Dueling Call Lights

Sometimes it’s hard to find amusing things to write about when you are tired and feeling so burnt from work that you can almost see the smoke. So this post won’t try to make you laugh. It will, however, try to put out the fire of burn-out that hits us all once in awhile, no matter how upbeat we may try to stay.

My ICU has been unusually busy and completely filled at all times for months now. Admitting  a patient and transferring them out 6 hours later, to receive yet another admit who is sicker than the first patient, is becoming more and more frequent. So we are all feeling the pressure and the pace, and anything that exacerbates the stress is something we try like hell to fix.

For me, it’s patient agitation. Pulling on restraints, trying to reach the ETT, and  triggering vent alarms all over the place makes me agitated. Sure, we have our propofol and Versed and fentanyl and Ativan, but it doesn’t always work when you are trying to walk the line between undersedation and oversedation, a decent BP versus one that’s in the toilet.

For the past 2 nights, I have taken care of a respiratory failure/pneumonia patient, who is elderly and has some degree of dementia. She’s been lightly sedated with a Versed drip, but has frequent breakthrough agitation, where she gets very close to extubating herself.  Now, most vented patients are scared in my opinion, but I kept getting a very strong feeling that this little lady was way beyond scared. She would refuse to open her eyes, although she was able to. PERRL @ 3mm, followed simple commands at times. She would calm somewhat with reassurance and holding her hand, but she wouldn’t open her eyes, keeping them tightly shut.  Having no other way to make contact with her other than verbal and physical reassurance, I decided she and I had to make some sort of eye contact.  I leaned over the bed and opened her eyelids, and looking into her eyes, said, “Hi there….I’m Kelley, and I’m your nurse tonight.” She kept the eye contact and stopped flailing. She tracked me with her eyes, with me still holding them open. “Do you know that you are in the hospital?” She shook her head “no”. I explained the tubes and the vent and the wrist restraints, and she would nod yes or no as I asked her questions. No, she was not in pain, and yes, she was warm enough.  I let go of her lids and asked her to open them for me, and she peered out through slightly opened eyelids. I thought to myself that this was a lady who is so afraid of what’s happening that she’d rather just shut out any visual input, and slam those eyelids closed and thrash around. And I had been considering increasing the Versed before this, truth be told. (Remember what I said about agitated patients…an agitated patient frequently equals an agitated ME!) But she was better after that–she would still thrash at times, but now she would calm down a lot quicker just with verbal reassurances. I still pulled back her lids at times to talk to her, because I need to make that kind of contact just as much as she needs to receive it. I don’t tell you all this so you think, “Wow, what a sensitive nurse! Bully for her!”  It just made me feel I had done something for this lady that she really needed. Fess up, people, we all need our warm fuzzies from time to time.  We couldn’t continue this kind of work if we didn’t get them–at least I couldn’t.

So to all my vented patients…I do know you’re in there. Next time you are trying to pull out your ETT, don’t be surprised if I peek in just to say hi.