ICU perspective

I take report from the day shift on patients and they are immediately mine, they are here in this moment needing my care regardless of what came before or what might come in the future.  It is not my place to question if they are deserving of my care and the expense of the procedures that we provide in ICU, those decisions were made in the admission or transfer to the floor, once here, I do everything within the scope of my practice to ensure the safety of the patient and improve their condition or make them comfortable.  Those issues don’t cross my mind until in relating a story to Hero (aka hubby) brings to my attention that many might question whether we should be providing this level of care to undocumented immigrants or incarcerated individuals. This boggles my mind, I try to clear the faces of these human beings from my mind and erase the direness of their condition to get a glimpse of the perspective that might deny these people care.  I can’t.

The septic patient we saved the other day who I took care of again just before he was transferred to the med/surg unit, looked at me with grateful eyes and said (through his son, interpreting) “you are pretty.”  Okay, flattery will get you everywhere with me, and at my age I don’t hear this particular one very often, but those words told me lots more than their face value.  They told me of a 73 year old man that has come through the worst of his illness with enough alertness and humor to even make that comment, they told me he was feeling better and on the way to being mended.  His sons; one or another of them were at his side every moment through his days in our unit, holding his hand and searching for reassurance from us, his nurses that their father was going to be okay.  He and they needed my care.

Another patient, came to us after collapsing in his jail cell, coding in ER, being resuscitated and placed on a ventilator.  He had taken a months worth of his blood pressure medication at once, and was in septic shock as well. In spite of the ventilator, being sustained with fluids, levophed, versed, insulin, bicarb, and fentanyl the sheriffs had him chained to the bed at the ankles with heavy chains and two of them stood guard at the door.  This guy was not responsive let alone an AWOL risk.  His pupils were fixed and pinpoint and he did not respond to painful stimulus.  The day I took care of him he was on a two nurse to one patient ration because he was getting CRRT.  We monitored and titrated all his drips to keep him hemodynamically stable, took care of the ins and outs, and basically tried to keep his vitals as stable as possible.  His perfusion was so bad that we were unable to get pulse-ox readings so we were constantly drawing blood gases. They were reassuring, 94-96 PaO2.  For some reason the lab was never able to get a good PTT reading on his coag panel that we were concerned about giving his heparin. We would draw blood from his art line, pulling off the first 10-12 mls before taking our sample, and still no reading. Finally the lab came and tried to draw a venous sample but they couldn’t get anything out of any veins they punctured. The central line was full of all of his drips so not useful for drawing blood.  We never did get a good PTT on him.  His platelets were steadily dropping from 250 to 91 to 37 over the last 48 hours and that had us worried.  During this shift this patient’s brother came to see him and was not allowed in, his mother called the nurse’s station and we were not allowed to give her any information.  At one point the brother was allowed in for a few minutes, and was clearly distraught about seeing his brother this ill.  I spent some time in the hall with the brother just listening to him and being a caring presence.  I’m pretty sure that when I am no longer orienting I will not have the luxury of time to spend with family members.  This patient needed our care and so did the family. I don’t know what he did that put him in jail, I can only imaging why he might want to end his life, but he deserves to be cared for as a human being and his family deserves to a compassionate ear.

The last patient I want to mention was the organ donor we took care of while the transplant teams got ready to recover her liver, kidney and lung.  By the time she was under my care, the family had made their decisions, said their goodbyes and left the hospital.  Although her body was being sustained medically, she was clearly gone.  I kept focused on the people her organs were going to help and how important it was to maintain perfusion and keep these organs healthy.  Even in death the patient and future patients need our care. And I do my best to provide it.