Monday, March 4, 2013

Flying Fickle Finger Of Fate

I, like 50,000 other emergency nurses, am pretty damn good at my job.

Which makes losing someone just that much harder to deal with, most times.

I'm not talking about when the 89-year-old senile hypertensive diabetic post-CVA Parkinson's patient with metastasized brain CA comes in as a full code, in full arrest, and with no family closer than 2,000 miles away, if any can even be found. Those are times when, instead of recording what's being done, I want to kneel down next to their ears and whisper "Walk towards the light." as the compressions continue.

I know hospice and ICU nurses who do exactly that, without apology, to let patients who've struggled in excruciating pain beyond any reasonable expectation for so long, know that they just want them to relax and let go of the rope, and they tell them it's okay to go.

And for them, and us, it is okay that they go.

But when an acutely sick patient comes in, and it's someone too young in our mortal estimation to be ready to check out, and our efforts fail, it really really sucks. Deep down inside, where we put the things we feel too much. It makes you feel want-to-cry sad, not-a-Catholic-and-still-feel-like-you-need-confession guilty, and how-did-this-happen inadequate. And if you're anybody but me, for whom a Dr. Pepper is a hypercaffeinated binge and alcohol is only for mouthwash and Nyquil, you probably have an urge to knock back an adult beverage or two. It's hard on our egos and humbles the sober estimation of our own skills and abilities against an implacable universe, it's tragic for the family, especially when they're standing right there, and obviously it's generally quite a shock for the patient.

Like Captain Kirk, I don't believe in the Kobayashi Maru scenario, the unwinnable test. It's an affront to our skills, looks bad, feels bad, and dammit it just ain't fair. We win so many times we forget sometimes we don't. So helpfully, reality delivers a nice cruel stinging gobsmack, just to keep us honest with ourselves.

There's a scene in The Guardian when movie Coast Guard rescue swimmer Ashton Kutcher asks Kevin Costner what his number, i.e. how many people he's saved, is.
Costner, playing a 20-year veteran rescuer, tells him it's 22.
Then he tells him that's how many people he lost over the years, which number, he says, is the only one he ever kept track of.

I can totally relate to that mentality. (In fact, I wish the guy who wrote it would get out of my head.)

As much time as we spend with the whiners, the crazies, the system abusers, and all the walking minor wounded, the battle we...alright, that *I* fight, is really mainly against Death itself. I say this fully appreciating that his batting average is 1.000. But by and large, not on my watch.

So when a guy not old enough for social security comes in the last 30 minutes of shift with severe abdominal pain, and you get his IV, draw the labs, and get him medicated, comfortable, and off to CT in mere minutes, glad he's feeling better and relieved that you aren't leaving any messes for day shift to clean up, nothing takes the wind out of your sails like the doc telling you just before hand off that he thinks the guy is ripping a Triple A.

Except coming back to get report from the same nurse you handed off to the same night of the day you went home, and finding out after he got his CT, and with his family standing all around the bedside, the ones who thanked you for easing his pain that morning, he finished ripping that AAA, bled out internally and died in about 3 minutes, an hour after you went home.

Sucks, sucks, sucks.

My number is 11.

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