Sunday, July 17, 2011

Last night an R.N. saved my life.

*names,details, etc. changed to protect anonymity. . . .blah, blah. . you know the deal.
(These are really ICU nurses.)
"Called you on the phone
No one's home
Resident, why you leave me all alone
And if it wasn't for the nurses
I don't know what I'd do, yeah.

Last night an R.N. saved my life
Last night an R.N. saved my life
from a pulseless heart. . . ."

(the ICU intern remix of Last Night a D.J. Saved My Life.)

When I was a brand-spanking-new intern, I remember taking a call that was so scary that it nearly caused me PTSD. This fearless senior resident was supervising me and thank God she was because the way people were coding all over the place felt exactly like stepping on landmines. My senior resident was the "Black Hawk Down"/Army Ranger of residents; she had already secured a spot in a Pulmonary/Critical Care fellowship, and was virtually like a mini-ICU attending. To that, all I can say is hallelujah.

Hallelujah, because the ICU scared me. Every single page that came through was about something really, really serious. No "can you write for a stool softener, please?" or "can I get a verbal for some pain medicine?" calls. Nope. Every beep was for the hell that was breaking loose in some part of the unit--and let me tell you--hell was sho' nuff breaking all the way loose. I am so glad that I was being covered by someone who knew what the hell to do.

As I already mentioned. . . .since this was the intensive care unit, for the most part, all calls were "real calls." ICU nurses are, by definition, "bad ass" and generally don't go bothering folks with simple things (unless of course they hate you.) These nurses were not only knowledgeable, but excellent teachers for new interns. So, despite my panic, between the unit nurses and my hard core resident, I had great support.

Hell kept breaking loose for most of the night and eventually slowed down some. The unit was full, and my resident told me that this "was a good thing because now we couldn't get anyone new." I decided to believe her, relaxing my new-kid-in-school expression and even laughing at a few jokes.

I guess I got a little too relaxed.

All that easygoing laughter must have made me look more confident than I was. That's the only explanation for what could have possibly given my mini-ICU attending/senior the unwarranted faith in me to nonchalantly shrug her shoulders and say to me, "I'm gonna go and get me a few winks since I have clinic tomorrow. I'll be back in two hours and then you can go get a couple of hours before rounds. You hold down the fort, okay?"

Say whaaaat?

Dude. It was 2 a.m.! That meant I had at least five hours of potential hell-breaking-loose-ness remaining!

Awww hell naww!

This resident was responsible and hard working, and I know that she would have NEVER left me if she didn't think I'd be able to manage things. But the thing is, I didn't agree with her. I was NOT ready for prime time. And being alone in the ICU at 2 a.m. was sho' nuff prime time. I offered her a sick smile but tried my hardest to look easy-breezy. Behind the cool expression was somebody screaming and waving her hands like a wild woman, "MAMA! DON'T LEAVE ME MAMA! I DON'T KNOW NOTHIN' 'BOUT BIRTHIN' NO BABIES!!"  (Well, not exactly that but you get the picture.) She didn't catch on. "Call if you need me, okay?"And before I could say a single word, she had disappeared through the automatic doors. Just like that.

(This is really a picture of me circa 1996.)

Lawd. Lawd. Lawd.

I remember standing in one place, kind of like some city dweller plopped in the middle of the Amazonian rain forest at night. That, or that terrified kid who video taped himself in that creepy Blair Witch Project movie. I was scared to move, speak, or breathe. All I did was pray in my head, "Please let nothing happen, please let nothing happen." I felt my stomach rumbling and my pulse quickening. I repeated my pleading prayer. "Lord, please let nothing happen. Please let me not hurt anybody. Please let nothing happen." 

(This is really an ICU intern.)

And for like ten minutes, nothing happened.

I sat in the nearest chair gripping my sign out cards. I jumped every time I heard a beep or an alarm on one of the vents. For a little while, I even held my breath. And eventually decided to put my head down on the nurses' station. Exactly one second after I laid my head down my pager went off. Before I could even dial the number, I overheard Ida, one of the ICU nurses, yelling for me to come.

"Doc! Doc! Are any of you guys still over there?"

The urgency in her voice made me feel sick. I knew this was going to be something and not nothing. I wanted so bad for it to be nothing. So bad.

I scuttled over to Ida and, in my most confident voice, asked what was going on. To answer me, she handed me a strip of paper with an EKG tracing on it. Intermittent runs of ventricular tachycardia---the kind of heart rhythm that precedes a cardiac arrest. I sifted through my brain for a logical approach to what was surely about to be a problem.

Mr. Jones was the 71 year old patient in question, and had just turned the corner after a near-death experience with multilobar pneumonia. He'd been intubated for nearly a week, and had just been extubated earlier that day. According to my sign out notes, he was now in a step down bed and was "doing just fine with nothing to do." Nobody said anything about V. Tach.


My brand-spanking-new intern brain wasn't on auto pilot yet. I took a deep breath and thought for a second. Electrolyte abnormalities? Was his potassium high or his calcium low or his magnesium low? Was he hypoxic? Were his medications some how screwed up?

Ida must have read my mind. She'd been an ICU nurse for waaaay longer than I'd been an anything so before I could say a word, she rattled off answers my short list of thoughts.

"Lytes are all normal--potassium is 4.1, calcium and mag are stone cold normal. Tolerating the 40% ventimask just fine and oxygenating at 95%. Renal function is also fine." I swallowed hard as I listened to all of that. Shit! Now what? Ida went on. "We were going to transfer him to the floor earlier today, but the attending decided to just watch him overnight to be safe since he'd had such a tenuous course. That was a pretty nasty pneumonia he had, you know?"

I nodded while staring at Mr. Jones. He didn't look good. His face had a grayish cast over it and his brow was covered with sweat. The whites of his eyes looked unusually white, enhancing what I am sure was an expression of fear. A sinking feeling rooted in my stomach and suddenly I recognized something that my senior had been trying to teach me for the past few weeks--the sense of impending doom.

Impending doom. That gut feeling that tells you that things are not right. It's how you know who is sick and who is sick-sick. This man was sick-sick.

"Mr. Jones? Sir, are you okay?" I asked. Which was a dumb thing to ask because he obviously wasn't okay at all.

His response was a widening of his eyes and an anxious pant. I looked at Ida.

"Come on, buddy. We're okay." She tried to prop him up with some pillows and readjusted the pulse oximeter on his finger. She pushed a button to recycle his blood pressure. "Doc, I sent off some cardiac enzymes and checked a twelve lead EKG on him already. Other than a few premature beats it looked okay."

The cuff slowly deflated and eventually displayed an error sign across the LED screen. Ida grabbed a manual blood pressure cuff before I could register what that meant and began attempting to check his blood pressure. All of a sudden, she pulled her stethoscope out of her ears and growled, "Dammit! We don't have a pulse!"

Famous last words. We. Don't. Have. A. Pulse.

No. WE don't have a pulse. Nor do we have a spine. I am 100% sure that, had I had time to eat dinner that evening, I would have evacuated my bowels right then and there. This wasn't supposed to happen. I wasn't supposed to be the one leading a code on Mr. Jones. He was supposed to wait until my resident was awake to have his v. tach and his no pulse.

"We need some help in here!" Ida bellowed to her fellow nurses. They quickly ran to her side.

Things started moving fast all around me. Ida quickly let down the head of his bed so that his feet were elevated. This position, called the Trendelenburg, assured blood flow to the brain when patients became hypotensive. Before I knew it, the room was filled with ICU nurses, industriously positioning themselves to save Mr. Jones' life.

good ol' Trendelenburg.

But the problem was, there were no other doctors.

Crap. Crap. Crap.

See, here's the thing. The ICU nurses already knew what to do. They had paddles nearby and were assessing his cardiac rhythm. They were doing chest compressions. They were drawing up meds and handing me gloves. The respiratory therapist pushed a mask over the now somnolent patient's face and began bagging in oxygen. And me? I just stood there with my gloves on. Paralyzed with fear. Terrified to say or do the wrong thing.

Ida saw the terror in my eyes and whispered in my ear, "Come on, baby. You can do this. We got you, baby. Just think it through. We got you."

And you know what? They did have me. They really did. I carefully walked through the stepwise interventions in the Advanced Cardiac Life Support protocols as experienced nurses helped me through it. They gave me gentle suggestions and firm "uh uh, baby's" when things weren't going in the right direction. It was like walking a tight rope with pillows all around you.

Finally, we regained a rhythm for Mr. Jones and they Anesthesia team reintubated him. Shortly after, my resident came in and helped with the rest of his stabilization. We confirmed his ventilator settings with the respiratory therapists and reviewed the stat lab results that had just come back. After a few more tweaks, he had turned the corner. "Strong work, Kim!" my resident said while suturing down an arterial line in Mr. Jones' wrist. "You saved Mr. Jones' life." 

I saved Mr. Jones' life? Uuuhh, I don't think so.

I glanced over at Ida who was now across the room giving report to the nurse on the next shift. She smiled and gave me a thumbs up. I tried to profusely thank her before she left that morning, but she disappeared before I could.

And so.

Mr. Jones' lived. The sun came up a few hours later. I gathered information on my patients for that upcoming morning. And rounds happened at 7 am.

That morning on rounds, my resident told our attending, "Kim saved Mr. Jones' life last night!"

To which I admitted, "The nurses were amazing. Especially Ida."

Because they were amazing. And, no, I can't exactly say that I saved Mr. Jones' life that night. We did. Together. . . . 


As I remember it, that night an R.N. saved my life.

Shout out to all the nurses who save patients--and doctors--every single day. 'Preciate you.

Now playing on my mental iPod. . . . .(insert "RN" for "DJ"). . .

Who's saved your life. . . or your butt?


  1. If doctors are the rock stars, nurses are the back-up band, the sound crew, and the roadies. They keep the show running.
    Beautiful post, Ms. G.Doctor. Beautiful.

  2. I LOVE the support and encouragement of Ida!! Gave me goosebumps :o)

  3. Great post. We have all been there and nurses are truly the unsung heroes of healthcare.

  4. I cannot tell you exactly why, but half-way through reading this post a big lump grew in my throat and this "You can do this. We got you, baby." made my eyes teary. So often in life, the only guardrails keeping us from falling and shattering into a million pieces are those words and the strong arms of the people saying them. May you always have sturdy guardrails along your path to the pinnacle, and I truly wish for every mother's child to have these guardrails too.

  5. I agree with you that ICU nurses are bad=ass and when they are on your side you really do have all the support you need. I stand in awe of them. I am a medical oncology nurse and the "saves" I do are more in the line of, "did you want to write for pain meds for this patient?" (and save yourself a call at 4am) or "Don't forget to write chemo orders and make an infusion time appt." (or the patient will get here and wait forever and the Infusion Room nurses will page you until you want to eat your pager.) Thank you Dr Brayer for your comment!

  6. Mary Alice, thanks for all that you do! I won't even begin to tell you about all the onc nurses have taught me. . . . whew!

  7. Man , this post is spot on ! I was in the ICU my first month of internship , and the only thing worse than what you so eloquently described , was being the " doctor" who accompanied these patients to their CT/MRI/ or the most horrible of punishments- THE BLEEDING SCAN - between the hours of 11PM and 3AM. Thank GOD for the ICU nurses who were there with me on the long, horrible trip through the halls, on and off the elevator and whatever study that had to go at some awful hour. I love the ICU but I don't miss those days !

    A Fellow Meharrian

  8. haha I love what Anon wrote... I dread going to CT/MRI overnight too.
    Thank you for writing this post! It is a reminder to me (especially during the summer months) that when you have no experience in the ICU it can be terrifying... especially for the intern/doc who is supposed to be the one who knows everything...
    Hopefully I can be an Ida to the docs that rotate in our ICU too. :)


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