Sunday, October 6, 2013

Combat Zone

We were trying to do emergent procedures in two rooms, three other rooms were actively crashing, and a patient down the hall was in acute delirium.  The night was hellacious.

It never stopped.

It has been like this the last few weeks.

One moment we were coding a patient, the next I find myself alone, with their child, in a waiting room, telling them that they had died.

Another moment it seems like a blood bath. Attempt after attempt after attempt after attempt and then finally success at the Seldinger technique.  

Blood pressures bottoming out – pressors, fluid, pressors, fluid?

Rising lactate levels: 11, 14, 7. Mortality risks rising comparatively.

Rapid Response. Rapid Response - ICU Transfer. Rapid Response. Rapid Response.

“X wouldn’t want to live this way”. I find myself standing alone with the family. We withdraw heroic measures and introduce comfort care: ativan, morphine, extubate, pressors off. Death rattle, death rattle, death rattle. . . . death.

I’m not sure whose blood is on my scrubs.

At times, I find myself under such physical, mental, and emotional stress that it is like I’m in a combat zone.

When I was done with work on that third morning that is exactly how I felt: as though we had been in combat all night.

The stress can be addicting. I was off that fourth night, but I offered to work. I didn’t, though.

After hours of day sleep I was relieved; the extreme exhaustion had finally hit. It was a church night anyway. I got dressed. I left the house with my exhausted mind and body to be around “normal” people and smile and be polite and sing. But I found myself driving to the grocery store, buying milk and heading home. How can one be around “normal” people when they don’t feel “normal”.

It is now days later. I went to church this morning. Time allowed me to be “normal” again. I’m going back in tonight, re-entering the combat zone, or maybe just a quiet boring night.

Oh the ebb and flow of the ICU.

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