When I work in the ICU I have a lot of responsibility, but I also have a lot of wonderful co-workers and doctors to back me up. I never really have to make the big decisions, at least not for long. (Grab the code cart, call the doctor, start compressions....)
Things have changed.
I have been working as a flight nurse for over 18 months now. The amount of information we need to absorb and comprehend is overwhelming at times. The learning curve is steep. I have studied almost every shift I've worked since I started. Reviewing and memorizing..what to do for what and when. Protocols. Protocols. Protocols.
Good nursing does not come from just being book smart. Learning from experiences and continuing to learn helps, but the ability to look at a patient, gather the information and realize you are about to have a really BAD day or a really good day is essential. Protocols cover a lot of subjects and situations but they are there to guide us. I've become a lot more comfortable with fixed wing flights but if you have been following me you know that I've been flying more rotor wing and have actually had a few flights.
How I feel after a successful transport of a super sick patient.
When a scene call comes in we have less then 5 minutes to get to the helicopter and get going. Sounds easy, but it's not like jumping into a car. We have things to unplug, sometimes we need to fuel and sometimes just getting my helmet and seat belt on is my own personal challenge. Then there is safety safety safety. Thank god.
I've changed some details of this story, but the feelings are the same.
I was just sprawled out in the chair playing some search and find game on my iPad. We were 10 hours into a 12 hour shift and NOTHING had happened yet. I was prepared enough to be in full uniform with my meds on me, but that's about it. The radio went off and the pilot turned to me and said, "That's us" and boom..out the door.
The scene was only a few minutes away. "Head in the game, head in the game" was going through my mind. Safety, watching out, helping to land. They all kept my mind busy but my stomach was turning and my butt cheeks were clinched TIGHT! What was I walking into??? Who's idea was this for me to be a flight nurse??? This is not a drill!!
The scene was remote. The patient was already in the ambulance. We landed and the medic and I jumped out after the all clear from the pilot and ran to the ambulance. (Rotor still going) Right here is where the bad ass fun stops and everything gets real....real fast! I was shaking like crazy. I was trying to pull up medications, doing math in my head, running through the protocols. I had been in this sort of situation before in the SICU and the ER, but you take it out of the hospital and take away the doctor and it's a whole new ball game. Add the fact that it's you and your medic making decisions...wow.
My medic was awesome! He had more experience with scene calls and took the lead. I performed my first intubation and once I did that my head cleared, I stopped shaking a little and I think I was actually able to think and ask questions.
The question I get most is how do medical people do this sort of thing? If we do something wrong someone could die! Although medicine is hardly that black and white I am pretty sure that most of us block out the emotional human portion for a while as we go through all the information and experience in our heads to do the very best to give that patient a chance. Think! Think! Think!
After about 30 minutes of interventions it was pretty obvious that no matter what magical medical thing we could come up with this patient was not going to make it. Discussion with the team working with us, with our medical control and the patient was pronounced. We all agreed. We were done.
I took this picture after we were back in the helicopter and our pilot was getting ready for flight. It was getting dark and the lights on the ambulance were still going. I was still surging with adrenaline, but I felt sad.
In my heart we always saved the day. Even looking at this picture all those feelings came back to me. I knew that someone had died and not even the patients family knew. They were going to be absolutely heartbroken! They were about to have the worst night ever.
I felt like we did everything we could. No matter how wonderful medicine is, it can't fix some things. This could not be fixed. I absolutely love my job but it doesn't come without great responsibility and accountability.
After charting, talking to my medic, talking to the oncoming RN and starting my drive home..I started to cry. I was so sad for the family. I was exhausted over using so much adrenalin and I was tired. Then I was even more sad for the family and for the patient.
I know that life can be taken away at any time. I stopped worrying too much about my kids long ago. I knew that they were adults and could do what they wanted. I figured that I would worry when there was something to worry about. But in the few days following this flight I called each one just to make sure they knew how much I loved them.
Because sometimes that's the last thing you get.