I had just walked in to start my shift when I got the news that I was to be in charge. Our clinician who normally works on Thursday night had called in sick, and I was going to have to step up. I was getting charge report when I realized that we had a lot of patients with advanced modalities that night which required our most expected staff to care for. That left "April" to care for "Harry"--the patient with the Intra-Aortic Balloon Pump.
She was a wonderful nurse, but I had just certified her in a beginner Balloon Pump class the previous month, and this was going to be her first patient with an Intra-Aortic Balloon Pump. I made a mental note to make sure to check on her frequently. I finished report and began caring for my own two patients I was assigned that night. About an hour later I began making rounds on the unit. Everyone was busy caring for our particularly sick patient population that night. I went to check on April and was relieved to see that she looked relaxed and in charge. Harry was going to the operating room in the morning to have coronary bypass surgery. He was on the Balloon Pump to optimize his heart before surgery the next day. I took a quick look at the pump and Harry and found everything to be quite stable. Then someone yelled "Get the Code Cart for room 27!" and I was off to assist my co-workers.
The night went by quickly and I had checked on April and her patient a few more times. She was feeling quite confident with her first balloon pump and I was glad that she was having a good experience. I had gone to the back of the unit to check on my patients and do some charting when I looked up and noticed that Harry's heart rate had dropped into the sixties and it appeared that he had some new ST elevation which indicated he may be having some cardiac ischemia.
I ran up front to check on him and went to assess Harry. I found him diaphoretic and pale. He looked up at me and said "I think I am going to die." He told me the pressure on his chest felt like an elephant. I started moving quickly, guiding April on what to do. I paged the cardiac surgeon and coached April what to say and what questions he would ask so she could give concise information about the patient to expedite his care. When the surgeon returned the call, he told April that he was taking Harry to surgery immediately.
The Operating Room team arrived within minutes to take Harry to surgery. We grabbed the emergency medicine kit and the portable defibrillator and were on our way. As we were getting off on the third floor Harry said that he felt dizzy. I glanced at the monitor and saw that his heart rate was in the 20's. Harry's eyes then rolled back and he appeared to lose consciousness... I tried to find a pulse but couldn't so I jumped on the bed and started administering CPR. April grabbed the emergency medicine kit and started administering medications. The Operating Room transporters were rolling us down the hall to the operating room where a wonderful team of nurses and doctors were ready to take over.
Two days later April and I went down to see Harry recovering in the Cardiac Surgery Unit. He was sitting up in a chair taking to his family. We briefly waved at him and left him with his family. Before we left he mouthed "Thank you." April me thanked over and over again as we walked back to our unit.
I explained to her that this was my job, to pass on our knowledge of critical care medicine to the nurses who will take our place. A warm feeling came over me as I realized I had just hatched a baby nurse!
Elizabeth Oster is a critical care nurse at a large teaching philosophy.