Nightmare Shift

Just another morning in the ICU (or so I think) as I walk up to the front nurses station to get my assignment.

I see my name next to a pair of patients, but then I notice it's also next to another pair of patients, but on the other side of the unit. 

"Hey Tracy," I call to the night charge nurse, "I think you've got me double assigned here."

"Weeeelll," she hedges, "Not really.  These two will be your assignment, but I need you to take these two also.  But just until their rooms are clean."

She can tell by my face, I'm sure, that I'm much less than thrilled.

"Don't worry, It will just be for a few minutes and you just have to wheel them upstairs, the night nurse already called report."

It occurs to me that the charge nurse, or the night nurse, seem quite capable of "just wheeling them upstairs".  I mean, I've heard of being tripled, but quadrupled?!  In the end though, I grudgingly accept the assignment.

By the time I get report on my two "real" patients, the unit secretary lets me know that the room is ready for one of my "fake" patients.  I glance in on my other patients to make sure they are breathing, load him up in a wheelchair and head for the elevators.

Once I return from settling him, the unit secretary tells me the other room is ready as well.  Maybe this is going to work out just like the charge nurse intended.  But that scares me almost as much as the stupid assignment, because if it does work, they'll be inclined to do it again.

When I go into the other room, the first thing I notice is that the chest tube atrium is almost full.  Knowing full well the floor nurses will bitch and moan about having to change it (and also a high likelihood they'll refuse to accept the patient until it's changed) I head to clean supply for a fresh atrium. 

I fill the atrium with the blue water (same color as the water in porta-johns, think about THAT for moment), clamp off the chest tubes, and make the new connections.  It's only when I slide the old, full one over that I notice the TWO other old, full atriums hiding under the end of the bed. 

Now realize, I haven't gotten any kind of report on this patient.  I really have no clue what's going on with him, even really what surgery he's had.  I assume he's had some sort of CT surgery, given the fact he has chest tubes in.  I pause, contemplating the significance of THREE full atriums.  I mean surely the physician knows, right?  Surely he wouldn't have written floor orders if it wasn't a resolved issue, right? 

Right?

I turn around and happen to look at the fresh new atrium.

The first chamber is already full.

As in 200 mls of fresh, frank blood.  And as I watch, the level is steadily rising. 

Ah crap.

I grab the chart to find out which physician I need to call.

Great.  Dr. Ballantine.  I have NO clue who he is, not one of our regular surgeons.  I fumble around, and find a cell phone number in the progress notes. 

Ring.  Ring.  Ring.

Finally a very tired doc answers the phone,  "....Hullo?"

"Dr. Ballantine?"

"...yeah?"

"Your patient Mr. Soandso is bleeding quite badly into his chest tubes."

"......"

"Um, I have 3 full atriums here, and he's put out 200, no, 400 mls now, in the last 10 minutes."

"......"

"Uh, sir?"

"What do you want me to do about it?" he slurs.

Dumbfounded, I stand there for a moment, only to be shaken from my reverie by the monitor alarming.  Guess whose pressure is now in the 60s.  He's also gone unresponsive.  I set the phone down on the counter to check a pulse.

Of course there is none.

I immediately leap up on the bed and start compressions.

"I need some help in here!!"  I yell.

But nobody seems to be coming.  I yell a second time.

Nobody.

Finally, I lean to the head of bed and while continuing compressions one handed, I mash the code button.  Now, normally we don't use the code button--we run our own codes.  Pushing the code button results in a room crowded too full of overeager, yet usually semi-clueless residents and interns.

Today is no exception.

My knight in shining armor turns out to be a first year resident.  I'm immediately reminded of the 4F's of a gallbladder differential diagnosis--Fat, Female, Forty, Fertile.  With huge boobs.  I wonder abstractly if her stethoscope is long enough to reach past her boobs?

She immediately decides my patient needs to be intubated--which is the most ridiculous thing to be concerned about at this particular moment.  No pulse, no pressure, probably no blood because the damn atrium is full again and the chest tubes look like red garden hoses.  And, since the patient was headed to the floor, no central access.  I tell the resident so.  She is clearly very pissed, but stops the intubation charade.

The room is filling up now, and someone FINALLY brings in the crash cart.

And of course, here comes RT trundling in with a vent.  The vent alarm is continuously going off, "Circuit Disconnect, Not Ventilating!!"

Only then I realize, it's my cell phone alarming.  And I'm home in bed.

Dreaming.

Awfully tiring working a shift in your dreams at night between two day shifts.