Everyone needs a friendly reminder now and then of why we do what we do - here's mine.
After carefully reading the printed handwriting on your flow sheet, I realize that your story isn't unlike many others that I've read. The night shift nurse gives me a detailed list of your injuries. You're young, I don't need to see your birth date to know that, as I glance up from the cubby outside your room to look at your face, only nineteen years old and your first trip to a level one trauma center.
You were the driver in the accident, I'll later see pictures of your car wrapped around a telephone pole on the local news station. It was pretty bad. You weren't breathing on the scene, so the first responders got to you ASAP. Your 15-year-old friend in the passenger seat was taken to a different hospital and discharged a few days later. You were much worse, so you came to us.
Your tox screen was pristine. The accident was in no way your fault, but it left you with a list of injuries: a broken pelvis, long bone fractures in your leg now placed in traction, and I had a sneaking suspicion that your head cracked the windshield when you so abruptly stopped. I'll tell your mother who is dutifully keeping watch in the back of the room that we needed to fix the things that would kill you within the first few hours before going back to fix your leg.
You're still on a ventilator on that first morning of three when I'm your nurse. You have a nasogastric tube and a central line with a pretty basic list of medications: pain meds, sedation, and fluids. Your vent settings are low enough, so I know your lungs didn't take a beating through all of this. It's a good sign, they might even be able to extubate you soon if only you would start following commands.
And so, I start my day like any other, gathering information from the computerized charting, the list of systems, and any concerns given to me by the night shift nurse. It's time to wake you up, coaxing you slowly out of the propofol haze so I can try and get you to put your thumbs up when I ask, wiggle your toes, stick your tongue out - anything so I know you're hearing me in there and can understand me. I encourage your mom to help when I wake you up, sometimes I think hearing that familiar voice helps keep you calm when you can't talk and are breathing through a soda straw as multiple people scream at you. We know it's not a good idea to yell at someone rapidly coming out of sedation, and yet we sometimes do.
You respond little by little, the slight shift of a foot, you even crack an eye open at your mom's voice. I go slowly, remembering the previous shift's warning that, "He wakes up like a bear!" This adds to my suspicion you might have a head injury. Not breathing after the crash, lacerations to your head, and that snap-like change in mentation from a groggy propofol daze to an anxious "WHAT'S GOING ON?" in 0-6 seconds. Yeah, it's not confirmed just yet, but I sure have my suspicions...
Fortunately, the "bear" doesn't rear his ugly head and I get enough of a response that I'll consider it almost following commands - for now. Unfortunately, it doesn't get any better than that for me, I can't give you the highest neurological assessment every time I pause the sedation, but every once in a while, I do. And I can lower your sedation to give you the best chance to respond without the risk of you yanking your breathing tube out, so your vent settings come down even further. Things weren't so easy that night.
Apparently, you have a few episodes where you thrash around and try to self-extubate - a four-letter word in any ICU. It scares your mom because the night nurse who comes in to tackle you back down to the bed doesn't have anyone else behind her, so there she is, pinning one arm down as the nurse takes the other and puts you back to sleep. The cavalry it seems is either busy at those moments, or they can't hear her. You happen to be one of the lucky patients in a corner room which makes things even more difficult. Your mom starts to feel obligated to stay and the sedation goes back up, you follow commands sporadically when it's safe enough to pause the sedation but fortunately, your vent settings stay low. Family members come and go on day two, because your mom looks exhausted, and your family all agree she needs some sleep.
But the second day I have some success, I start to bring your sedation back down. Your friends even come in, your buddy from the accident is in a wheelchair but he's doing okay. I later texted my boyfriend (who was at the wreck and transported your friend) that your buddy looked well.
And then the tipping point happens where I think we might actually be able to take that tube out. Your sedation is low enough that when the trauma team rounds on you in the mid-afternoon on the second day, I hear their attending ask why you aren't extubated.
"He isn't following commands, we're working on it though," I tell him.
There goes the trauma attending, a tall and imposing military man who scrubs with hand sanitizer, walks in the room, puts his hands on your traction frame, and barks out in his best drill sergeant voice, "Open your eyes!"
Oh...well hello there.
Caught between thoughts of men...and you little... I watch as you wiggle your toes, put your thumb up, and stick out your tongue. Okay...you're one of those guys. The night nurse and I were women, and so is your mom (obviously)...maybe you just need us to be mean...or men. And note that neither me, the previous nurse, nor your mother are soft-spoken...you just like to listen to guys instead of us. Your mom and I share a satisfied glance and she starts to tear up and hug the doctor... it's a sign you're getting better.
When you were finally extubated neither the Drill Sergeant Attending nor the nurses could get you to say anything, although without the propofol you did follow commands. In fact, the only word I got out of you was "broccoli" immediately after you were extubated and started spewing green florets everywhere. (Where were you packing that by the way? I had your NG tube on suction for a full hour before we took the tube out). Then there was the time when you wiggled all of your 6-foot 2-inch frame to the edge of the bed while in 30 pounds of traction and tried to flip over on your stomach (which we would later learn was because you were sporting a DAI...). Oh yeah, you were strong...strong enough that when I called a nurse in to help fix the sheets you nearly picked me up off the ground as we turned you on your side and you somehow got your arm around my waist.
Frankly, I'm not sure how it happened either, but by the end of the third day, your mom was asking where she could leave a comment card about my care. And in the week after she always took time to say hello to me in the hallways, as did your brother and your aunt. I even remember one night when I helped your brother who was panicking because he saw your arterial line go flat (you were flapping your wrist around). I kept your arm still as he helped me re-zero the line.
You came in once for a follow-up visit too. You were talking then, all the lines and tubes out of your body, and a knee immobilizer on your leg. Your voice was still soft and quiet as your mom introduced me. You didn't remember me, but I have a feeling you knew you had spent some time here. It was okay, I had the biggest smile on my face. You're only the second patient I've seen who came back to the floor and recognized me in some form or another, even if it was your family, and it felt good.
What feels even better is after I saw pictures from the accident, seeing you and your friend standing tall 8 months later. There's not an ounce of hesitation or softness in your voice, just a little hitch in your step. We fixed you up and in return, you're hosting a blood drive to give back to the community. You can bet I'll be there!
I can't tell you how it feels to see someone I've cared for look like he blends right into the crowd. Oh, I know things aren't the same, and this experience will probably shape you for the rest of your life. But I'll look back on that day and when the shift is rough and things are going to hell in a handbasket, I'll be able to say this is why I do what I do, and know that every once in a while, I do make a difference.
Jenn's note: Awesome story Liz - thanks for sharing!
For more stories of compassion: https://amzn.to/3SUHcCL
Published by Jennifer Tipton / This post may contain affiliate links.