The New Job, Three Months In

So my blogging has been scarce, lately, largely due to my being exhausted, working insane hours. We'd lost a couple of people on our team-- one moved to Nevada and one went back to his old job. This week, I worked a more normal schedule-- only about 40 hours. A couple of people who were training came online this week, easing our workload a bit. I'll miss the overtime, but love catching up on sleep.

Where do I begin? My first couple of weeks were terrifying. No matter how many situations arose while I was training, there were bound to be things that came up that I hadn't seen yet. Fortunately, they are wise enough to make sure to schedule us "newbies" with a veteran dialysis nurse nearby for the first couple of months so that we can get some help if needed.

The first patient I did dialysis on my own was a bit eerie; he was born the exact same day as I was, May 11, 1961. It was strange thinking about the paths our lives took since that day-- here he was in an ICU with renal failure and a bunch of other problems, and I was the one treating him. It made me glad I have taken pretty good care of myself healthwise.

Since then, I have learned a ton. Things that were difficult or made me nervous have become routine. Problems that pop up have solutions-- I've seen them before. On Friday, I found myself helping out one of the new "newbies." Still, I've still got a lot to learn-- I'm still trying to master "cannulating" a patient when I have to use a needle to do the dialysis, rather than a catheter. One of the veterans, Jojo, gave me the advice that I'll feel fairly comfortable doing this when I'm six months in. I'm looking forward to it.

A month ago, something happened that I knew was going to happen sometime-- I just thought it would happen later, rather than sooner. I was called on my "call" night to do an emergency dialysis. I got there to discover that they had come close to cancelling the treatment. The patient was extremely unstable. Most of the family members wanted to forego any more treatment; only one, the woman's oldest child, a daughter, wanted to go ahead with treatment. I huddled with the primary nurse and a the physician. The physician had done a consult with a neurologist. The woman, who was only 48 years old, was brain dead. I asked the primary nurse, and experienced ICU nurse, if he believed that the patient was stable enough to undergo dialysis. He said he did.

The primary nurse gave the patient some meds to raise her blood pressure temporarily for treatment. I proceeded with treatment, but was still having trouble keeping her blood pressure up. The primary nurse, who was training someone, was in and out of the room a lot. About an hour in, I started having a lot of trouble with the blood pressure. The primary nurse popped in and looked at the cardiac telemetry and told me that the patient had "coded" the last two times she had shown the cardiac pattern she was presenting. I decided to take her off treatment. I hurriedly returned her blood, and as I disconnected her from the dialysis machine, the "crash team" descended on her. She "flat-lined"-- after I got her off the machine, fortunately. They got her heart going for about 20 minutes, but they knew she was dying. Family members were called in. I left the room to allow them in, and to go notify the night supervisor of what was going on. He reminded me to make sure all the paperwork was filled out to the nines.

The woman died right in front of me and 8 or 9 other medical professionals, and a dozen family members.

Later, as I filled out the paperwork, I had to find out the admitting diagnosis-- abdominal pain. It sounded to me like she might have had a ruptured aortic aneurysm. If that was the case, dialysis-- or almost any other thing any medical professional-- was not going to help her.

I was pretty shaken, but when the night supervisor asked if I would come out to where he was and finish a treatment for him, I jumped at the chance. This is what I do. I'm a nurse.

A lot of my patients are in bad, bad shape-- they have "co-morbidities;" other things wrong with them medically. For a lot of my patients, the dialysis I'm doing is only managing the end. Sometimes, though, something happens that makes you realize that you're doing some good.

About two months ago, not long after I finished training, I got called out to a hospital that's about 40 miles away-- the same hospital as my patient who died. It was a "stat" treatment-- one that needed to be done right away. I got there and assessed my patient. He was in "fluid overload." His kidneys, ruined by diabetes, could not take water out of his body. He was gasping for breath-- when someone is in fluid overload, the fluid backs up into their lungs. He was miserable. His family stood around his bed, obviously very worried. As I got set up, the family said good-bye and told him they'd come to see him tomorrow.

I'd only been in the hospital once before, while training, so it took me a little time to figure out where everything was. I finally got my patient on and treatment proceeded. About two hours into the treatment, I could hear he was breathing much easier. I was astonished at how much fluid I was able to pull from him. Toward the end of the treatment, he started chatting-- he was delighted to find out that I speak Spanish pretty well (he was latino). He even managed to crack a smile and laugh a couple of times.

Later that night, as I drove home, I remembered how irritated I'd been I'd been called from the hospital I'd been at, which was five blocks from my home, to a hospital 40 miles away. I thought of the family-- how happy they were going to be in the morning when they visit my patient and discover him to be feeling much, much better. And I realized that I was pretty happy to be in my profession.