The hospital where I work – we’ll call it: GHOAT, “The Greatest Hospital Of All Time” (or so human resources would have us believe) – is often seen as the last stop for some patients. Other hospitals send their patients to my unit when they have run out of options. As a new grad, I often wonder just what it is that we do that is so different from other hospitals. Do we have some secret technology that we guard and use only for special cases? Do our docs and nurses have some sort of super-natural diagnostic and healing powers? Families seem to have this notion that “If anyone can save my loved one, GHOAT can.” We end up with some disappointed families.
One of the things that we do is to pump unit after unit of blood products into a person who is bleeding out of their GI tract. At GHOAT, GI bleeders go straight to the MICU. And while I might sound cynical, I have to point out that I have also been amazed. One patient that comes to mind had 60 units pumped into him, on three separate occasions (The blood bank hates us!) The third time I really thought it was his time, but he survived. When I was an orientee, I had a patient who managed to start bleeding, get a cordis placed, received numerous blood products, all while I was at lunch and my preceptor was watching my patient.
So GHOAT received one of these GI bleeders the other night. The primary nurse was a friend of mine whom I had gone through orientation with. She had recently confided in me that she was miserable working on this unit, and that she was even questioning whether she was cut out for nursing. She knew this patient was going to be diffcult so she quickly enlisted the help of the entire unit. A table outside the room was turned into a makeshift assembly line, with bags and bags of fluids, flushes, and tubing. The Level One was in position and ready to go. There was nothing left to do but wait. Then we heard the ominous sound of the helicopter landing. Minutes later she was there. It was a young woman with cancer. She had a huge mass in her lower abdomen and was bleeding from somewhere in her lower GI tract. She was lying in a pool of blood. She was awake and alert and I think that’s what made it so difficult. So everyone on the unit began working on her. The teamwork was amazing. Each person there seemed to effortlessly shift into a task. Someone was hanging pressors. Someone was checking blood. Someone was putting in a line. Someone was making runs to the blood bank, someone was manning the level one. Someone was giving oxygen. Someone was doing chest compressions, as she went in and out of conciousness. Someone was getting out the emergency drugs. Someone was holding her hand and telling her that we were taking care of her. Any nurses who were not in the room were making sure all the other patients on the unit were being taken care of. This went on for about two hours until the patient gave up and died. We were pretty despondent. There really was a point where it looked like she was going to survive. The unit was a mess. There was blood everywhere, being tracked around on the floor. The patient was lying in her own personal pool of blood. Her face was swollen from the rapid infusion of fluids. One of the nurses was very upset. “Where was the family? Why did this woman have to die surrounded by strangers? What chance did she have with her cancer?” And of course the answer to all of these questions is that she came to GHOAT, and that’s we do at GHOAT. You want everything done for your family member? Take them to GHOAT.
Since the very beginning of my critical care education, this issue has always loomed large. How much do you do for the dying patient? When is it time to let go and just help the patient die in peace? Everyone in this field has a strong opinion on the matter, one way or the other. I’m starting to learn that you can’t generalize this issue. You have to take it on a case by case basis.
The next night the palliative care nurse paid us a visit. Someone had told her about the recent death and she felt that we could use a tiny bit of counseling. She is no stranger to the MICU and thank God for that. In the MICU there are so many reasons to build up an emotional wall so you can continue to take care of business. I think she helps us to preserve a little piece of the emotionally vulnerable side. The wall is necessary, but you have to leave a little room for escape. So we talked about what a horrible blood bath it was, how it wasn’t right that her family didn’t get to see before she died. How it was so awful to see her face puff up like that. How the whole thing was futile because of her cancer. The palliative nurse’s reply to all of this was completely surprising to me. She said, “You are all heroes.” She pointed out that we joined together and made every effort possible to save this woman. Every person on the unit contributed in some way towards the effort. We did everything we possibly could do. And every step of the way there was a nurse speaking softly into her ear, telling her what was happening, and holding her hand.
So the above title is pretty corny, I know, but when she was saying the whole hero thing, I was mentally conjuring up this Michelangelo painting, where God and the angels were calling for this woman, and the MICU team was working on the ground, fighting to make her live. And my friend, the primary nurse who was thinking of giving up nursing? She did an excellent job. I said to her the next day, “You can’t possibly be thinking that you’re not cut out for nursing.” “No,” she said. “I’m thinking about transferring to the ER.”