Today

5 am has come way too soon. On nights before I work a shift on the unit, I worry so much about oversleeping that I wake up nearly every hour through the night to make sure I haven't slept through my alarm. Usually my jaw muscles are aching and quivering by morning because I've been clenching my teeth--a sign of the tension I'm carrying about my upcoming shift.

As I pull out of the driveway, the brisk 50* March morning breeze tousles my hair. It's one of the things I love about owning a Jeep--the removable top. My morning NPR thrums in time to the tires rhythmically bumping over the expansion joints in the concrete roadway. I sip on the Dunkin Donuts french vanilla coffee that my wife brought home for me to try. Its toasty roasted warmth permeates my sinuses, coaxing my brain awake.

I get to the remote parking lot just in time to catch the early shuttle, saving me a 1 mile walk from lot to unit. I sit near a former classmate of mine from nursing school that got hired into the OR internship at my hospital, happy to see a familiar face. Early morning small talk splatters across the aisle, like dew dripping from hesitant grass.

Once on the unit, I'm 30 minutes early as usual, and check out the assignment board. I discover I've been assigned to a tough pair of patients--neither one entirely lucid, swimming instead in the murky waters of ICU psychosis. I notice my hard-ass preceptor is back from his 2 week paternity leave.

*Sigh*

It's going to be a long day.

I head into my pod and get report 20 minutes early, just to get a jump start on my day. As expected, both patients are super busy, and heavy on meds and tasks. They've both been on the unit a full week or more. That's about a week longer than most of our heart patients--we transfer out on post-op day 1 when things go right. One patient has had seizures and other neuro complications. The other has been in 4 point restraints for most of the week to prevent him from pulling out his balloon pump and flopping onto the floor to writhe around like an out of water guppy.

As I'm doing my morning assessment, my seizure lady kicks into full-on anxiety mode. Taking her hand in mine, I get her to focus on my face and gently talk her down from her ledge. She tearfully thanks me for helping her, and profusely apologizes for being troublesome. I assure her that everything will be ok, and it's my pleasure to help her. "We're going to get through this day together," I promise.

It's a scene that will repeat several times during day.

Meanwhile my 4 point restraint man is satting 100% on bipap, but shaking his head like an angry mule trying to dislodge the mask. I DC the bipap to a simple mask at 30%, just to see what he's going to do. Eventually I get him down to 3L NC, still satting 100%. He begs me to get him up to the chair, and I oblige--releasing 2 soft point restraints per limb. Once he's in the chair, he is completely lucid and cutting up, causing trouble.

The good kind of trouble.

As his family comes in to revel in his new found lucidity and good fortune, he gets very emotional. His fear that he'd never see his wife of 65 years again is a heart-rending confession when she comes in to visit with him. They're only 87 years old. Halfway through the shift he starts weeping, and as I try to console him he thanks me for saving his life. What words are adequate to respond?

I kick seizure lady's family out of the pod so she can sleep. I'm convinced her psychosis and seizures have more to do with sleep deprivation than a neuro issue. Towards the end of the shift I convince the CT surgeon to transfer my seizure lady to the floor where she'll have a private room, and blessed sleep. I lecture her family about talking her into asking for pain meds. Maybe if she's not on Dilaudid every 4 hours her GI tract will break free from its paralysis. They fuss at my iron-handedness. They thank me profusely as I transfer them to floor, regardless of me taking them to task. In the waiting room I overhear them bragging on me to the other families.

When I get back from transferring my patient, I assist with a new admit surgery--a fresh CABG. That's when the woman across their pod chooses to tamponade and code. I'm next in line to do compressions when we get her back. Her 16 year old grand daughter was bedside when it happened. I shepherd her into the waiting arms of the chaplain as I dash down the hall to pull another 750ml of 5% albumin from the Omnicell. It's a delicate ballet--a well orchestrated exercise in futility. Her RCA perf'ed in the cath lab, and her entire right ventricle and most of her septum has infarcted. She's not long for this world, but we did buy her another afternoon conversation with her grand daughter. Worth it I think.

4 point restraint man gets visibly upset when I let him know I won't be back the following day. He worries that his new nurse will let him down and that he'll sink back into the confusion. I settle him as best I can, and reiterate his goals to get to floor, and then home. I think he halfway believes me when I tell him that he's going to be fine.

Surprise. I admit a patient with Marfan's. She's been in the ED all day with hemoptysis and a deep tearing pain in her chest. Hmm, dissection anyone? I have just enough time to get her settled and an assessment documented before I have to total out my I&O's.

Night shift has moseyed in. I'm lucky--the nurse taking over my patients is as punctual as they come. I give report, astounded that the 12 hours I've experienced can actually be condensed down into a 10 minute synopsis. We check orders, and I autograph the chart with a flourish.

My crusty preceptor tells me, "You did a good job today," as we clock out. I'm dumbfounded.

My nursing school classmate that works on my unit was the primary nurse on the patient that coded earlier, and I let her decompress on me as we walk the mile back to the remote lot. Her husband is supportive, but doesn't understand all the pressures we go through. He doesn't understand the subtlety and gravity of the events of our day. She destresses and I just listen as we walk. By the time we reach the parking lot, she's calm enough to drive. I know she'll do the same for me, and likely soon.

As I climb into the Jeep for the drive home, I realize I've parked under a flowering pear tree. There's a layer of fragrant petals sprinkled across the interior. As I pull onto the highway, the freeway evening breeze turns them into a petal snowstorm. They swirl around me and lightly flutter across my face, reminding me of the gentle way we as nurses can affect the recovery of our patients. It goes way beyond the obvious, lifting gently into the air in a menagerie of healing.

And for what must be the hundredth time in a week, a month, a year, I thank my lucky stars that someone, somewhere saw it fit to place me in this time; this moment; this space.