Thursday, June 14, 2007

Code Blue.....

Though I keep searching for an answer,

I never seem to find what Im looking for,

Oh Lord, I pray that you give me strength to carry on,

'Cause I know what it means,

To walk along the lonely street of dreams.....

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("Here I Go Again", Whitesnake)

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Things are worse. The rain keeps coming and so does the sadness...

As you know from my last posting, we sent Mrs. Turnwater to the hospital. She was admitted, diagnosed with pneumonia, and has not been doing well.

Today Jenna, one of our home health aides who works part-time at the hospital, was helping Mrs. Turnwater take a bath and get into her robe. (Today was one of the days Jenna just happened to be working at the hospital, and she had been assigned to Mrs. Turnwater's ward.)

She said that Mrs. Turnwater was very glad to have her as her nursing assistant today (as all of our company's patients are when they're in the hospital, as it's so nice for them to have a familiar face to help them while in the uncomfortable environment of the hospital).

And then it happened.

Jenna was helping Mrs. Turnwater hobble over to a chair next to her bed after her bath, and Mrs. Turnwater suddenly grabbed Jenna with both arms, pinning Jenna's own arms. Then Mrs. Turnwater went unconcious and limp.

Jenna instinctively grabbed Mrs. Turnwater as best she could with her own restrained arms to prevent Mrs. Turnwater from falling onto the floor. This caused Jenna to lose her balance--- and they both tumbled sideways onto the bed. But Mrs. Turnwater's grip on Jenna did not loosen for some reason. And thus, Jenna couldn't reach the Code Blue button (which is on the wall in almost all rooms of hospitals). So Jenna screamed out for help.

"Help me in here!" she hollered out desperately to anybody nearby who could hear. "Code Blue! Code Blue!"

The staff came running---and then formally called the Code Blue. The Code Blue team arrived in seconds.

Jenna was immediately shoved out of the way, and she took a place in the corner of the room, fearfully watching the Code Blue Team try, valiantly, to save Mrs. Turnwater's life. Jenna became so upset at the traumatic scene that she couldn't help crying her eyes out, watching the Code Team's efforts as they did all the things that are done in a Code Blue, "intubating" Mrs. Turnwater, shocking her heart area with the defibrillator, and shooting umpteen life-saving drugs into her IV in order to attempt to bring her back to life.

As a veteran ER nurse before doing road nursing, I will just go ahead and tell you the "real" truth about Code Blues.....

It is not the glamorous, exciting situation that you frequently see on medical TV shows where the Code Blue team members move as fast as lightning in a gloriously coordinated ballet of tasks which seem to always end up with the patient returning quickly to consciousness--- with TV viewers getting the impression that the patient was never "really" dead" at all---only appearing unconscious for a few minutes. In the TV shows, the patient is usually "saved" and brought back to life.

That is not how it happens in real life. In real life, a Code Blue is a last ditch effort, an absolutely desperate attempt to save a person's life who has just died in front of you. The Code Blue team will nervously and courageously try those certain ACLS protocols they have been taught for Code Blues (based on the particular way the person's heart is delivering it's last few, ineffective and quivering beats--- while in the meantime their body is continuing to "die" as that quivering heart no longer delivers oxygen to the patient's brain or body)----- and most of the Code Blue team members are as frightened as shit.

ACLS protocols are very difficult to learn and memorize, and one trained in them must know them so well that they can change from one protocol to the other at the drop of a hat in the middle of a Code Blue if the patient's status changes. Sometimes they must change protocols 5 or 6 times in a Code Blue....sometimes more....

And the reason most of the team members are nervous is because they know......

They know that the statistics for bringing somebody back to life from performing a Code Blue are very poor. The statistics for "survival rates" for Code Blues are pretty bad. In some hospitals' statistics, out of all the Code Blue's they perform, their survival rates can range from only 37% to 57%, depending on the age and illness of the patient. And the survival rates for the elderly are extremely dismal. If I remember correctly, the survival rates for age 75 and older are only about 30%. And even if they do survive the code, they will most likely die shortly afterwards.

And also, the Code Team members don't move recklessly fast during a Code in real life like they do on TV shows. They try to move quickly, but they move less slowly than the TV dramas show, methodically and thoughtfully, because they don't want to make a mistake while burning their brains up to ensure that they correctly identify the right drug or amount of joules (units of electrical energy) to use with the defibrillator paddles to shock the hell out of the patient with, per whichever ACLS protocol they are following. And the doctor doesn't always "run" the Code Blue. If a doctor is not available, an ACLS trained nurse will make the decisions and run the code until he or she can get there to take over.

Sometimes codes can get very confusing among the team members for various reasons, for example if the team is not used to working together or else the patient's dying heart changes rhythms during the team's interventions, requiring the team members to change protocols in the middle of everything. Things can get crazy then....

I have seen code team members arguing during a Code Blue--- arguing about which drug to use next or which IV drip to hang. I've seen people tossing drug vials across the room, through the air, at each other--- to save the time it would take to run the drug over to the receiver. I've seen patient's IV's "go bad" in the middle of a code, necessitating the team to lose valuable time by having to start another IV. I've seen Code Blue situations so desperate that the team wasn't able to establish a working IV quickly enough and so they were forced to break open the vials of medicine and then drip it down the patient's throat in a REALLY last ditch effort to get the drug into the person's system as quickly as possible.

And when you shock a patient repeatedly with the defibrillator paddles, sometimes the patient's skin gets so burnt that it smells like cooking bacon, filling the room with a sickening, "pork-ish" aroma.

Sometimes the team member who has placed the ET tube into the throat of the patient doesn't get it placed correctly---and the tube goes to the "wrong" place, causing the oxygen which is being shot into the patient to accidentally get pumped into the stomach instead of the lungs----which then causes the patient's stomach to gradually (and horrifyingly) start to blow up as big as a basketball. Then the tube has to be pulled out and re-introduced again....and maybe again.....

Code Blue Teams don't like to lose a patient. I have seen Code Blue teams try courageously to code somebody for so long----not wanting to "give up"----until the patient actually went into rigor mortis and was obviously LONG GONE....

To this day I still have nightmares about certain Code Blues that I have been a part of during those years I worked in the ER....

True confessions here: I am a diagnosed "burn out" of ER's--- and I can never go back. I'm not proud of this fact. Actually, I am very embarassed and somewhat shameful about it---because I was considered very good at it and loved my years in the ER's. It still haunts me even though I know that burn-out happens to many ER/trauma nurses a lot more often that one might think. ER nurse "burn-out" rates are actually quite high. In the end, with the help of counseling, I figured out that I had simply put in the amount of years in ER's and trauma centers that God had allowed me--- and that was that. And I was going to have to accept it and let others continue on in my place....

Anyway, poor little Jenna witnessed the whole Code Blue of Mrs. Turnwater--- standing there in the corner, quaking in shock and fear, all the while crying her eyes out. Nobody paid attention to her. Hospitals are notorious for not paying attention to "lowly" nurses' assistants. Unfortunately, nurses' assistants are not always treated very well a lot of the time.

The doctor and the Code Blue Team were able to intubate Mrs. Turnwater successfully and got her heartbeat and blood pressure back. After stabilizing her, they promptly sent her to the ICU.

I don't expect her to live through the weekend.

We will watch and see.....

Later, as it was the day for me to do payroll, and when her shift at the hospital was over, Jenna stopped by the office to turn in her timesheets and mileage reports for her job with our company.

She was still crying hard.

I took her gently by the hand and made her sit down in a chair. Belinda and Jane-Anne then grabbed their own chairs and gathered around in a circle around Jenna---because they knew what I was about to do. And they knew, too, that it was necessary.

I wanted Jenna to be able to sit down and tell us about it----and have an opportunity to "get it out" in a safe environment. I wanted her to be able to tell her friends (we, her co-workers in in the road nurse company) the things which she couldn't say at the hospital---- where they are so busy that they frequently ignore nurses' aides and don't consider their feelings. I wanted Jenna to have an understanding place to be able to tell us how traumatic her experience had been and how sad and shocked she was. And about how helpless she felt when she couldn't reach the Code Blue button. And about how worried she was about the patient.

Mostly, I wanted her to know that we were there for her and that we understood how much pain she was in---because we happen to know that she loved this patient very much. And so, she did tell us and she did get it out. But pain like that isn't easily gotten rid of.

Because when she left the office, she was still crying.

After she left, I quietly collected the rest of the employees' time sheets, finished my payroll duties, and faxed the data to headquarters. Although the day before "payday" is usually a happy and boisterous day, the rest of this day in the office was subdued all the way around---for everybody. The sadness and pain in the air was so thick you could have cut it with a knife.

We know that the chances of Mrs. Turnwater coming out of the hospital alive are practically nil.

And so, I trudged back to my apartment at quitting time, not even stopping at the store for my evening meal ingredients (usually junkfood anyway), tired again, feeling beaten, and again dripping wet from walking through one of the everlasting start-and-stop rain episodes.

When I checked the computer, I noticed that I had received an email from an ER doctor friend, a guy I used to work side-by-side with in an ER for years.

In the email, he stated that he'd seen a baby mockingbird in his back yard "practicing" flying--- and that it had made him "think of me".

That cheered me up a little bit.

And also when I got home, I checked on my own Mockingbird Family, of course. And I saw mama birdie sitting on the nest, protecting the eggies from the rain--- on the official Day 11 Since The Discovery of The Eggs....

(I told them this morning: "Don't make me come in there....")

Because, as you can see, the eggies have not hatched yet. What are they waiting for? Engraved invitations?

Sigh....soon....maybe soon......

And so I will sit and knit tonight. Thankfully, the weekend is coming soon and I will be able to get some rest and "re-charging" then. Please pray for my patient in the ICU tonight.....

Thanks for being there for me, guys----because you are MY safe place. Where I can "get it out". You are the ones who I trust to be there for me when I need good, understanding friends who will let me rant and rave about troubles.....

Thank you for being there.

(And in regard to the picture at the top of this posting....Yes, it's true. You CAN really see "Spiderman 3" around here for 99 cents at the matinee. That little theater is in one of the tiny towns which my company services, about 20 miles from the office. Jane-Anne and I were in that town today putting up signs to advertise a Blood Pressure Clinic we're hosting next week and I couldn't resist snapping a picture in order to gloat at my sister, who lives in Dallas and has to pay about $8.50 to see a movie.....)

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13 comments:

Warrior Knitter said...

I think it's always hard when you know there is nothing you can / could do. Especially when you're in Jenna's position. She couldn't reach the Code Blue button and when the team showed up she was shunted aside like it wasn't her patient anymore and she was in the way. Good thing ya'll were there for her.

Vent any time you want about anything you want. The baby birds will hatch when they're ready and Mrs. Turnwater will go . . . home when she's ready.

Enoreios said...

I can relate to being "shoved ... in the corner," and feeling helpless & filled with foreboding at what was possibly coming. It's not quite helplessness; It's far worse.

Your post had me thinking: When I was young, I had a teacher that, "burned out," after working for many, many years in a very high stress job. And several years later I worked a related job for quite a while, (though I currently work elsewhere for reasons other than burnout), and she allowed me to lean on her when things were rough.

She maintained me, (and still does, really), by allowing me to call her and "get it out" with someone who understands. The most salient point-- and the one I was reminded of toward the end of your post-- was that she rarely gave me any specific advice... She just understood & listened. And that was what kept me above water.

ER nursing must be profoundly difficult, and your choice to leave sounds well reasoned and appropriate. But it seems to me that you are still quite capable of healing someone in an emergency. Just ask Jenna a month from now.

Bless you for that.

[P.S. I just added you to my RSS aggregator yesterday, though I've seen your comments elsewhere for a very long time. I look forward to finishing your archives!]

Cyndy said...

It cost me $15 to see "Spiderman 3" last Saturday......

You can vent anytime you like, Bo. That's what we're here for. It's a priviledge to share with you.

And Bo? You should never be ashamed to have retired from ER nursing. The self-preserving decision you made then has made you the great road nurse that you are today, and given you the strength and insight to help Jenna and others like her to cope with the demands of our job.

And warrior knitter is right... all in good time.

Taueret said...

Poor Jenna, she is lucky to have such a caring boss. That photo of the big, butterschotch horse? Wow!

Joe said...

Although I myself have never worked in the ER, I am familiar with the ER burnout rate. Many good friends of mine have experienced it. One of my friends that graduated from nursing school with me worked in the ER at our local hospital for 4 years until one fatefull night...the ER was extremely busy and 2 codes occurred within seconds of each other as she was punching in to work. She ran to the first one, which already had plenty of responders. That was when the second code was called by ban orderly. She ran to that one and had to "run the code" herself. She was very experienced, and very good with her ACLS skills - the only problem was that this patient turned out to be her brother. None of the doctors arrived in time to relieve her, and she lost him.

It was her last day ever, working as a nurse.

aj said...

Oh, Bo, the thing that made you burn out as an ER nurse is the same thing that made you a good ER nurse - you cared. And when you could no longer give it everything you wanted, you did not just quit trying and go through the motions like some people do, you "burnt out".

When I worked in a mental hospital, I saw many workers who just did not care about the patients. The day when I saw Wendy readmitted and thought "oh, crap, another manic-depressive off her meds again" instead of "Oh, no, not Wendy" was the day I quit - a state job with good benefits - and went back to being a waitress.

So please don't feel bad because you were not Superwoman or because you did not choose to stay working in an area where you could not longer care. And give Jenna an extra e-hug from me - and tell her that Mrs. Turnwater was feeling happy and safe before this happened, thanks to her.

Try and survive, both of you. Positive energy to you both.

danielle said...

Wow - Joe....that put the chills right down my back. That is so wrong. That poor poor woman. I dont even want to contemplate that situation...and I am having trouble shaking those chills!

Bo...there is no shame in burning out in an area. It means only that you gave more of yourself than you had to give in those situations. And that is what made you (and makes you) a damned good nurse.

It is also how you go on to your next calling...once you have closed one chapter, you go on to the next. And you take all your lessons and learnings with you.

There are many reasons I could never work the "big floors" again, mostly because I am too old and also because I have been out of them too long. But I also exhausted part of my psyche the last year I worked oncology..too many and too much in one year. I cant go back and face that again.

Please use this weekend for some good down time...

Claudia Dunitz said...

That was a lovely thing you did for Jenna, I'm glad you all have each other, your jobs are not easy...

poody said...

LOL 99cents may be too much to pay to see that movie I was not impressed! Sorry to hear about your pt. I know how attached we can get to these folks we visit. I was out today doing visits and got caught in a reall gully washer i tell ya! Shock, shock, shock, everybody shock. Little shock ,big shock, shock, shock ,shock! That is what I recall from my first ACLS class. Oh the algorhythms!

Beth in MN said...

Thank God Mrs. Turnwater had Jenna with her when that awful experience happened, at least she wasn't alone ... she was with someone who cared about her, and she cared about. It may not give Jenna much comfort yet, but maybe eventually she can see she was "meant" to be there.

Prayers going up from MN!

T-Mom said...

I went and lit a candle today for you and Jenna and Mrs. Turnwater

Katherine said...

I'll say it again--God blessed us with nurses, and entrusted our care to them as His angels. ER nurses--I wouldn't know where to begin. I am constantly amazed at my DD who handles those code blue situations in a pediatric ER. God bless you all! You and Jenna and Mrs Turnwater are in my prayers.

Anonymous said...

I discovered last year that I'm "elderly" (it was a shock, and kind of an insult), but I'm in excellent health and very active.

However! After reading this post, Bo, I called the doctor's office and asked them to send me the DNR and Do Not Intubate forms, and a do-not-do-CPR-on-me if they have one. I'll get my signatures notarized (for extra emphasis) and send copies to my doctor and the local hospital, keep some in my car, in my purse, and maybe use a magnet to hang them on my fridge. Criminy!