Thursday, March 15, 2018

Annual "I haven't blogged in months, but I'm still alive!" post

Oh hai guys! Lookit that, it's been yet another multi-month stretch where I haven't blogged. Sorry about that. Every year, I somehow get surprised by the fact that over the dark cold months of November-February I withdraw into myself (and my couch) and then suddenly rediscover joy and socialization and friends once the sun comes out and warms everything up for more than two consecutive days. It's like haven't gone through this before...except I have, every year, for the past fifteen years. One day, I'll buy one of those happy lights or just take a vacation to Mexico in January.

ANYWAY. Blog. Here we go!

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I had a patient a while back who died.

She was one of those patients who, by all rights, should have died before she got to the hospital. I triaged her in from the ambulance after she had a sudden syncopal episode while driving and thought, since she was also diaphoretic and complaining of chest pain, that she was having a massive heart attack.  I was wrong - I got an EKG on her before doing literally anything else, but it was normal. So I proceeded to get her undressed, on the monitor, get vitals, and start a line. I did all this within five minutes. Her pressure was in the 80's, and all of a sudden she told me her lower back had just started to hurt.

Fuuuuuuuuck. After announcing to the ER MDs that I thought she might have a ruptured AAA, one of them went into the room and promptly confirmed my suspicion via bedside sono.

I did everything right for this lady - from ER arrival to OR arrival was around 80 minutes. It would have been sooner, but the cardiovascular team was already operating and had to close before they could take my patient. We were short staffed, and somehow by myself I still managed to get this elderly patient undressed and triaged, on the monitor, obtain an EKG, start two big IVs, send down all the labs including a type and cross (which at our facility is a step that takes an extra minute or two), get a doctor in quickly, find the sono machine, order blood products, keep this sweet and totally oriented patient and her family from panicking, move her to the critical care side of the ER, give report to vascular when they did arrive, keep the patient alive, AND chart all that shit. I did a fanfuckingtastic job, all by myself. This was one of those situations where everything went perfectly, and I felt like a complete badass for correctly diagnosing a critically ill patient and giving her the best possible shot at making it though alive.

She died the minute they moved her onto the operating table.

It was emotionally devastating, and I was fortunate enough to find the family and spend some time with them to express my sadness and cry with them. I've thought about this patient for months, but always was comforted by the fact I really did give her an amazing chance at surviving - and that the family saw how much work I did to help her.

***

I found out this week that the patient's case was reviewed by the hospital for a possible delay in care, and I'm furious. It just goes to show that even when everything is stacked against me and I still manage my patient perfectly, instead of a congratulations for a job well done I get told it's still not enough.

3 comments:

Portia said...

I don't know how it works... did they review and say there eas delay in care, or are they still reviewing? If it's the latter, could it be a cya kind of thing? Report "Yes we reviewed and we did everything right" at the end of the review? Should my name be Pollyanna?

I'm sorry that happened, but I am glad to read your post.

Old FoolRN said...

I once worked with a chipper young nurse named Bonnie who could interject a feel good comment or reference into the most dire situation. "Don't judge yourself by the outcome..bad things are going to happen. You still did a great job." She said this as she put her arm around me. I was mourning the loss of a cerebral aneurysm patient. I never forgot what she told me. You went above and beyond for that patient, but there are so many variables beyond our control. Don't let office sitting busy bodies influence your self opinion.

Shrtstormtrooper said...

@Portia - it was definitely more of a CYA thing, but still irritating. I think it stung so much because that patient meant a lot to me, and the letter reopened all the feels.

@Old FoolRN - thank you. I just need to remind myself of that sometimes.