It seems like every time I take a class (and there are many offered at GHOAT), whatever I have learned about I will soon see in action in the MICU. Last week I took the ACLS certification course. So naturally I came to work the next day fully expecting to either shock someone or perhaps do some chest compressions, or maybe both.

And there she was. She had been in the MICU for a while (never a good thing), and had had a bad night. Every system had gone south. She was in multi-organ failure. Her worsening and hopeless condition had been explained to the family the previous day, but the family still wanted to forge ahead and “do everything.” In short, she was an ACLS algorithm waiting to happen.

It’s funny, when I first used to come into contact with these situations, I would feel outraged: Here is a woman lying bed, She is oozing serous fluid from every little scratch and old insertion site all over her body. She’s unresponsive and all her systems have failed her. She is practically, but not quite dead, and now we have do all this invasive “stuff” to her because we have somehow failed to explain to her family that it’s fruitless to continue on with this medical care. It somehow seems amoral. But the situations are never that simple. We have the dreaded “family meeting” (the meeting where the docs tell the family that chances are, their loved one is going to die). It always makes me think of the movie “Dumb and Dumber,” where the girl tells Jim Carey that there’s only “a one in a million chance that she’d ever go out with him.” Jim Carrey is jumping up and down with glee. “Why are you so happy,” she says? “Because you said I have a chance!”

But alas, this is not another one of my rants about how everyone in the MICU is dying a horrible death and they should all be showered with palliative care… No, this is a story about ACLS.

So realizing that this is my fate for today, I go on to take care of my practically dead patient. I still talk to her and let her know what I am doing because, after all, who knows? Maybe she’s still in there somewhere. She may even be hovering over the bed, just killing some time, waiting to meet her maker. Perhaps she is finding amusement by watching me blunder about in her room. She’s been in A-fib all night but now I am watching her heart rate increase even more rapidly. 120s. 130s. 170s. I call the medical team to the room and right away the fellow says, “Time to cardiovert!”

See, I just knew that there was an ACLS algorithm in store for me that day! And it’s an algorithm that I am not experienced with – synchronized cardioversion. Of course I aced the asystole and PEA algorithms because that is mostly what we see in the MICU. I’m all about pushing epi, atropine, and bicarb until the cows come home. But anything that involves electricity I am hopelessly inexperienced with. So I put the pads on her. The resident is turning on the AED and a nurse is showing her how to set it up for cardioversion. They set it to 50 joules and SHOCK.

OOPS. They forgot to put it on “synchronize” mode. Now my patient is in V-tach. So now she gets the REAL SHOCK. 200 Joules. And moments later she’ s in a normal sinus rhythm. Just. like. that. It’s amazing. She’s still dying, (and would later die that night, surrounded by her family.) But I watched her heart being manipulated by electricity and it was truly amazing.

The moral of the story is that now I will never allow that mistake to happen to one of my patients. This is a very scary but true thing about nursing. Once you make a mistake (or witness a mistake being made on your patient) you will never allow this mistake to happen again. I will always remember my first cardioversion, and how easily you can send someone into v-tach by neglecting one small step. In fact, there is no such thing as cardioversion in my book. It’s called SYNCHRONIZED cardioversion.

***********************************

Faithful readers, (and I wonder how many of you are still there out there since I have been neglecting my blog for my adventures in reproductive endocrinology) you may be wondering how I have managed to start posting again. Ah, the magic of pregnancy. You see, I am now at week sixteen. A few days ago I woke up and decided to clean my entire house. Instead of cleaning maybe a room or two and then pooping out (like I usually do,) I ended up actually cleaning the entire house. I was shocked when I looked back at all the work I had accomplished. The next day I did a twelve hour shift, came home, made dinner, and actually did the dishes. What in the heck is going on? I wondered. Well yesterday I was reading a pregnancy book and it said that week sixteen is when you get all of your energy back. It’s like clockwork. And I intend to milk it for all it’s worth because who knows when the energy will disappear again? I’m guessing sometime around week 20.