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CritCareRN

10 Jan, 12 tweets, 3 min read

Expect the worst, hope for the best...

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.'

I know. I know.

From time to time as I was caring for patients nearby, I would wander into his room and talk to him. "*Sam, it's me. You are still in this place with us. Please stay in this place with us. We are doing everything we can to help you stay on this side of things"

This last set of shifts that I'm working, things have not been looking good. I am not directly assigned but I'm hovering. Hoping. From a distance.

On my last shift as I'm writing report someone yells out from inside a room, "Need some help over there!"
In an ICU, that is code for: drop everything & go.
While throwing on my PPE I look into the room & it's the patient I've been hoping & praying would recover. It's Sam.

His oxygen levels are in the 30's.
So is his heart rate. His monitor is alarming & the other team members are putting in lines across the way.

This patient encounter has come full circle. My mind starts to spin... I think about nursing school & the therapeutic relationship...

They taught us that just as important as initiating the relationship was also ending it. That's always been the hardest part for me and me bleeding heart. And why do they call it that? Of course it's bleeding, it's a heart.

"When you go in can you turn off the monitor?"

I snap out of my spiraling thoughts and go in to turn all the alarms off but keep the monitors going. Sometimes these patients have been so sick for so long, unless you sit listening with a stethoscope it's hard to know the moment of their passing without the monitor.

I pull up the cpr stool beside his bed and instead of stepping up and over his chest, I kneel down beside him and cup his hand into mine, and talk to him. "It's ok Sam, it's ok to go. Your wife said she will meet you later. Do you see your mom? She's there waiting for you..."

"Shall we pray once more? Our Father, who art in heaven..." I fumble my way through it this time. The words are jumbled up with my grief response and I feel silly for this reaction to a person I had a very limited encounter with.

I'm not just grieving Sam, I'm grieving hope.

"Expect the worst, hope for the best"

It's what we say with a guarded prognosis. When the odds are not in favour of a successful recovery.

It's getting harder & harder to keep that hope as these covid flames continue to spread and the worst outnumbers the best.

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More from @rn_critcare

CritCareRN

@rn_critcare

24 Dec 20

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.

Read 12 tweets

CritCareRN

@rn_critcare

19 Dec 20

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.

Read 16 tweets

CritCareRN

@rn_critcare

7 Dec 20

I just sat down to do my assessment after a busy start to the shift. It's been like that lately, hit the ground running. Staff are dropping like flies, resources thin. We've gone back to 'team nursing' where we travel in packs room to room to do patient care
Anyway, just sat down

The phone rings and it's my coworker in another bay asking me to come help with matted hair if I have time. I don't really but I also love the challenge & satisfaction of getting matted hair fresh and braided.
I grab some supplies and head over.

There's two nurses at the head of the bed working away. They almost seem angry with how they have a fistful of hair and are attacking it with the comb. But I know better, this project is an act of love. I get to work and start braiding.

Read 10 tweets

CritCareRN

@rn_critcare

17 Jul 20

The alarm goes off at 0535. And again at 0545. Can't trust myself to hit snooze when the first one goes off. Since the beginning of COVID I started taking a sleeping pill before dayshift. Otherwise it's just tossing and turning, wondering what the day will bring...

My dayshift routine is always the same: lunch made for upcoming days the night before. Shower in the evening, clothes laid out. Coffee maker ready for go time when my feet hit the floor. These days I leave 15 minutes earlier due to the staff screening line up...

Are you experiencing any fever, cough, diarrhea? Almost always I must sing the Pepto song: nausea heartburn indigestion upset stomach diarrhea. We all have a nervous laugh while they wait for me to answer. No.
In the past two weeks have you travelled outside of the country? No.

Read 21 tweets

CritCareRN

@rn_critcare

13 Dec 19

When my kids were little, aged 4 & 5, it was our first Christmas with me as single mom. I had just completed a hard semester of nursing school (they're all hard - I know!) and we were making the 7 hour car ride to visit family for the holidays...

It was one of my first times driving on the 401 (busiest hwy in North America), and my kids in the backseat fighting over the imaginary friend was not helping my stress levels. 🤯
I yelled at them to settle down.

To my surprise, they both fell asleep

My daughter, 5 years old at the time, woke up a while later, "Mommy I'm sorry we were being bad"

My heart shattered. I'd been trying so hard to hold it together since my summer divorce, to keep my grades up but mostly to be a good mom. This was all for them.

Read 10 tweets

CritCareRN

@rn_critcare

15 Nov 19

I went in to help boost my coworkers patient. "Careful", he said, "there's no bone flap on your side"

I assumed this was a trauma patient with an increased ICP, removing part of the skull to allow room for the brain to swell is common practice in our centre.

"Was this guy in the accident from last night?" I asked. Turns out he wasn't a trauma pt at all. He had TTP, (thrombocytopenia purpura) and had suffered a massive stroke.

As I was leaving, the plasmapheresis nurse was getting ready to head in for his PLEX treatment.

I helped check blood products for the plex then went back to caring for my own patient. It was a pt with ARDS, sedated and paralyzed... One of many this flu season. I wrote my assessment and wandered to see if I could help my coworkers.

Read 17 tweets

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