Look, we are in the business of solving the case, of being the kiss on a boo-boo, of the patient having a problem and we need to fix it, of being the buzzer beater every damned time.
Sometimes that doesn’t happen.
And it sucks.
I had a difficult case a few weeks ago.
The kind of case where the patient is going to sleep and I am holding their hand, telling them that their son told me to tell the patient “I love you from your Danny.” He told me this while I was getting a phone consent with another nurse because the son was frantically waiting for his flight to get to the area and the patient, who was struggling to breathe, smiled.
The kind of case where you are listening to the pulse ox beeping get lower and lower and, without letting go of their hand you turn your head and tell the scrub tech to please let the first arrivers to the pre-op area (0530) to be on stand-by because the patient might need them.
The kind of case where the abdominal blocks are on hold because if the patient goes straight to the unit what’s the point of them?
The kind of case where you call the anesthesiologist back to the pre-op area that is also PACU at 0400 to tell them of the patient’s desired code status.
The kind of case where the anesthesiologist came right back and spoke to the patient and the son on the phone about what needed to happen about the code status during surgery.
The kind of case where there are a thousand different needs from the field, from the anesthesia team, from the front desk calling you for some reason because they want to tell you not to call in the PACU nurse.
The kind of case where before you even are in the room with the patient you look to see where the open beds are, hoping that there is an intensive care bed.
The kind of case where you text the nursing supervisor that you will need an ICU bed as you are on the phone with pharmacy looking for the coumadin antagonist that has been ordered. STAT.
The kind of case where the surgeon asks for an impossible item that does not live in the hospital, despite you mentioning it several times that it has been requested. The surgeon didn’t want to use the off-brand disposable.
The kind of case that when day shift workers, who have shown up by now, are in the room for the sixth time asking how they can help you send them to get gloves and to try to find the piece of equipment that the surgeon is demanding that you know doesn’t live in the hospital.
The kind of case where the surgery is cut short and the surgeon says that the patient will have to come back to the OR in the next day for completion of the surgery after the patient was worked up a bit more (we call that resuscitation). Because the surgeon knew that the patient was too ill to continue surgery, after the offending part had been excised.
The kind of case where you’d love to go home and get back into bed but you’ve a full day planned between meetings for the hospital and a long delayed birthday lunch.
The kind of case where you leave the patient open because of the need for a further surgery shortly. Open but with a wound-vac.
The kind of case where you call and ask the pre-op area to please get the ICU bed from ICU and a transport monitor and the bed that is left for the patient is a regular patient bed. And the transport monitor? It is dead.
The kind of case where it takes so long to pack the patient and their various lines up and get ready to bag the patient all the way to the ICU the ICU bed and monitor make it downstairs. And you help put the patient on it, making sure that all the lines and the foley is untangled and not caught.
The kind of case where you clock out at 0830, an hour and a half after your end of shift.
The kind of case where you tell the front desk, the unit admin, the charge nurse that the ice cream you’d made for the ice cream social that afternoon was in the freezer and every damned person in the lounge and at the desk freezes and says they forgot that it was today. You collect money and go to the grocery store across the street and buy 4 gallons of ice cream, ice cream bars, 3 different types of syrup, canned whipped cream, sprinkles, spoons and bowls for the exact amount that you collected from the guilty coworkers who forgot about the 11th annual ice cream social. It isn’t like this happens every year.
The kind of case where you go home and stare at the wall for awhile. But you have meetings to attend! So you get up and join the meeting.
The kind of case where you never know the outcome because the patient was transferred to a higher acuity hospital and it is against policy to open up charts willy-nilly because you are curious.
Ugly calls will exist.
What matters most is that you were able to comfort the patient as they went to sleep and you were able to pass on the message from their loved one. What matters most is that you were able to manage all of the calls and push and pulls of day shift and the call shift in that moment.
And that there was ice cream.
Dispatches from the Evening Shift 