I pulled into the hospital parking lot for night shift with an uneasy feeling in my stomach. I'd heard on the radio about a bad trauma when I was on my way in to work. Somehow I knew it was going to be a rough one...
After dropping my lunch bag off in the lounge I called to check in at home. My dad is visiting and having a movie night with my kids. Tomorrow is football & he travels 2 hours every week to spend it with us.
I was disappointed to have to work, unsuccessful at trading the shift away. At the main desk where we get our assignments the station was abuzz with chatter about the new trauma. I check, I'm nearby, but not directly assigned. A small mercy. My heart's just not in it tonight
I introduce myself to my patient. A lovely stable independent fella who is ready for transfer out of the ICU. I question why this is my only pt.
"We need you to help with the trauma"
Ugh. That pit in my stomach is back.
I peek in the room, and am surprised to see that they are already removing her breathing tube.
'Can't be that bad' I say to myself.
I do the assessment on my own pt. They can come get me if they need me... I regret not bringing a book, it's going to be a long night
I finish writing my assessment and am about to grab a coffee when a number of family members come in to see the trauma patient, followed by a number of doctors. Grim faces. Shit. Something else is going on...
I'm asked to stand guard at the door, which I notice hasn't been fully closed. It's too stuffy in that room with all the people so they've left it open a bit. The patients husband is visibility upset, I watch him be guided into a chair at the bedside.
The patient is starting to fully wake up. She's asking about her kids. Her mother grabs her hand while the husbandlooks like he is going to faint.
"We're so sorry to inform you..."
The screams and wailing that follow let me know exactly what they've told her.
My role as guard has been upgraded.
I'm now helping transfer the patient, who herself has more fractures than I can count, onto a stretcher.
So we can wheel her to visit her dead children.
The wailing haunts me to this day.
We carefully bring the stretcher up to the bed where her children lay lifeless. Despite the broken bones, she attempts to crawl into bed with them. The pain of the fractures are no match for the pain in her soul.
It's unbearable.
After we get her back in her room we give her & the family some alone time.
We spell each other off for time outs. Mostly to weep. The nurse assigned here tonight has children the same age. I know she's not ok. I also know she will be the very best of us tonight.
We remember that there are other patients to tend to. Evening baths, meds, scans... We scurry about performing our tasks.
Catching our breath between the bouts of wailing from our trauma pt.
We have ceased to speak to each other as we try to absorb some of the grief
Somehow morning comes. We can hear the chatter & giggles of dayshift at the desk until they round the corner & see our faces.
They know & understand these looks.
We know it's not our grief to own, but we carry the weight of it just the same.
Our comrades are ready.
I arrive home, the household is still asleep. I'm hungry. I'm thirsty. But oh am I tired. As I change out of my scrubs, I attempt to remove the blanket of sorrow that envelops me.
But I cannot help it... I turn into my pillow to uncontrollably sob myself to sleep.
I wake up hours later to the sound of my children's laughter with my dad. I drag myself out of bed and pour myself a cup of coffee. I notice large bouquets of flowers on the counter, not in a vase, but still in the wrapper.
I look to my dad and offer a sad smile of thanks
"I thought we would take a drive" he says. And without having to say a word about my shift we go to the scene of the accident. A memorial scene is already under way.
We lay the flowers.
And go to football.
And carry on.
• • •
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A co-worker ended their life after our shift the other day. Didn't go home and shower. Didn't change out of scrubs. Don't know if it was planned or spontaneous but I do know we got the last living moments. And I don't know how I feel about that.
Our broken team is shattered.
I don't know contributing factors. I do know that nobody can deny how fully draining these last few years, months and weeks have been on our ICU. In hospitals around the globe...
We pride ourselves for being badass in the ICU, we can take on anything, right!? But these last few years have shown us otherwise. We are not exempt from the trauma and despair and we have been swallowed up by it.
The way my dying patients wife spoke those words took my breath away. The pause between each word. The emphasis on each word as though willing him to feel the power, the pain, and the emotion.
It was as if it was a plea and a fact at the same time.
It's been weeks for him in our ICU. Weeks of ventilating, making gains and losing ground. Weeks of family updates and he's not doing well today but then a bit better tomorrow. Weeks of slowly failing organs. Weeks of sedation and life support.
We finally approached the wife and told her the terrible news that his lungs just would not recover. It's as though his lungs were made of concrete instead of balloons. And she decided that enough was enough. She would not put him through any more.
My pt *Tim was admitted with Covid. A relatively healthy guy. Exercises more than I do if you don't count the steps I put in at work.
It's rare that Covid patients are already intubated before coming to the ICU, which can be both a blessing and a curse... ICU + covid =
Not a great combo.
But it does give us a chance to get to know our patients.
Tim was doing ok with self proning, he watched his oxygen levels and flipped himself over for "tummy time" to get them up again when they were low.
He's been here for weeks so he knows the drill.
I try hard to connect with my patients on some level, either through food, family or music. It helps them relate to me and reminds them that I am human too. I think it's paramount to building trust.
Tonight we talk about food. It's a safe starting topic.
It's been many weeks now since we admitted the 'Lords prayer' Covid patient. He came to us awake and talking but deteriorated quickly overnight. After calling his wife and praying with him I held his hand while he was intubated.
Each shift back to work I would casually wander to his bedside to see how he was doing. Each shift a different plan of care to accommodate his failing lungs and subsequently his failing organs.
Sometimes he would be on his stomach with arms positioned like a swimmer.
The bedside nurse asked me, "Do you know him?"
I sheepishly responded with, "No I was with him when he came in. He was very sweet. So scared. I'm just hoping for a win"
Then the nurse & I would lock eyes, and exchange that knowing look, 'this won't end well.'
Our Father, who art in heaven. Hallowed be thy name...
He was admitted for monitoring but we know how it goes. With the high flow nasal oxygen and the mask his oxygen levels were still only in the 80s.
"Try to lay on your stomach for as long as you can tolerate, I'll be back."
He did not tolerate. It's hard with all the things on your face to lay like that. It's hard when your lungs betray you and don't do their job. It's hard when you see the news every day and know that the ventilator is the last resort.
He was tiring. It would soon be time...
All garbed up in PPE I go back in the room to talk to him before the team comes in. He knows it's getting worse. I ask if he wants to call his wife to talk to her before we rest him on the ventilator.
He asks if we can take the mask off to make the call.
It started as a normal shift... I mean, whatever normal looks like for us these days. I was extra staff so I busied myself with little projects, helping with turns and baths and dropping off meds. I was present but not really invested in this shift
I check in on the new nurses. They are always my favourite. They have just as much to teach me as I do them. Today they want to know the quickest way to the blood bank in case of MTP (massive transfusion protocol). I take them to show them, it's better than giving directions.
Next I pop over to check on a new admission. It's like a game of Red Rover: people from inside the room are calling out the things they need to the people outside the room. It's a flurry of activity. It usually is with a new admission, especially an unstable bleeding trauma.