Quantity over Quality

Last night I had an extremely sick patient. She was a 30 something woman who spent her first hours out of jail injecting her hip with drugs filled with, among other things, dirt. By default, dirt is full of a particularly nasty bacteria called Clostridium. This bug, once introduced inside a person, rapidly and systemically overruns the body, its defenses, and our ability to fix it. The infection she came in with is 100% unsurvivable. No person, ever in the history of medicine and/or IV drug abuse, has ever survived an infection of this magnitude and classification. This woman was no exception. She was dying when she came in, she was dying when I got there. She died under my care.

As it went down, I knew it was inevitable. I knew it was going to happen. What I didn't know was how I would react to it. After five years of nursing, I have come to accept that there are things we have to endure. Death. Death is one of those things. Although some people do it to themselves, I always take it personally when it happens on my watch. My quantity of nursing has taught me many things. Among them, when you take care of someone, its on your oath as a nurse to do everything you can to keep that person alive and make them better. When you cant do that, it always becomes personal. That's not to say I blame myself in any way or have any doubts about my skill. I know I am a great nurse. I know I have a great supporting cast in this theatre of chaos. I don't debate what I do for a living. I would never be happy anywhere else. I always find myself surprised in the most unlikely situations.

What surprised me wasn't the 40+ units of blood products she received. Nor was it the 50+ liters of fluid. I wasn't shocked by the poor blood pressure or the terrible heart rate. It wasn't her lungs being flooded by all the fluid. It wasn't the pool of blood she lay in. What surprised me was my own seemingly anesthetized response to the whole situation.

Let me explain. As she started to code, as her heart slowed and her blood pressure dropped, I went through all the motions. All the right steps. Called the docs. Called the code. Pushed the drugs. Started CPR. Hung the blood. Pushed the fluids. Prepared for the chest tubes. This is what I do. This is what I love. When you are in the middle, there is always that stinging feeling of someone else's life in your hands. Usually, I cant help but feel a buzz, sense of euphoria, a slight tremble of hand. But this time was different. This wasn't how I normally feel. Through it all, I couldn't help but feel paralyzed. I did everything I was supposed to do. And yet, I felt nothing. I just remember thinking, why are we doing this? Why are we wasting so much on something so futile? Why are we so driven by quantity and so completely detached from quality? We knew before the code even started that she was going to die. And yet, we felt justified in pumping liter after liter of fluid into an already flooded body. We compressed and bagged an already lifeless soul. As I stood there next to the doctor, all I could think was that we are truly selfish beings. We are so wrapped up in what we can do, we don't stop and think about what we should do. We want totality. More, it seems, is better.

What about dignity? What about grace? What about plausible outcomes and quality of life? What about the baby in the ER who needs that blood? What about the teenager in the trauma unit who needs that fluid? Did I give my patient the best care by doing everything? Did I give her the dignity she deserved by letting anyone who walked by into my room to compress her chest? Does being a great nurse really have anything to do with quantity??

I say no. No it doesn't. Being a great nurse has everything to do with quality...

The Sound of Music

I love music. I think it is one of the most amazing gifts to have and receive. I would like to say its a gift I can give, but unless you are strictly talking about buying a c.d. or an i-tune, then I am not the person to go to. I cant carry a tune in a bucket, even with a lid tied on. However, I am not afraid to admit that I cant sing. I am okay with the fact that I will never win a Grammy or be on Broadway. I sing anyway. Although I sing badly, at least I sing loudly. Music has always been a big part of my life. Growing up, my Dad taught me to love the best and greatest of the 50's, 60's and 70's. My Mom taught me to love opera, show tunes, Sinatra, and country (you can take the girl out of Montana, but you cant take the Montana outta the girl). Grandpa showed me the beauty behind classical. My brother played the drums, so from him I learned to appreciate metal, jazz, and rock. In college, I was introduced to punk, ska, hip hop, and alternative. And, on a personal note, 2 of the last 3 guys I have dated have been musicians. I guess I have a thing for guys with a guitar.

Back to the point, music is so important to me, sometimes its even more enticing than food and water. There isn't a day that goes by that I don't hum along to a tune, turn on my i-pod (I know, I am a material girl in this material world), or flip on my radio. Music not only inspires me, it motivates me. Its a driving force to my existence and something I fear I will miss greatly when I leave this life behind. Regardless of the situation, no matter what is happening in my life, there almost always is a song that relates to or embodies the emotions of the moment. I think music is a way of personifying emotions we cant verbalize. Its a physical way of showing others how we feel. Whether it be happiness, sadness, pain, pleasure, grief, lust, heartache, love, humor, or even nothingness; it can almost always be translated to music. I think what I love the most is that music is a true universal language that spans every culture, every continent, and hundreds of years.

When it comes to music, I have had the same conversation with all my friends and even strangers. I love to hear what people say when asked the same question, "If you could have a soundtrack for your life, what would be on it?" Most people don't answer right away. I have heard all kinds of different answers. Mostly its mainstream pop culture tunes that are popular here and now. Some put a little more into it and rattle off some classical pieces or religious hymns. Some just make a list of old school favorites. Very rarely am I actually taken by surprise. When that happens, it honestly gives me goosebumps.

The power of music is something that always floors me. I always have a play list going in my head. Even in the most tense, high stress, hopeless situations, I can hear a song somewhere behind my ears. I think its a way for me to cope and filter. Its my way of letting only the necessary information in and keeping the useless out. Whatever the cause or rationalization, I know that the day I stop hearing music is the day I find my way home. So, whats on my soundtrack?? Well, its an incomplete list, but its along these lines: 1-big eyed fish. 2-amazing grace. 3-fur Elise. 4-the dawning of the angel aquarius. 5-map of the problematique. 6-what a wonderful world. 7-let it be. 8-for you. 9-into the ocean. 10-story of my life. 11-walk the line. 12-tomorrow. 12- into the west. 13-drift away. 14-have you seen the rain. 15-young folks. 16-no rain. 17-black door. 18-steady as she goes. 19-its your love. 20-them bones. 21-the cowboy song. 22-crash. 23-walking on sunshine. 24-imagine. 25-closer to fine...

The Hamster Wheel

Recently I was reading an article about nursing in the coming decade, the extreme shortage of qualified nurses, and the work load we deal with on a daily basis. I was taken aback by the statistics, as well as my own realization that I too have fallen through the camouflaged trap door of overworking myself.

When I stopped long enough to think about the stress and expectations that my job, my responsibilities outside of work, and my lifestyle require, I realized none too soon- or perhaps just little too late, that I am gambling on a slanted table. Things do eventually roll downhill.

Just looking at my job alone, I can now see how much of a drudge to the system I have become.

I used to have romantic notions about my job. I would like to think that they still, in some muted subconscience capacity, drive me to come in every single shift and fight for what matters. I know in my heart of hearts why I do what I do. I know what really matters to me. I know I am a good nurse, well educated and willing to fight for my patients no matter what. However, after much reflection, I have come to one simple discernment. We; be it nurses, business folk, laborers, blue collar, white collar, black collar, whomever works hard for a living; are like hamsters on a wheel. We go forward each day, each night, each shift. We drive ourselves on for the remote or even unobtainable goal of "the end". We know that if we work hard enough, the reward of a good day will greet us happily, like a lap dog who waits for his biscuit. Our "end", however it may be, is our treat. But what I have come to understand is that there really is no end. One may live. One may die. One may never be functional again. One may recover fully and completely. However the chips may fall, however hard I work, I do not embody the capability of change the outcome of fate. Ergo, I can not change the fact that there will always be more to come. My job doesnt end when my patient dies, or when he goes to another unit. My job doesnt end when I drive home, no matter how blurry eyed and exhausted I might be. I am always a nurse. 24/7. 365 days a year.

Within this realization, I find my inner monolog singing through. I say it to myself mostly, but also without any reservation to anyone willing to listen, "I, or we rather, have to find a way to step off the hamster wheel from time to time." I have to find a way to take a step back and focus on the one part, the one person, in my life that I so often readily ignore--me. So, I have started a list of things that make me "jump out of the hamster wheel" and focus on just what I need. For instance: I can spend that spare 10 bucks I have on some fresh flowers, instead of a coffee and bagel on my way to work. I can turn off my phone for three hours and take my dogs for a hike rather than sitting and waiting for "that" call. I can enjoy a glass of wine and be okay with the fact that tonight is my night off.

I think its very important, for myself, all nurses, all people stuck on the hamster wheel of life; to take a step back, jump off and even turn away from the perpetual chase and focus on what really matters. If even for a few moments, its neccessary to find a balance and release yourself from the eternal race to "the end".

Mr J's Triumph

Its been way too long since I have written anything, let alone a good blog. I would like to think I have been accomplishing something great. Truthfully, I have been out enjoying the sun and surf. I have been training my new puppy how to sit. I have been out with friends and living life, enjoying the summer in the city. While out enjoying the beautiful weather and scenery, I was thinking about whats been going on lately. I began to reflect heavily on what I have learned, what I will never forget and how my life as an ICU nurse has changed in the last few months. I think I have finally come to grips with the changes and expectations of being a trauma nurse in the burn/pediatric ICU. Looking back, I see the shell of a young, apprehensive nurse. Looking ahead, I see the shadow of a great, well rounded and experienced nurse. I realized, that while I still have a lot to learn, I am not the one asking all the questions anymore. People now come to me and ask me the questions I asked but a few short months ago. What a tremendous shift of perceptibility.
There is one patient that comes to mind when I think about my personal shift in guise. While taking care of Mr. J, I distinctly remember the exact moment when I said to myself (with my seemingly very audible inner monologue), "Holy crap, if I don't step it up here, and run this theatre of mass chaos, he is going to die"... I said this with my hands buried up to mid forearm in his dehissed hip incision. Bleeding out, on a heprin gtt, I fought with the idea of letting go of pressure to reach for the code cord. Instead, I exercised my full lung capacity to anyone in a 4 octave range. Marne, the charge nurse, was the first to arrive. She took the situation in hand while I shouted out orders and expectations to everyone else. Eventually, I got on the phone with the operator. After that, everyone and their mothers...including the Gen. surg docs and ortho docs with their minions, I mean, med students in tow, showed up.
By the way and for the record, paging supposedly important people at 0300 STAT overhead does have a certain degree of wicked satisfaction. At one time, 5 docs showed up, asking questions and demanding answers...I felt my patient swirling and my mind clouding over. After 20 minutes of this and that, should we, will we, how did this happen, what did you do??...I stopped, kicked every single person--doctors and nurses, med students and MAs alike out of my room. After I got my patient settled and retrieved his family from the waiting room, I stepped outside. I sat with the R3 of the ortho team and explained for the umpteenth time what happened...
While he listened to me, I could tell he didn't believe or care about what I was saying. I stopped and walked away. When he questioned me, I looked at him point blank and said, "If you don't want to hear what I have to say, then I am not going to waste my time talking to you. I have a patient to take care of. I have a family to explain to. I have an attending, in fact, I have your attending, to call. I need to tell his family when he is going to surgery. Unless you have something earth shattering and otherwise important to tell me, then I think we are done here." With that, I turned my back to him and walked into my patients room. I knew that I had overstepped my boundaries (as classically defined by disciples of the"old school" paradigm) as a nurse. I knew my manager would hear about this. Secretly, I hoped she would. I imagined, as I walked into his room, what she would say when I got pulled into the office and asked what really happened. He was wrong, I was right. I finally realized that it is my job to stand up and make decisions for my patient, even if that means going against authority, even if it means barking orders or reaching outside of my scope of practice. Doing what it takes to keep my patient safe, to keep him alive, is what it truly means to be a great nurse.
Until I stood up to that arrogant physician, I didn't know what it meant to really define my arena of practice. Until that moment, I hadn't been able to define what it was that makes me fight so hard for my patients. Now I know that its not about who does what or who's role is more important. Its not about my license or their title. Its not about me or them, doctors or nurses. Its about whats best. Its about what I need to keep my patient alive. Its about my ability to trust that everyone involved will support my ability to take care of my patient to the Nth degree. Being able to stand up for myself, my decisions, my role, and my judgement meant I was standing up for my patient, his rights, his needs, his life. In the end, I knew I was right and that my patient was the better for it. I have no regret, no reservation, and no doubt. In hindsight, I flourished as a nurse at that moment. To me, Mr. J's triumph will always be my triumph.

Best Moment in Medicine

I was watching an old episode of "Scrubs" the other day. The topic of the show was 'Whats your best moment in medicine?'. I thought it was an interesting subject to blog about. When I stop to think about it, there isn't anything or any one specific instance, patient, or case I can recall that stands out as my personal best. I think there are many reasons for this. Mainly and most obviously, its because I don't do this for me. There is nothing about nursing that makes you do it for yourself. There isn't glory or badges to be earned. There isn't a big paycheck or a huge bonus waiting at the end of the week. Nursing is a selfless career filled with the most giving and unselfish people I have ever met. On that note, I also think there are so many wonderful, insightful, heart warming, heart wrenching, moving, jarring, and fundamental life changing moments to choose from, its really hard to pick just one and pinpoint it as my best.

If I really sit and think about this question (and I have--A LOT), then it becomes quite clear to me that the only possible answer isn't one big moment, but many small moments combined into a huge life lesson.

There are the tears of joy and the tears of sorrow. There are the moments of doubt and the moments of confidence. You feel the duality of every emotion imaginable. You question everything about yourself, your career, your choices and your ability to keep on fighting the good fight. Its at these junctures when you really find your personal "bests" in medicine. Each moment where you sit and ponder your next step. Each time you take the time to hold a hand or wash a face, its your best. I find its the small things that really make me feel the best about my job. Titrating drips, pushing meds, doing chest compressions, giving blood, replacing electrolytes....that's all part of it. But for me, my best moments come from things like painting the toe nails on my teenage girls', or holding the babies when they cry at night, or holding the hand of an old lady who is scared by the shadows. For me, being a nurse isn't so much about my best, but rather my patient's best moment.

One thing I can recall is not something I did. Its something I witnessed. One particularly bad night, I was walking down the hall toward the nurses station. We were slammed with some really sick people (several burns, a post code, a couple of kids, and some other trauma sickies). I was on with a great crew and I knew that no matter how deep we where in, we would be okay. But when you are that busy, you don't think about that final hour until its already gone. You focus on the tasks at hand and only see what you have left to do. I was focused on my patients crazy labs and what I would do next. While passing a room with a particularly sick patient, one whom suffered a head injury, I heard not the silence I expected, but this hauntingly beautiful song. It was Tura, Tura, Tura, an Irish Lullaby. I stood in utter amazement at this gorgeous song and thought that there would never be a more appropriate time to hear such a melody. I felt like I was in a trance, with all the other nurses whizzing by me. It was Val, one of our most experienced and outstanding nurses. She was singing to her patient, a song he hadn't heard since he was a child. He laid there quietly (something we all hadn't seen him do since his head injury) and listened to her sing. He cried when she finished, saying that his mother used to sing him to sleep with that song. He promptly (for the first time in weeks) fell into a peaceful sleep. At that moment, watching Val give her patient the one thing medicine itself could never provide, I knew that this was my best moment...

The Quiet Warrior

I think a lot about the things we see and do as trauma nurses. The people we treat and the people save. I think about the lives we touch and the ones that touch us. We are often not remembered, hardly recognized, and always behind the scenes. We are the quiet warriors, the ones leading an army of gifted individuals toward a common goal. The human body is an amazing piece of machinery. We are an amazing team of mechanics. But what happens when the machine is too broken, and there is nothing left for us to fix? What happens when our role suddenly becomes undefined and the lines of battle are no longer clearly drawn? Who do we turn to when all we can do is nothing? We see the worst of the worst, and yet, we hardly ever hear, see, or feel any sort of collective "how can we help you?". We are left alone, to conquer our own demons, whatever they may be. For some, its the trauma of trauma. For others, its the helplessness of being helpless. So what do you say, who do ask, how do you cope with the undefinable emotion of an unwinable war? How do you look a family in the face and say. "I am sorry, we have done all we can do. There is nothing more we can do for your son". How do you look a father in the eye and say to him, "Your daughter is strong, but we cant save her."

You do it with grace, with compassion, with emotion. You cry too. You hurt too. You feel their pain because it is your pain too. If there isn't a father, a mother, or a family to ask; then you alone are all that person has, and you still cry, you still hurt, you still feel the same agonizing pain.

When you go home, you you realize you are a solider, and sometimes you have to fight without any weapons, without any armor. You become enraged at a world that doesn't let you choose whether or not you will have to give it 150% for little or nothing. However, after you leave, you always come back knowing you are there to do it all over again. Its your fight, your battle. You are the quiet warrior...

JS-BS and Biscuits 'n' Gravy

I asked some of my co workers to read my blog. I asked them to suggest what else I should write about or what they would like to read about. I got a lot of interesting feed back. I heard some great ideas and I heard some "colorful" suggestions. Mostly it came down to, "Write about what you know."
I thought long and hard about that. What do I know? What can I say that nobody has heard before. I could blog for pages about staffing and the nursing shortage. I could go on and on about the doctors I like and the ones I don't. I could tell you my biggest mistakes and my greatest achievements. But, when I think about the blogs I have read, I realized that I have already read all of that stuff several times. I want something new and different.
So, I want to tell you about my "nickname game". I have a habit of giving people and/or odd situations funny, and sometimes clever, little pseudonyms or catch phrases, if you will. Its a game I play to entertain myself when I find myself staring out into the pitch black night. Often, these names or phrases cause quite a ruckus amongst my peers and coworkers.
I have two short stories (details and names changed, but true to a 'T') to illustrate my amusing pass time. Story #1: When I was a new nurse, we used to take a 1/2 hour in the morning to sit together for breakfast and discuss our night, or plans for the day, the oncoming night, the staff, the docs, the people we knew and things we did. Mainly, the real reason we got together for breakfast wasn't so much about the shift (we where all there, we knew how it did or didn't go). We met to check out the new residents and study them in their element. Well, one fine fall morning, stuck in the basement cafeteria, we all noticed this poor young doc, looking lost and unsure. Looking hungry and preoccupied. That poor guy...Someone piped in that he looked like he had just fallen off the tractor on the nearest farm. Another chimed in to say, "He looks like he came straight out of a Nebraska cornfield". I ended the conversation with, "I bet he went in hunting down a big ol' plate of biscuits and gravy." Sure enough, at that moment this poor young farm fed Nebraska 'husker walked out of the grub pit with nothing short of a mountain of biscuits and gravy...He is an R3 now. The top of his game, a chief in medicine. He is a great doctor and a tremendous surgeon. But to me, and to everyone at that table, he will always be "Biscuits and Gravy".
Story #2: Often in the most tragic and unbelievable of events, we see the selfishness in people shine through. You would be amazed at the lengths some people will go to in order to make sure that they are never out of the spotlight for more than a split second. It never ceases to amaze me how crafty and egocentric people can be and how they are so accomplished at turning someone else's tragedy and pain into their own source of vanity driven stardom. Such is the case with a recent tragedy we all experienced. An entire family destroyed by tragedy. The kids harmed and the parents clueless. So wrapped up in what they would or could get out of the catastrophe, they failed to see that really the most important factor was/is the children. I never realized the vanity of people until the day I saw the family of this traumatically injured child put their own selfish needs above the safety and needs of their loved one. I couldn't believe the lengths and limits they pressed to ensure that everyone knew who was to be the center of attention. In giving report, I coined it the JS-BS of the day. Just the kind of BS you would see or watch on Jerry Springer...
To most people, that situation isn't funny. And believe me when I say, its not. However, I have learned that if you loose your sense of humor around here, you loose your sense of coping. Finding even the smallest way to see things from a different perspective makes the situations we have no control over at least somewhat tolerable. If there is some way I can laugh, even (and most often) at my own expense, then I know I can get through the roughest, most formidable, most unimaginable situations. I guess humor is our greatest safeguard against tragedy.

Even the Sickest Still Need a Bath

Its been over a week since my last post. I have been working, and I have to say, its been the most challenging week of my career. I decided, for whatever reason, that I would step it up and start taking some sicker patients. I have a lot to learn and although there is always room for improvement on time management and organization, I feel like I have straddled that horse for long enough. I am finally ready to exercise my critical thinking skills, open my "never done that" doors, find my limits and break them. I decided I needed to challenge myself. What was I thinking? My first night, a really sick burn patient. I didn't do much but sit with her niece and wait for that long inevitable moment. I didn't get to change her linens or give her a bath. She was too sick, too unstable. She was on all the drips; epinephrine, norepinephrine, vasopressin, LR at 750ml/hr.... We weren't going to code her, but we were trying to keep her "chemically coded" until the family could arrive from out of state. I tried; maxed out my drips, maxed out my fluids, maxed out my vent, maxed out her heart, her lungs, her body.... She waited until I could do nothing else but call the doctor and say, "There's nothing else I can do." Her niece held her hand. I turned off the monitor. She died at 0555.

The next two nights, I took the sickest medicine patient. I don't know why. Maybe its because nobody else wanted to take him. Maybe its because his leg was rotten, and I had a stuffy nose, so it didn't really bother me that his room smelled striking like a bag of 3 day old dead fish stuck under a pile of sun ripened baby diapers... Maybe its because I knew he was sick and I wanted to keep up my goal of self destruction, I mean self challenge. Whatever the reason, I got him, dead leg and all....

What I found out was that "all" turned out to be way more than I bargained for. He dumped his pressures, right off the bat. 80/40. Then he went into arrhythmia, A flutter, then A fib...I got his labs back--K+ of 2.0. Mg++ of 1.0. iCa of 0.74. Metabolic acidosis. No urine output. No A line. Crappy triple lumen. Unreadable CVP. Depressed ST. Bradycardic to 30!! Atropine given. ...and this was all in the first 4 hours. Time management and organization went out the window. Critical thinking skills, oh my. "Never done this before", oh my. Found my limits, then broke them, oh my, oh my, oh my... I stepped into a whole new world of "what the hell do I do now?" He survived the night. I corrected his lytes. With that, I brought him back into a sinus rhythm. He pressures came up, with a liter an hour bolus. He stabilized out. I went home exhausted.

Day three, same patient. RN report, "he went to the OR and had an above the knee amputation." OR report, "we did this, we did that, he got a ton of blood and even more fluid. He has no pee. Boy did he smell bad." General surgery took over his case. Although he is a DNAR, we will treat him they say. More fluid. More drugs. More blood. More lytes. I work my ass off for the second night with this guy. I feel like I am fighting a loosing battle, knowing he probably will not survive his extreme sepsis. I know he has a very slim chance of surviving the next 24 hours. But, with all of that, I know the most important thing I can do for this man is not titrate his drips or give him more fluid. The most important thing that I can do for him is simply give him a bath. He has smelled like rotten flesh for three days. We have treated him, medically, surgically, and chemically. Now it was my job to treat him compassionately. If I were in his position, what would I want the most? I would want to be clean. I would want to die smelling like a human, not a dead animal. So, I set aside my swan cath setup and put down my flow sheet. I got out my soaps and lotions. I bathed this man as I would my own child. I cleaned him and washed his face. I combed his hair and shaved his week old stubble. I cried as I did it, because I knew that I was giving him the one thing that medicine often overlooks, his dignity. Whether he lives or not is out of my hands. I cant say I saved this man, but I can say that I did give him the compassion and humanity he deserves, that we all deserve...

Most Memorable Moment

I often get asked what my most memorable moment was/is. There are numerous memorable moments. Lots of firsts. Lots of bests. Lots of worsts. But there is always one that stands out. One that makes you realize how much of a gift life really is. Being a burn and pediatric nurse makes you understand, in a rapid fashion, how fragile the thread of life can be. All it takes is an instant, and the thread snaps. My most memorable moment was neither a burn or a kid. When I started on this unit, the prospect of taking care of a burned baby scared me beyond the worst traumas, the sickest adults, or even the biggest wounds. I guess its the innocence factor. What I consider my most memorable moment took me by surprise. I remember it distinctly. It was a calm and quiet April night. I was up for the next admit and excited to get something other than the standard 80 something old lady who fell off her step and smacked her head. Although I had secretly hoped for something interesting, something exciting, something I could learn from and gain another notch in my belt...I had no idea of what was in store.

Report from ER-- 20 yo F. Spontaneous bleed. Neg drug tox. No family here yet. Boyfriend at bedside. Devi stating. Unstable. Organ Donor.

Oh my God I thought. She is younger than I am. She was a good girl. A college girl working her way through life. Happy. Healthy. She was just like me. When I went to the ER to get her, I immediately found myself personally involved with her story. She was at home with her boyfriend. She had a bad headache. She was sitting on the couch in his arms. Then, he said, "She just went limp." He was there. Her boyfriend. Distraught and devastated. Her brother had just arrived. 18 years old, the first family member in house. He became the decision maker. Mom was away on a business trip on the east coast. Dad was in route from rural where ever. We brought her up. It was clear she was brain dead. Neurosurgery had already completed the first of two brain death tests. Her pupils where fixed and dilated. No cough, corneal, or gag. No painful stimuli response. Unstable vitals. The organ donation team was there. The brother being asked what she would want. The boyfriend crying and shaking. The nurse crying and titrating drips. We could save her organs. We could save other lives, if not hers. A good heart. A good pair of lungs, a good liver, kidneys, pancreas, intestines, corneas... I began to fight to save people I would never meet. People I would never know or take care of. I became the advocate for what good she had done and all she had left to do. I became her voice. I hugged her brother, held her boyfriend's hand. Prayed. Hoped. Cried.

Her dad made it in just before the second brain death test. I finally had her stabilized and ready for OR. We had most of her organs placed. She was ready to complete her role. I had become her mode, she became my muse. I helped her family say goodbye. I helped her friends let go. I helped her boyfriend brush her hair. I left the end of my shift as she was taken to OR. I know she saved the lives of 6 strangers. I know her family and friends are closer to each other because of her death. I know I am a better nurse, better woman, better person for what she taught me, for what she gave me. I remember her the most, because with her death I realized that life is but a single thread in a endless blanket. She taught me that when one thread breaks, others will bind.

My First Float

Today I floated to another unit for the first time. I had the interesting opportunity to go to the Neuro ICU for the last 8 hours of my shift. Its a nice unit, full of nice people, nice patients, nice pictures...I have nothing bad to say about it. I enjoyed my time there. Nothing exciting, but then, maybe that's a good thing. I met some new and interesting people. It is always humbling to be put in a situation where you are out of your comfort zone. To be thrown into a place I have never been, let alone worked, before is quite intimidating. I like new challenges and I enjoy a change in atmosphere from time to time. It makes me appreciate the comfort and stability of my own unit. Knowing the people you work with, knowing who you can count on, who you can trust, and where the things you need are always kept is an essential and often unrecognized attribute to critical care nursing. Its often the little things, the minor details, that make or break your shift. Comfort with your surroundings is one of those things. When they say "you will be floating", they dont just mean that you will go from your unit to another. They mean that you will just be there, floating in midair, waiting for the end of your shift, hoping nothing happens, because you dont know where anything is, who to ask for help, or what the unit norm is. You just glide along, float on through your shift, and at the end, come back down to reality. You know you did your best and your patients survived another night because you did all the right basic things. They floated because you floated.

1 Year Today!!

Today I celebrate my first year as an ICU nurse. I cant believe I have come this far. I cant believe all that I have done, seen, experienced and been a part of. If you would have asked me a year ago where I would be now, I don't think I could have said here. I always knew I would be a critical care nurse. I have always, since the age of 7 or so, thought of myself as a healer and care giver. Just ask my mother...I even tried to help the mashed butterflies on my Dad's truck grill. Helping others has always been a part of my being. But, when I think back to nursing school, I distinctly remember saying, "I love nursing...but I will NEVER do three types of nursing. I will never be an OB/delivery nurse. I will never be a burn nurse. I will never take care of sick or hurt kids." One thing is true, I have not set foot in a delivery ward since second semester of junior year. As for the rest, well, I learned to never say never. I find myself now, at this moment, sitting in a room with an adorable 3 year old, who happens to be 40% burned. It has occurred to my recently that I have an incredible knack for getting myself into places I swore I would not go, and then realizing none too late that I am in way over my head...Its sink or swim. I am happy to report, I can swim. After a year I can, on most days, keep my head above water and get my things done. Its been a huge learning curve for me and most mornings, I go home mentally, physically, spiritually, and emotionally exhausted. I have learned more than I can ever express in words, both about my career and about myself. I have redefined priorities and ethics. I have extended my beliefs and searched my soul. Perhaps that has been the greatest challenge of all...Perhaps I was always a good nurse, I just needed to become an ICU nurse to discover who I am as a person. Perhaps its what I said I would never do that led me to become who I really am...