant mother. In fact, we only do that once or twice a year. Add to that, many of our nurses are recent or expecting mothers. Adults dying? That hasn’t bothered me in years, but when a child dies, it’s like a little piece of you dies with them. It’s heart wrenching and it takes weeks to get over it.

For the rest of the day, you would enter a medication room or a storage closet to find a nurse in there crying. Two of the nurses were doing so poorly that they had to be sent home for the day.

Me, I did OK for the remainder of the shift, even though I was on the verge of tears. I held it together and went home. As soon as I saw my wife, that was when it hit me. I sobbed like it was my own child that I had lost, and did so for about 20 minutes. Then I drank some booze and went to bed. I didn’t speak very much to my wife for a couple of days. I didn’t blog, except to post some posts that I had already written and was saving for later. I ate very little.

I feel better now, but you can’t imagine how hard it is to hold a dead baby. I still see that child’s face at night. The only thing that enables me to sleep is the knowledge that we did our job well, and managed to save the mother. I can’t think of a single thing we could have done differently that would have made a difference, and that is what will enable me to go back to work.