a day in the life of....

an ICU nurse. i am completing my final rotation for nursing school in the ICU...not my choice, but a welcomed learning experience after accepting my assignment. each day so far, i take one of two assigned patients to my preceptor. on this day, we had one patient and were waiting for a new admit to show up from the OR, so i assumed responsibility while my preceptor answered questions or assisted with procedures as needed. my patient was an older gentlemen, who suffered from dimentia and a host of other issues that contributed to his being found unresponsive by EMS. he was brought to the ER, intubated - though he had specific wishes to not be, and transferred to the ICU with suspected sepsis. upon receiving this patient, his BP dropped and fluid resuscitation commenced, followed by dopamine and levophed to artificially increase his BP, also against his 'do not resuscitate' wishes, but following specific MD orders until family could be contacted....again. i guess you can never be too sure about DNR orders. throughout the day, i cared for this man trying to be sure he was as comfortable as possible. though he couldn't verbally respond to me, i knew when i started an IV he was in pain - because he cringed... his 'power of attorney' came for a visit mid-afternoon and chat with the MD. she, his girlfriend's daughter, was the only 'family' he had. and she came to discuss his wishes and when she was done, said her good-byes and told me to take care of him. she had searched for some sort of sign for reassurance on his DNR orders... pleading with him to blink his eyes or squeeze her hand if he wished to say 'yes' to removing the breathing tube... she looked to me for confirmation, and knowing i couldn't tell her what to do, i just stood with her... "what would you do" she asked... "do you think he can hear me?" she was full of tough questions.

orders to withdraw care were written...and the decline of the day commenced...along with the decline of this man's stability. respiratory came to withdraw ventilation per orders, and with no weaning, removed the vent (which had been running at 14 breaths a min, with 80% FiO2), and extubated the patient, and placed him on 4L nasal cannula. needless to say, the drastic change in respiratory support left him fighting for air. presenting this information to my precepting nurse, and expecting to follow orders with pain meds for comfort and weaning of BP meds....i was met with what i found a particularly disturbing response: "i am going to wait because i don't want him to die on my shift....it's a lot of paperwork." stunned, i paused. i turned back to the patient for a moment....and then said....he is fighting for air. there are orders to make him more comfortable. i will complete all of the paperwork necessary....but it isn't fair for him to struggle. a few minutes later, she appeared with printed orders for me to be able to access pain meds...and we began weaning his BP meds. i watched, over the next couple of hours, as his BP and heart rate dropped, but knew he was more comfortable with the relaxation of his breaths. after i gave the last dose of pain med, he took just four more breaths... and he was still. time of death 1820. and while it was not easy to watch him die, i knew at the very least, his wishes had been honored...and he was as comfortable as he could be in the given situation.

nurses are in interesting places and positions sometimes.

on a lighter note, it was a rest day for workouts! so nothing to post there... time for resting, and a day in the office tomorrow...