Full Moon

'bad things happen in hospitals when there is a full moon. '

i'd heard this before, and always pooh-poohed it as a stupid superstition. like the one that a nursing school instructor told me about. she said that when she had a patient that was going south, she would tie a knot in the patients bedsheet, and swore up and down that it kept patients alive.

baloney.

then, i had a full moon night.

1900 hours.

first of all, the ER was nuts. that seems to be the first prerequisite for a truly crayzee full moon night. eventually, they went on divert, at around 2 in the morning.

before that, we had been triaging people like crayzee. the neuro/shock/trauma/cardiovascular intensive care units were full, so that left us as the the last stand for new/crashing admits. yay.

2300 hours.

triaging means that you look at the patients on your floor and decide who is MOST stable. we move people to less acute floors that maybe would have been going there anyways the next day......and so forth. so, you make a hard decision, ship somebody out, and prepare to get a crashing patient. not fun.

of course, thru our charge nurse, we hear the scuttle-butt from the rest of the hospital that this patient is going to this floor or that floor. we watch the ER board like hawks, waiting to see where the chips would fall. we had, like three codes blues and a couple of rapid responses.

0000 hours.

one of those code blues needed one of our rooms, and while we were busy triaging, they had to bag the entire time, until our room became available.

good times all around.

0200 hours.

there was also a storm, and so, of course, the power goes out. just as we're stabilizing the crashing patient that we just admitted.

nice.

darkness for a few seconds, then auxiliary power comes on......and we're back. we have these green, glow-in-dark outlets that are the designated outlets for these situations. problem is, we don't really have enough outlets to go around for all the equipment AND the computers. so not only do most of the computers in the rooms not work, neither do most of the computers in the nurses station.

well, the power will come back on later, we'll chart stuff then.

0245 hours.

hey, nurse J, looks like we need to triage another patient. somebody in the ER needs it so........ lets move 29.

okay.

the patient in 29 is a recovering abdominal surgery, stable as anything, totally on the mend, on the way out for sure. mid fifties, newly retired, looking forward to an impeding grandson. pt spouse, on the way out early that night had jokingly admonished me to,"keep my sweetie alive, nurse j, i'm too young to be alone." smile and nod, "of course i will."

right?

0300 hours.

walk into the room right behind the respiratory therapist, who got the same news i did and is in there to get the CPAP ready for transfer.

i glance at the monitor. sinus rhythm, sats in the.....90? well, the waveform looks like crap, no wonder. i grab the sat monitor to see if it on the patients finger correctly and yeah, it's on there good. hmmmm...........

89.........88........87..........

0301 hours.

uh oh, where's my pulse? (feeling for a pulse, patients is still warm in the legs and feet)

can't find a pulse.

0301 hours 30 seconds.

i see the charge nurse walking past my room, hey, man we're not gonna be able to transfer this patient, we're gonna code'em in second.

charge nurse, great. we better call it overhead.

0301 hours 45 seconds.

help arrives.

i'm trying to find a pulse and getting ready to start CPR when another nurse walks in to help.

uh-oh, what's going on with the QRS? quick glance at the monitor from me reveals that i've lost the nice even sinus rhythm i had going, and my QRS's were now getting really really wide.

shit.

0302 hours.

start CPR. begin nightmare dream sequence.

0302 hours thru 0320 hours;

attempt to intubate. pt vomits on most people within a three foot radius. intubate. can't get labs up or a history because the computers in the room aren't working because the power is still out. draw stat labs (100% WNL-within normal limits-100%). continue CPR, with pauses to see if we can ever get a pulse. no joy. try to answer the questions of the cardiologist, the hospitalist, three residents, and a pulmonologist (who was the gal that ordered the pt be transfered in the first place.)

no, nothing is wrong with the labs, everything was normal. crit, electrolytes, lactate ..... everything. afebrile, alert and oriented, vital signs stable.

WITHIN NORMAL LIMITS.

0319 hours.

cardiologist, 'does anyone here object to ending this now? anything we missed?'

silence. except for the rhythmic beat of the CPR, and the whoosh from the person bagging my patient, no one objects.

0321 hours. call off the code. TOD (time of death) 0320 hours.

0322. start cleaning up the patient. is it an ME (medical examiner) case? nope.

okay. remove lines, tubes, drains, leads, patches. clean up vomit, poop and blood. change the sheets. throw stuff away.

deodorize the room, throw away the garbages.

hide the evidence of my failure and my broken promise.

0340 hours.

patient spouse arrives from motel down the street. it took a while to get to the hospital, what with the storm and the power outage and having to get dressed by the light of your cell phone, but the spouse is here now, sitting in a chair outside the room, speaking with the doctor.

i'm sorry, but there was nothing more that we could do. we did everything we could. i'm sorry for your loss.

0345 hours.

room is clean. spouse is at the bedside, holding hands with the deceased. i close the door and leave to go sit at the nurses station. the cameras still have power, i promise the doctor that i will keep an eye on the spouse, because she "doesn't need another patient tonight."

0400 hours, accompany spouse to the parking lot, in a light drizzle. find the car.

are you gonna be okay?

yeah. i think. i'm not sure. pause.......i'm not ready to be alone.

0630 hours.

mercifull the shift is over. as i pull into my driveway, i happen to look up and see that, nice, tonight was a full moon.

damn you, stupid moon. and my disbelief about nursing superstitions. that's what i get for dissing the karmic gods of nursing, they piss buckets of horribleness out on me.

shoulda tied a knot in that patient's bedsheet.