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.