Two Choices

Around the corner, I heard a soft, but labored, panting.

Curious, I walked into my patient’s room to find him breathing rapidly.  I took his vital signs: blood pressure was a little high, pulse ok, temperature ok.  His respirations were fast, but his oxygen saturation was 100%.

Normally, when I call a doctor to report a patient’s worsening condition, I’m ahead of the game.  If my patient’s short of breath, I hook them up to oxygen.  If they have ‘as needed’ medications available, I give them. If he’s aspirating (choking on fluids), I raise the
head of the bed, I shove a yankauer in their mouth and suction the crap
out.

But this time, I was empty handed.  “Doctor.. please come see your patient.  I don’t know what’s wrong but he looks bad.”

Thankfully he came not long after my call.  He ordered some blood work and it showed that his fluid and electrolytes were way way off.  Then he ordered some medication and
repeat blood work.

A long hour passed.  The doctor returned, saw the patient again, the lab results, and consulted another physician over the phone. He ordered some IV fluids… but that was it.

My patient was clearly deteriorating.  I asked the doctor if we could transfer him to the ICU.  3 times.

“No..keep him on the floor. Wait for the IV fluids.  BUT after you hang the fluids, if he gets worse, you can transfer him.”  He started to walk away.  “Don’t call me if you transfer him.”

While waiting for the fluids, I did some research on my patient’s condition.  And I realized… he was probably going to die. Soon.

Okay, Soapie. Let’s think about this.  

You have two choices:

this man can die under your care,

or

he doesn’t have to die at all.

Time to bust a move.

I harassed the pharmacy for my IV drip.  I hung the bag and immediately called the house supervisor to get my patient transferred to the ICU.  I briefed the ICU nurse over the phone with my patient’s status, and she didn’t waste any time either.  Before I
knew it, she had run all the way from her unit to assist us in transferring the patient.

“Hurry and get this man off the floor before he codes!” she shouted.  We pushed his bed down there faster than my legs could move.  The ICU staff worked swiftly to stabilize him.

Returning to the floor, I felt drained. I still had 5 other patients to care for, and now one open bed- meaning I could get a new admission at any time.

~ ~ ~
In the morning, I had forgotten to put something in the patient’s
chart, so I returned to the ICU.

“Any better now that he’s on dialysis?” I asked the ICU nurse.

“Nah. He’s a dead man,” he replied.

Crap.

~ ~ ~

Over the following week, I wondered and worried about that patient.  Was he still alive? Nah, he couldn’t be.

Then a few days ago, I saw one of his doctors.  “Doctor, what happened to that one patient…?”

“Oh, him? He’s coo. He already went home.”

“Really?! You mean he was talking, walking and breathing?!” I couldn’t believe my ears.  “But… what made him so sick?”

“All the other stuff is extra, but the real culprit is HIV,” he answered.

“You serious?! I transferred that patient to the ICU that night when his attending wanted him to just lay there…”

“Well, you did good,” he said, while busily flipping through a chart.  “You saved that man’s life; he almost died.”  He continued writing, without glancing up, not even looking at me.

As if it were no big deal.

~ ~ ~

 

Massachusetts will vote on an important ballot measure to propose safe patient-nurse ratios in Massachusetts hospitals. To share some insight as my work as a nurse and why I am voting YES on question 1 for safe patient limits, I am reposting some of my previous blog posts here.