At 1035 pm my patient rolled into the ICU directly from the OR surrounded by her surgical team. She had been taken to the OR emergently and was being brought up to the ICU in as quick a fashion. As the bed rolled into its established position in the room, a choreographed dance began. The physicians stepped back to discuss their plan of care and treatment options for the night. They talked to me about what they did in the OR and the specific monitoring they wanted done throughout my shift as well. They wrote the orders for her care and the medications she would be needing. They discussed the expected outcomes for her that night: her breathing and oxygenation needs, her bleeding and coagulopathy risks, as well as her need for pain medication and sedation. While I was being updated by the surgeons and anesthesiolgist the seven other nurses working in my unit came into the room automatically without question. They entered the room and set into motion the work that we do over and over again getting care established in the ICU for patients when they are admitted: drawing and giving blood, setting up specific monitoring equipment, and the respiratory therapist set up the ventilator.
Over the course of the next 2 hours she received many units of blood products and a lot of IV fluid. She needed medication to keep her blood pressure up and within normal limits as well as medication to allow her to relax and breathe with the ventilator. Shortly before 1 in the morning it became evident that something was wrong. Her abdomen grew hard and firm and it appeared that she was bleeding internally. After a quick, urgent discussion with her attending physician it was decided that she would be crashed back to the operating room to open her abdomen and look again at what was bleeding. Within minutes of my call ending with the attending I was being notified by the charge nurse in the OR that the room was ready. The patient was in the operating room for about an hour and a half and when I received a phone call that she was to be rushed to interventional radiology to look at the vessels in her abdomen that were bleeding. I met them in the radiology suite and donned my 20 pounds of protective lead and set up my charting area. At that moment the anesthesia attending rolled in to setup for the case, and the interventional radiology fellow and his attending appeared and were reviewing my patient’s chart and surgical procedures from that day. Within moments the chief surgical resident and OR team rolled in with my patient and we, three sets of medical specialists and myself started working on this patient, together. After we had been in the radiology suite for about 20 minutes I stopped and took pause of what was being accomplished right before my eyes. I sat and allowed myself to reflect on the work that had taken place earlier in my shift in the ICU as well. It’s a prideful, emotional experience when you stop and contemplate the work you are doing, especially during times like this.
Watching and being a part of the mobilization of multiple medical specialties and departments throughout a hospital in the middle of the night is exciting and at the same time, quite an honor. Every one of these professionals; nurses, doctors, and therapists came together and worked together to save the life of my patient.
In my ICU everyday we place the lives and well-being of the patients ahead of everything else. It is never a question of whether or not you will get the help you need to take care of your patient, it is just a matter of how many people do you need to help you. Starting as staff on this unit was a big jolt to my ever so slightly cynical side that had developed over the years. It is greater than just having helpful coworkers; it is the culture of patient care that was created at this hospital a long time before I ever even arrived in Seattle. As new staff nurses start on the unit they fit themselves into the culture of care that has already been established. While we aren’t all the best of friends, there isn’t back biting, attitudes, and egos that get in the way of providing the best patient care possible. The pride I have working at this hospital comes in waves for me, especially when I think about not only the lives we save everyday but how we work together to accomplish it.
In the ICU that night all of the patients were very sick, though none of them went without turns, pain medication, baths, skin care, or individual attention. The immediacy of the situation facing the patient I admitted, requiring many skilled RNs to work quickly and effectively, did not affect or take away from the care of the other 11 patients on the unit.
Over the course of my career and throughout my years as a travel nurse, I have worked at about 10 hospitals and have worked with many great people and made many great friends, but I never felt like I was home until now.
I know I take for granted the care we provide and the coworkers, whom I have the honor to work beside every day. Every once in awhile I find it good to step back and revel in our synergistic majesty.
While the definition of synergy is: conditions such that the total effect is greater than the sum of the individual effects. The impact is life altering.