First off...they call it the ED now. I wonder if they will rename the television show...?
Emergency personnel are my heroes. Hands down. Talk about a group of steely-eyed professionals. I was in a the emergency department big city hospital with a Level 1 shock trauma center and it has been such a great leap for me in terms of advancing my clinical skills. It was also terrifying to realize how on top of everything these nurses need to be and the enormous gap I have yet to traverse to get there. If there was ever a profession that epitomizes multi-tasking, it must be ER nursing.
Every student's experience on a given day will be different -- some of us will hop from patient to patient fairly quickly and see a good number of them during our shift. My first day, I really only saw 2 but that was because I was in the two rooms right next to the trauma bays and we had a couple of patients that needed a lot of care, and took a lot of time.
Codes don't happen in real life like they happen on TV or in the movies. Heck...probably because of this, I didn't even realize I was in one, until my instructor asked me about it later! All I knew, was we had about 15 people in our room for about an hour. Then somehow things turned and poof! -- it was back to just me and my nurse and our very sick patient. During the Code, people were hopping, but somehow it seemed like controlled chaos, this team knew all the dance steps and stayed out of each other's way as they all performed their own tasks. The doctor was so relaxed and no one was shouting, just quietly going about their business. Amazing.
Since I could do hardly anything but just stay out of their way, I had time to notice random things. Since my nurse and I had personally inspected the room and gone through every drawer with an inventory checklist -- I knew we were ready. And I could see why he took this step VERY seriously. As the Code ran it's course...the floor just got filled with debris. All the packaging for every supply was on the ground and they ran through supplies in a shockingly fast clip. I began to think about how, not having one critical item and that crucial moment could just make it or break it for my guy on the table, fighting for his life.
Then there was a whole nurse just standing off to one side documenting everything that happened, every drug given, dose and time. Every order. Procedure. She was like the court reporter. And...its because of today's law-suit happy society that we have her.
All of the "right ways" we learned to do things in class...many fall by the way-side when there is no luxury of time. And that's not a criticism.
Then I saw symptoms occurring in my patient that I wondered if I would ever see. It's called "Decorticate Posturing" and it's sad that I got to see this in real life, because it's never a good sign when the arms go really stiff and flex outward. But I saw it.
I also noticed veteran nurses who have done it a million times struggle with things that I would struggle with now, and that kind of comforted me. After a patient is given an artificial airway, they often need to get a tube down to decompress the stomach. Getting that tube down can be tricky. Even for the pros.
So we got through the Code and after a few hours, our patient was transferred up to the floor and we turned our attention to the next patient. She was thrashing around and confused, so when it came time to give her an IV, I had to wrestle to keep her arm still so my nurse could get a line. After a few failed attempts she had so much blood running down her arm and onto her hand that it looked much worse than it had to be. But she managed to work her arm free at one point and grab my white sleeve with her bloody hand and I looked like I had been finger-painted. It reminded me of old episodes of MASH and how Hawkeye was always awash in gore.
For this lady I got to apply restraints. Something I haven't really had to do before. She was a really sweet little old lady who just needed a little help to keep her safe.
The next day was more excitement and I saw many more patients and got to do more things. Sunk my first IV, a nice big 16 gauge needle, which was awesome. There's this thrill when you see the flash of blood return in the catheter and know you got it I just can't really describe. I'm sure they would discourage cheering, but that's what I wanted to do.
One patient stands out and will likely change how I worry about people who live alone. She had gone down in her home for a week before she was found. She was in a very bad state by the time we got her, and she smelled wretched from having laid in her own filth for that long. Soooooo sad! My eyes would water any time I approached her room. The other nursing students hadn't gone in, but I finally wanted to help and went in and offered. It was just so great to take care of her and make her comfortable. I figured if the whole floor could smell her, surely she could too! We made it better and that's when the nurse I was helping looked up at me, laying across her and holding her arm in position for him to try and get a vein, and said, "Now there's a REAL nurse!" Meaning me! I asked him why he said that and he replied, "You see any other people in here offering to help? We're not that busy..." I floated on that compliment the rest of the day.
I do want to be a REAL nurse.
:)
