Sunday, December 14, 2008

Exhausted

Holy Moly, I’ve been MIA and I have lots of catch you all up on. First, the entire month of November I was feeling really down. Some days it took all the energy I had just to get out of bed. I wasn’t excited about anything, nor did I want to do anything. I even hated going to the gym or running (yes, you read that correctly). I was rather concerned. I knew it wasn’t normal to feel that way; however, I didn’t care much about anything.

When my family saw me at Thanksgiving, they thought I looked bad. My schedule wasn’t helping my case. I was working 5 nights a week, 12+ hours a night, and not sleeping more than 3 or 4 hours in between shifts. I don’t care what you say, sleeping during the day does not even compare to sleeping at night. Plus, all this exhaustion was wreaking havoc on my body.

I’m very conscientious about what I eat, how my clothes fit, my weight etc. So when my pants started getting tighter ,and I knew I hadn’t changed my eating habits or how much I exercised, my stress only increased. I finally reached my breaking point when N called, asking me to dinner, and I broke down and cried. I told her that I’m just miserable. I hate working nights. It’s lonely. It’s isolating. I can go an entire week without seeing my roommate. I don’t do that much for myself and the few things that I do (i.e. working out, running, cooking) I no longer enjoy. After an hour of her listening to me sob and sob and sob, she convinced me to go out for sushi in the Village. It was freezing cold outside, but I needed the fresh air. After another restless night’s sleep (that’s the other problem, now that I’m used to staying up at night, I can’t sleep on my days off) I called my doctor. Not being one who EVER takes medication, I now have lovely prescription for some @mbien. Magic.Little.Pill.

Even better than the fake sleep that I’ve been getting is the fact that I’m doing a month long rotation on days. It’s heaven. They’ve also been giving me a lot more responsibility at work. In addition to acting as charge nurse, I’m also precepting some of our new nurses. It’s extremely flattering to be given so much responsibility after only working in the BICU for 16 months.

My transition from nights to days was a little hairy. I worked Thursday and Friday nights, had Saturday off, then worked Sunday, Monday, Tuesday days. Despite the fact that I hadn’t worked a day shift in a year, I was in charge on Sunday, Monday, and Tuesday. Let the games begin!

I won’t bore you with the details but we were slammed with boarder patients from the PACU, two of which were extremely unstable and ended up getting emergently intubated and rushed back to the OR. One patient died. One patient coded six times over 48 hours. The repeat coder also ended up swanned (twice, after the first one was defective), had a transvenous pacer placed by cardiology, then had a GI bleed, then stopped oxygenating his body as indicated by his PO2 of 45 from his ABG.

On top of all this activity, we had another patient who came in intubated with an unknown medical history; she was found down in a house fire after smoking and drinking in bed. Turns out this lady had quite a history with IV drug use and alcohol abuse, so she was damn near impossible to sedate due to her high tolerance of narcotics. Her magic cocktail turned out to be 150mcg of Fentanyl and 50mcg of Propofol.

The above situations kept all of us doctors and nurses very busy, but I had a very emotional experience on Monday. I can’t remember if I ever posted about this patient, but back in July I admitted a five year-old boy started a house fire and ended up with 65% total body surface area full thickness burns. He was intaubted and sedated, teetering the line between life and death.

The night I admitted him, I thought-on more than one occasion- that we were going to loose him. His mother was the first parent I had to address regarding life and death. I took off all my surgical garb, took her by the hand, and walked her into her son’s hospital room. I explained, in lay man’s terms, the physiology of burns. My knees knocked, but my voice never faltered, as I told her that the first 72 hours were the most critical. I caught her in my arms as she broke down; she wept on my shoulder like baby.

I took care of this boy four nights in a row and countless times over the next few months. His hospital stay was complicated by infections, sloughed graphs, respiratory and neurological issues, but every time I took care of him I felt a sense of pride and hope. I was there the afternoon they extuabted him; I watched him take his first non- ventilator assisted breath; I teared up.

This little guy became a fixture on our unit. Everyone knew him, and he knew everyone. Two weeks ago he celebrated his 6th birthday, it was a 24-hour, non-stop party. Everyone from the attending physicians to the house keeping staff joined in the celebration. I knew he was getting better, but the idea of him leaving never crossed my mind. So when I found out that he would be discharged to rehab on Monday, my stomach knotted.

Monday morning I went into his room and had a long talk with him. I told him that although I was very sad to see him go, it was a very special day for us both. For him it marked astounding progress, for me it was a happy ending to a six month journey. I can’t begin to express how meaningful it was for me to discharge the very patient who I thought I would loose.

As I reviewed the mounds of paperwork with his mother, she looked up at me and started to cry. Much like the first night I met her, I caught her in my arms and she wept on my shoulder. However, this time her tears were that of joy not fear. She looked at me, as I wiped away her tears, and mouthed “thank you.” And it was that moment that reminded me why I do what I do. It makes the long hours, the back-breaking work, the stress, and the frustration all worth it. I must have some angels up in heaven, because this reminder couldn’t have come at a better time. Once again, I feel at peace, ready to take on whatever comes my way.

2 comments:

MemeGRL said...

Oh, Kelly, I'm so glad to hear that little boy is going...well, if not home, then at least to the next stage of recovery/new life. It must be tough in some ways to lose a long term patient but how nice to "lose" him that way!
We're home tonight (I typed "hoping" instead of home)--if you are up to it please call.
And remember, sleep deprivation is considered torture under the Geneva Convention for a reason! Good for you for getting the Magic Little Pill, even temporarily, to get yourself back on track. Yay you!
We miss you and can't wait to reconnect!

Anjali said...

That little boy and all the people who helped him are the true meaning of Christmas.

And as far as the night shifts -- my husband rotated shifts his fist 1.5 years out of college and it nearly killed him. After a few months he looked like death. How you describe it is exactly how it was for him.