Juxtapose

Sometimes I forget that when I go to work in the morning, if I have one little oversight, one small but notable thing written on my little 4x4 sheet of paper with all the patient's information written on it that I might miss, someone could be seriously hurt, harmed, dead, etcetera. Sometimes I'm just not into that kind of responsibility. Things more so fast. The surgeons are in so quickly, they want all this information so fast and right off the top of your head and I'm just trying my best to bring it together, grabbing around, picking the little fruits of knowledge, critical thinking, and common sense off of a million swinging vines in my brain. And based on that information and their assessment they get these ideas in their heads to do something about whatever is happening with the patient and sometimes it happens so fast for me.

Yesterday I came into work with a full assignment and two new grad nurses (one of them not yet having taken her boards) to oversee while they each took on a patient. I'm thankful for the help, obviously, but it takes longer, more effort, and more discretion on my part to make sure my patients are okay while they're being cared for under MY nursing license. Nobody told me I'd have new grads to help orient, I just don't like being in the dark about these things and, surprise, good morning at 0645, you need to make sure that you don't kill anyone, and, also, that these two other people don't kill anyone while your name is all over the chart. So last night I had a close call. Someone else was doing all this stuff for the patient they were assigned to, and when the surgeon ordered a procedure and the new grad and one of the clinical instructors was helping prep the patient for it, they told me as I went zipping by doing other things that the procedure was ordered for the patient and they'd be fine to send the patient down without my help, as a learning experience. Not looking at my paper and not stopping to take the time to consider the whole implications of the procedure, because, heck, the doctor ordered it and he knows what he's doing! I said, "Okay!" and went on to what I was already doing.

Twenty minutes later, I'm giving report to the next shift when I'm reading things off my paper and realizing that one of that patient's labs shows an absolute contraindication to doing the procedure, no ifs ands or buts, and even though I had specifically addressed this lab with the doctor earlier in the day, he had apparently forgotten when he decided to perform the procedure, and I had not prevented the patient from going down for it. Four frantic calls later, I finally got the surgeon on his cell and asked if he had started. He said, "I'm about to!" My words came out bluntly, "Did you know that his INR is 4.4?" Quiet. "It is?!" "Yeah." "Okay, thanks." The charge nurse wasn't in on all this drama because a minute later she came to tell me and the next shift nurse that the patient was getting sent back up because they didn't feel like the risks were worth the benefits with an INR of 4.4. As if the doc knew the labwork all along and was just going to weigh it out while the patient was down there.

All the while I was on the phone and freaking out, the new grad assigned to the patient, the one who had sent him down for the procedure, was standing at the counter looking at me with the nurse for the next shift to whom I was giving report. I hung up the phone and batted back a few post-panic tears, sighed a big sigh, stood up to look at the ceiling and blurted out this big, hearty, "Thank you, Lord!!!" that made a few people shift uncomfortably. I walked back over to the intern nurse and the next shift nurse and the intern said, "Did he already do the procedure?" "No." "Do you think he'll be mad that you interrupted it?" "No." And she said, "Oh, that's good," with none of the understanding that comes from seeing something go terribly wrong to another person while under your care or the care of your coworkers and the relief that comes from being able to prevent something terribly wrong from occurring. Getting yelled at or feeling the condescension of an ornery doctor is nothing compared to how terrifying it is to see a person not get the best care they can and to suffer from it. It doesn't always happen, it doesn't even happen often, but when things get missed or things get rushed or people are overtired and overworked and overwhelmed with the complications of the intricate machinery that is the human body, the things that can happen are unforgettably disturbing.

I learned a lot in school, I learned a lot in books, but I learn my most important lessons, the ones I never forget, when things go wrong and they need to be fixed. Those ones I never forget.