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Imagination in the ICU

I don’t think I would admit this to my colleagues, but I find some of the expressions used in the ICU to be kind of heartwarming, if not downright charming.

For example, when someone is about to be extubated and the nurse might say, “I really don’t think he’s gonna fly.” The vision of a coughing, sputtering extubated patient turns into this:

Or when someone is “bucking the vent” (which means the patient is breathing over the ventilator) the sick, struggling patient turns becomes this:

Or my absolute favorite, “The Renal Player.” This simply means a patient who has kidney problems. Whenever I hear this, I picture a bunch of dialysis patients sitting around playing poker in Las Vegas.

For more interesting ICU imaginative stimuli, check out Bob’s Dreams. This patient actually recorded his dreams after being vented and sedated with ARDS.

In the weeds…

I really got beat up the other night. It was my first my first nightshift with two ICU patients. I came on at 7PM and both of my patients were missing 6PM meds that hadn’t yet come up from the pharmacy. Looking back this seems like a minor detail and yet it was enough to put my entire night into a tailspin. I never felt fully in control, and with each hour it got worse. My preceptor was close by the entire night but she purposefully left me alone. I know this is what the preceptor is supposed to do. Otherwise, “how am I supposed to learn?” Persistent thoughts kept cropping up… “How am I ever going to be able to handle this?” and “Why did I not become a psych nurse?” I could be sitting in the day room right about now, playing UNO with the mentally ill…

So now I am spending my precious free time composing a cheat sheet of all the commonly used protocols that I will be using… Calcium, Heparin, Insulin, Potassium…all the major players. It’s one action that may or may not contribute to my perceived loss of control. I will also go to work and hour early and plan out my night. The rest of the time I will repeat in my head: You can do this you can do this you can do this. And hopefully somewhere in this process I will remember why I am doing this.

It reminds me of when I was 19 and I got my first waitressing job in Ocean City, NJ. I lasted two days and finally gave up, thinking, “I will never ever be a waitress because I totally suck at it.” Instead I took my fallback job as a pretzel roller at one of the first Auntie Anne’s franchises. I was actually trained to make pretzels by Auntie Anne, herself. Little did I know that I would eventually go back to waitressing and it would end up being a 10+ year career.

I can tell death is going to be an issue.

It seems like the majority of the patients on my unit don’t make it out alive. Most people who work on the unit say, “If they ever try to bring me here as a patient, shoot me first.” They’re not kidding.

It really hit me the other day. I was looking through my alumni magazine (from the other degree) and in the “deaths” section I saw the name of a patient I had cared for. I was surprised because as far as I new he did make it off the unit and his wife had written a thank you letter to the staff. I yelled out, “Oh my god! It’s (blank) (blank)! I cared for him in October!” My husband replied, “Don’t tell me that!!! Remember HIPPA!!!” I briefly wondered if HIPPA applied to the deceased. Of course it does.

On Thursday I was on the unit for an orientation day. I walked down the hall and I just happened to look into a room and I saw a patient dying. It was so strange. Her family was gathered around her. She was still as a statue with yellow, waxen skin. Her eyes were wide open. I felt fairly certain that she was already dead. How strange to think it will soon become an ordinary part of my job. Here I am with my orientation binder in my hand, going to the next class and there is death, just a few yards away from me. And with no ceremony, or outpouring of emotion. It was just … there.

So there’s a lot of death on my unit. There’s even a smell that I associate with death. Inwardly I think of it as “that MICU smell” and I’ve come to believe it’s the odor of dying cells. I’ve suprised myself by how quickly I’ve gotten used to it. I can actually eat lasagna in the break room while I’m smelling it.