if you ask me why i’m still awake after 12 hours of pure, back breaking, leg aching, bladder bursting shift, i’ll tell you why.

my adrenaline level’s still high. that’s why.

i started the shift with only two patients. patient A was an isolated trached female in her 60s whose transfer to the rehab unit was pending because they want her to have a BM on her own before they accept her. i was warned by the AM RN that she was very particular with things. she wanted her call light at a certain spot, her fan on at number one facing a certain spot, and that she requested/needed suctioning every hour or so.

patient B was a female in her mid 60s. a dialysis patient whose shunt stopped working and had a temporary dialysis catheter placed at noon. i was told the site was slightly bleeding after dialysis at 1700, but other than that, she was pretty stable.

at 1900, i went to A’s room first. i found out that she did have a lot of secretions. doing it every 2 hours to avoid irritation was out of the question. also, her stomach was really distended. her stool was manually disimpacted the night before and in the morning, but she still looked loaded.

after 20 minutes in A’s room, i was told that B’s son was calling, and he was very anxious. he had every reason to be. the dressing over the dialysis catheter was soaked with blood. blood which leaked through the gown, which leaked through the pad, which leaked through the sheet. that much blood will freak any kind of son out.

i reinforced the dressing. changed her gown and pad, checked the vitals (which were normal), and told them i will inform the doctor.

by the time i finished washing my hands after seeing B, it was almost 2000, and A was calling for suction again. the secretion was blood tinged by then, and  i told her i hope she wouldn’t need suctioning that often because clearly, it was getting traumatic.

i browsed through my meds and charted. i was told i was getting a third patient from the basic medical unit. i got report at 2028. patient C was a female patient in her mid 90s who was admitted for dehydration due to severe diarrhea. the reason they wanted her monitored was her heart rate just went up to high 160s out of the blue, BP on the high 150s, without warning.

after i got report, B’s son was looking for me, upset and reasonably concerned. i was embarassed, but i told him the truth. “no, i have not called the doctor yet, but i’ll be there.” the reinforced dressing was soaked with blood again. blood which leaked through her gown, and her pad. again. i reinforced it, changed her gown, and rushed out to call the doctor.

just in time for patient C (yes, it took them only 4 minutes to transfer her!) to arrive from the basic unit. upon transferring to our bed, we were greeted by a very large amount of nasty loose BM, and the monitor showed that her heart rate was staying in the high 150s to the low 160s. i helped clean her while waiting for the IV med.

even though i witness it quite often, it still amazed me how a few seconds after an IV drug is pushed, the heart behaves accordingly. when her heart rate significantly lowered to the high 80s, i was ready to prepare my meds. just in time for the oncall intern to return my page.

i explained B’s bleeding episodes and updated her on the latest vitals. she honestly told me she didn’t know exactly what to do, and asked me to call vascular surgery or interventional raidiology for input, since they were the guys who placed the catheter.

it was already 2115, and i have not prepared meds, but i had to page both MDs and wait for them to call. vascular surgery called and told me to keep the patient upright, and “just keep changing the dressing”. he added he’ll try to come up to look at it, but i shouldn’t count on it because this kind of bleeding is not uncommon in new catheters used right away for dialysis, given the large amount of heparin they place to avoid clotting the line.

i talked to B’s son about what the doctor said and assured him i will not leave his mother bleeding to death like he repeatedly asked/implied. i then changed the reinforced dressing for the third time.

at 2130, i finally gave A’s meds through her NGT. i cleaned her trach site, changed the trach dressing, changed her disposable trach, suctioned her, and helped her to reposition. i was just about to take off my isolation gown, when the charge nurse peeked through the door and told me she just changed the dressing in B’s dialysis cath site because it was soaked with blood, and her son was freaking out.

i called the medicine intern again. begged her to come, just to reassure the family, and to complete transfer orders for C, whose heart rate, thankfully had been stable after that one dose of lopressor IV. my stars were aligned because the intern was one of those who are actually concerned, and within minutes, she was at B’s bedside.

it was 2230 when i finally had the chance to catch up on my charting. i was, by this time dying to pee, but A called, and by the time i was done in her room, it was time to do vitals again.

at 2320, B’s BP was 91/48. that concerned me a little bit, but at least the bleeding stopped. after charting the latest vitals, the clock mocked me with the time. it was already 2345. it was late, but i still had to do give A a harris flush, one which i was supposed to do at 2300.

did i mention i was dying to pee for ages since i don’t know when? well, my bladder had no choice but to wait. i was thinking i could run to the cafeteria before it closed at midnight, but A called, so i marched into her room with the enema pail on my hand.

with her stool blocking the tube opening, the usual 5-10 minute flush took me forever. not only did i not have any success in relieving her discomfort, i also spilled water all over her gown and sheet, which i ended up changing.

thanks heavens for intervening, B’s dressing was dry, her son happy and thankful. C’s heart on the other hand, started playing tricks on me and was staying on the high 120s. i paged the doctor, who ordered another dose of lopressor, and while another nurse ran down to the pharmacy for the med, i eventually got to pee. yay for me and my bladder! it was 0100!

one nurse gave me half of her banana and orange. thanks goodness for kind hearts.

between 0130-0230, i caught up with my charting, suctioned A a couple of times, C pooped, B pooped. don’t ask me why people in the hospital, even without diarrhea, poop in the middle of the night. i don’t know. i have a theory that the smell from other patients’ rooms probably stimulates their reflexes to join the fun, but that is just a silly theory.

at 0300, vitals and Is and Os. break at 0400. at 0430, suctioned, repositioned, charted.

at 0545, i had to give A another harris flush. when i was almost done, she motioned to stop it and asked me to suction her. i told her i was actually done and was just tidying up my mess. “suction me NOW!”, she mouthed.

i saw her sats drop to the high 80s, i found out i ran out of suction catheter, i ran out of the room to get some catheter, i came back to a paper white faced C, whose sats dropped to 24%, heart rate to 43, and was unresponsive!

i called for help, they called the rapid response team, i increased her oxygen to 100%, somebody pulled the code cart, i suctioned like my whole life depended on it, a team of experts in their fields were in the room. in less than a minute.

i got a big chunk of thick mucous, saw the sats go up to 70s, then 80s, then 90s, heard A respond to the doctor, saw her smile when i asked her if she was okay. i breathed a big sigh of relief, and yes, i almost peed in my pants. because it scared me to death that i thought i was gonna do CPR on a patient i actually learned to like in a short period of time.

when it was established that A was stable, i changed her gown and sheet. before i left the room, i told her “don’t scare me like that again. especially when i am about to go home.” she smiled back and joked that it was me who scared the living daylights out of her.

it was already 0625 when i finally got the chance to update the oncall intern about what happened to A. by then, the unit was buzzing with RNs going out and coming in.

that’s why my adrenaline is still pumping. i have already eaten breakfast, told the same story to my poor husband who gets to hear the same thing everyday, but still, i can’t just sleep yet. not yet.

because my adrenaline’s still pumping.

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i started this post monday morning after work, and just finished it today. it’s specially for people who stumbled upon my site searching:

“what does a nurse do the whole day?”
“what is a day in a life of a nurse like?”
“what do nurses do at night?”
“why are nurses so busy?”
“what do nurses do in a 12 hour shift?”

this real example of a busy shift does not happen everyday, but they happen quite often.

if not a bleeding problem here, a fall there, a seizure here, abnormal vitals there, there will always be the usual confused patient who will pull out their IVs or NGTs, or foleys while getting out of bed cursing everyone in the unit for tresspassing. add in those patients who are not sick enough to complain about everyone and everything, or some family members who are dissatisfied with everything and everyone, and you get the whole nine yards, just in 12 hours.

never a dull moment. not when you are trying to help save lives. or at least trying to help make their remaining hours comfortable.