“And starting this weekend, at least one Toronto-area hospital will begin training physician volunteers so they can help critical care nurses in the ICU, as a way to immediately add more staff to keep up with a flood of severely ill COVID-19 patients.”
I had to laugh about this one. The medical residents, aka “baby doctors,” barely know how to do anything. I’ve had to teach doctors how to place an IV line, how to reduce a prolapsed rectum, how to talk to patients about death. And there’s no way they’ve ever considered giving IV antibiotics or other medications. Talk about chaos in the ICU.
I couldn’t find the original news article. See video report on Global News
Work has been shit lately. Covid is still surging in my ICU, and we’re busy with other things too.
Last week was an especially difficult week for our heart failure service, as every patient on service was deemed “not a candidate” for advanced heart failure treatment. Bottom line: this is end-stage heart failure and hospice is the next step. For many patients, this means removing a piece of equipment that’s been helping their heart do it’s job (like an intra-aortic balloon pump, or an Impella). This can mean almost immediate death, but many patients do go home from the ICU to die there. It’s emotionally exhausting but incredibly important work.
And it’s so important to spend some quality time with these patients. Last week, I helped a gentleman who was just days away from getting his Impella out to go home on hospice. He was itchy from laying in bed. I washed his back with real soap and water and washcloths. The put on lotion with a little massage. 20 minutes including gathering supplies. And it made his day! We chatted about traveling and life’s simple pleasures. These are the important moments at the end of life, and I was so happy to be there for him.
But despite that part of my job being so meaningful, there are other parts that are nearly unbearable. There is a day shift charge nurse who is mad at me no matter what I do, and who demands a ridiculous amount of report on our patients. She wants a full head to toe but the 90 second version. Do you know how long it takes me to prepare a cohesive and comprehensive 90 second head to toe report that also includes the plan and updates from when she was last on shift??? It takes about 5 hours to do it for 30-36 patients. And when I don’t give her all the info she wants, she asks for it in aggressive tones. If I don’t know the answers, she will eye roll, sigh and slam turn the pages of her printout. Actually, she does that sometimes anyways if she’s annoyed by something, anything.
I find this to create a workplace so toxic that it gives me panic attacks. I dread giving her report. I get short of breath talking to her. I often cry after interactions with her.
So what do I do when I tell my managers about this and nothing changes? That is the million dollar question facing me right now.
Oh, I almost forgot my dream. I had a left ventricular assist device (LVAD) in my dream, but it became dislodged internally. FYI, I’ve never ever seen this happen in real life… I was bleeding to death, surrounded by work mates. They could do nothing. And finally, as I was about to die, one of the help pressure on the bleeding spot as the warm feeling spread through my chest and I lost consciousness.
Covid. Still everywhere & people are dying. It is going to take MONTHS, maybe the entire YEAR of 2021 to roll out the vaccines. Keep wearing your masks, stay home & stay distant.
There are some heart attacks that should kill you, in my opinion. Maybe I’m just traumatized by my job, but when your heart is so damaged that you need A NEW ONE, it seems like life just wasn’t meant to be.
People always talk about nurses not being able to pee for their whole shift. But when you extend that metaphor, having a job where you can’t sneak away to take a poop is also horrible. Gas pains hurt really bad!
We have a patient here in the ICU whose been admitted to the hospital for two months. That is a long time to be anywhere that’s not home, especially when you’re sick. She has been in the ICU for more than a month.
During the course of her hospitalization, her mother has become her rock—as you would expect. But what the mother has become to the health care providers cannot be described so nicely.
Is she controlling? Yes. Is she demanding? Yes. Is this understandable? Yes.
But has she turned her adult child into a will-less person who can’t speak for herself? Also yes. Does she coddle her and tell the nurses she won’t get out of bed because she’s tired when getting out of bed is literally the only thing that will help her get better at this point?
Does she ask the doctors for opiates and benzodiazepines on behalf of her daughter’s severe pain and anxiety? Does the daughter as a result always looked totally out of it and unable to participate in her own care?
I can actually feel myself getting angry as I write this. Then why am I even doing it, you may wonder? Because today, we were presented with a list of unacceptable and acceptable nurses to care for this patient. And we were gifted with a daily schedule from her mom, in coordination with our supervisor.
Really? Taking directions from a non-nurse.
So, apparently the mom has caught on that the incentive spirometer is important. But she doesn’t seem to realize how important anything else is, nor does she seem to care that nurses may be off schedule due to their other patient’s medical condition or unavoidable delays in pharmacy or dietary.
Also, giving a critical care nurse a schedule like this insults the years they spent an education and training in order to become skilled enough to take care of patients who are trying to die all day every day. Not to mention that each critical care nurse usually has their own internal clock, rhythm and way of doing things. It follows the same trajectory as all the other nurses but also has individuality.
This is a DOCTOR’S ORDER that mother requests no tv watching. WTF?
In the end, do you know what’s really happening here? This mother, who can’t come and be with her daughter right now, and who feels very lost because she cannot control the diabolical illness affecting her child, has chosen to lash out at the only thing she feels she can control. The nurses.
But we are not her employees, nor her slaves. We do our best to accommodate the families of our patients but in the end, WE DO WHAT’S BEST FOR OUR PATIENTS.
And in this case, it might be forcing her to get out of bed, go longer in between doses of Ativan and the big D Dilaudid so she can wipe her own face and FaceTime her own mother. Because, just to remind you, I work in an adult ICU.
Pondered your own mortality while rubbing the arm of a man who speaks a different language than you, who is tied to the bed with 2 different kind of restraints and is still trying to hit you, who has survived a brutal car accident that deformed his skull and has now lost more of his brain to cancer, who is on a medicine to make him sleepy and comfortable but still flops restlessly in bed, who somehow manages to fart right in your face as tears come to your eyes, thinking about how you’ll probably die alone.
Received the most vitriolic dressing down from an entitled white woman who no longer wants to be in the ICU but has unfortunately just had her 2nd brain surgery to remove a metastatic tumor. You try to set boundaries by saying “this is not a hotel; it is a hospital” to no avail.
Bonded with your colleagues about all the shitty stuff that’s happened in your night—assignments changed, 2 admits, charge nurse yelled at you, expecting to get yelled at by cardiac surgeon because you didn’t extubate your patient, massive transfusion, and so on. It’s true that working in an an ICU is like going to war. The trauma bonds you.
On Thursday evening, while watching tv and learning to draw, practice session #4 this week, I decided I needed to get tested for covid before my parents arrived to visit for thanksgiving next week.
Just to be clear: I’ve been working with covid patients since early March including during the chaos when the entire country was running out of masks. But we have been lucky in the Bay Area, our surges have been smaller and more manageable. We’ve even had periods recently where no covid patients needed ICU-level care.
There was a time when my work mates and I were 100% sure that we’d already had covid—because how could we not?!?! Protocols were in flux, the federal government who was guiding our policies couldn’t decide what type of isolation precautions and PPE we needed. Not that the PPE (personal protective equipment) was even readily available then.
We probably had 20 pairs of goggles in our whole hospital… and reusable face shields? Oh hell no. Luckily our administration ramped up quickly, and many of our doctors with friends in tech hit donations of things like 3D printed face shields. We did have some crazy gowns mixed in there as our normal supply (made in China I’m sure) got depleted, but we got through the initial surge.
And while we were doing that, we also made our overflow hospital, overflow ICU, and organized anything else we needed. And then we did a trial run to make sure everything was do-able just to make sure.
As time went on, I actually became confident in all my colleagues’ abilities to deal with the covid patients. The isolation gear and protocols became second nature. I’m not worried that someone is going to expose us all.
So how does it feel to be tested for the first time this it a far in to the pandemic and be negative? I’m proud of my work crew. We’ve been keeping each other safe for 9 months now.
On NPR, you can listen to this 4 minute interview from an ICU nurse on the frontlines as she discusses patient regrets, masks, and surviving the pandemic with Audie Cornish on All Things Considered.
Mobley describes this very common experience:
“A lot of times before they’re intubated — which means put on a ventilator because they can’t breathe on their own — when they’re still struggling to breathe, and they’re saying, ‘Well, I didn’t know COVID was real, and I wish I’d worn a mask.’ And then it’s already too late,” she tells NPR’s All Things Considered. “You can see the regret, as they’re struggling to breathe and it’s finally hitting them that this is real. It makes me very sad.”
