Work stuff.
Jan. 24th, 2012 09:56 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
midnightsjaneI occasionally write about work, but usually in a non specific kind of way, because I have been somewhat conflicted about doing so; we have the whole patient confidentiality thing that the PTBs are very keen on, and I don't want to have them somehow find something I've written and have it become an issue. However, this month's Canadian Nurse magazine had an article about nurses who blog about nursing, and most of them are a lot more upfront and public than anything I might write here, so I guess it's okay for me to talk about work with you all.
I don't talk much about what I do with my friends in RL, mostly because they're non medical people, and after the first little while their eyes kind of glaze over, or they are grossed out by some of the details, or it just depresses the hell out of them. I love my profession on most days, and I wouldn't really choose any other career if I had to do it over again, but you know, it's not always glamorous or happy. In fact, some days it's just plain shitty..literally. Sometimes it's so depressingly sad, and somedays it's terribly frustrating, and sometimes what we do to patients in the name of treatment is painful and morally ambiguous. I've more than once wondered what the hell we were doing and how could it be right to carry on treating someone who more than likely was going to die whatever we did. Critical Care medicine deals with people with life threatening, and life altering illnesses, and often causes staff to question the ethics of their actions.
Often we carry on treating patients for weeks, seeing them through all sorts of complications and problems, finally getting them well enough to go out to the ward, only to have them bounce back to ICU time and again before they finally die. Have we done right by them, and their families? Sure, we give them extra time, but it's not quality time in many cases. I don't know the answer. All I know is that we can't predict who will do well, and who won't. We've had patients in our ICU for as long as a year; one man I remember was there for over a year, went through all sorts of hell, but fought on, finally got to the ward, and was dead in less than a week.
But there are lots of successes, too; a woman who I will always remember was ill with flu-like symptoms just before Christmas one year; by Christmas Day she was on a ventilator, with eight chest tubes (a record she still holds) and so sick we considered a heart lung transplant. She didn't have one, was in ICU for six months, and finally got better and went home. She occasionally would come to visit, but wouldn't come through the doors of the unit. If we'd given up when she was sick to die, her story would have had a much different ending. That's what keeps us going, and the fact that sometimes what looks like a hopeless case turns out to be that miracle.
I have been thinking about these things because on Friday we admitted a young man who was found down in a shelter, in cardiac arrest. He was resuscitated and brought to ICU, and we worked on him for a long time before he was declared brain dead. When we think someone is brain dead there are tests the doctors do: cold calorics is one - ice water is syringed into the ears and if there is no response, it's pretty much an indication of brain death. We took this young man for cerebral angiograms; even though his heart and lungs were still functioning, the angio showed that there was no blood flow to his brain; the brain swells, and blocks the circulation because it's a closed system within the skull. The doctor then had to call the patient's mother and tell her the bad news, and ask her about making him an organ donor. It was so sad.
I do love what I do, even when it's hard. Sometimes I don't like what I do, and sometimes it's really quite disgustingly gross; the other day I looked down at my shoes and there was shit on one of them. Ewwww. The human body can be messy and smelly and nursing is so not glamorous, and some days I come home exhausted and aching from all the lifting and turning, but there is not one day that I don't look at the people in the bed in ICU and count my blessings. Those folks have the real problems; mine are just temporary ones. Keeps me grounded and aware of how very lucky I am.
I've been working in this ICU for 31 years this month. I have stories that would curl your hair, stories that would make you fall on the floor laughing, and stories that would make you weep. Perhaps I'll share some with you.
I don't talk much about what I do with my friends in RL, mostly because they're non medical people, and after the first little while their eyes kind of glaze over, or they are grossed out by some of the details, or it just depresses the hell out of them. I love my profession on most days, and I wouldn't really choose any other career if I had to do it over again, but you know, it's not always glamorous or happy. In fact, some days it's just plain shitty..literally. Sometimes it's so depressingly sad, and somedays it's terribly frustrating, and sometimes what we do to patients in the name of treatment is painful and morally ambiguous. I've more than once wondered what the hell we were doing and how could it be right to carry on treating someone who more than likely was going to die whatever we did. Critical Care medicine deals with people with life threatening, and life altering illnesses, and often causes staff to question the ethics of their actions.
Often we carry on treating patients for weeks, seeing them through all sorts of complications and problems, finally getting them well enough to go out to the ward, only to have them bounce back to ICU time and again before they finally die. Have we done right by them, and their families? Sure, we give them extra time, but it's not quality time in many cases. I don't know the answer. All I know is that we can't predict who will do well, and who won't. We've had patients in our ICU for as long as a year; one man I remember was there for over a year, went through all sorts of hell, but fought on, finally got to the ward, and was dead in less than a week.
But there are lots of successes, too; a woman who I will always remember was ill with flu-like symptoms just before Christmas one year; by Christmas Day she was on a ventilator, with eight chest tubes (a record she still holds) and so sick we considered a heart lung transplant. She didn't have one, was in ICU for six months, and finally got better and went home. She occasionally would come to visit, but wouldn't come through the doors of the unit. If we'd given up when she was sick to die, her story would have had a much different ending. That's what keeps us going, and the fact that sometimes what looks like a hopeless case turns out to be that miracle.
I have been thinking about these things because on Friday we admitted a young man who was found down in a shelter, in cardiac arrest. He was resuscitated and brought to ICU, and we worked on him for a long time before he was declared brain dead. When we think someone is brain dead there are tests the doctors do: cold calorics is one - ice water is syringed into the ears and if there is no response, it's pretty much an indication of brain death. We took this young man for cerebral angiograms; even though his heart and lungs were still functioning, the angio showed that there was no blood flow to his brain; the brain swells, and blocks the circulation because it's a closed system within the skull. The doctor then had to call the patient's mother and tell her the bad news, and ask her about making him an organ donor. It was so sad.
I do love what I do, even when it's hard. Sometimes I don't like what I do, and sometimes it's really quite disgustingly gross; the other day I looked down at my shoes and there was shit on one of them. Ewwww. The human body can be messy and smelly and nursing is so not glamorous, and some days I come home exhausted and aching from all the lifting and turning, but there is not one day that I don't look at the people in the bed in ICU and count my blessings. Those folks have the real problems; mine are just temporary ones. Keeps me grounded and aware of how very lucky I am.
I've been working in this ICU for 31 years this month. I have stories that would curl your hair, stories that would make you fall on the floor laughing, and stories that would make you weep. Perhaps I'll share some with you.
