Clueless

Nurses do stupid things, and I am certainly no exception. If you feel like you want to laugh at my ignorance as I explain this situation, please let loose. The setting was an ER long ago when I was but a newbie to nursing. Even though I had worked as an ER tech for two years prior to graduation, I was not thinking in broad enough terms when I received a patient who had been stabbed in the abdomen nine times with a homemade ice pick.

Mr. White Power was a crude and disgusting individual. To allow him to die would have been a service to the country. Mr. White Power came from the local federal prison along with six guards to watch him inside, and two guards outside to watch for bad guys. We could always tell how bad the person was by how many guards accompanied the prisoner. Two or three guards was the norm for a run-of-the-mil-killer or rapist, this guy had eight.

We nurses were not thrilled at having armed guards with bulletproof vests in our ER. I have nothing against guns, just break into my house at night and find out just how much I love them. Where are our bulletproof vests, we always asked? It was a running joke, one we really didn’t consider a joke. The guards would laugh and tell us to stand behind them if anything started to go bad. Yea right!

Dr. Divorce was on duty that night. She was so preoccupied with finalizing her divorce, and saving her financial ass, she couldn’t be bothered with little things like patient care.

Mr. White Power arrived and I started a 16-gauge catheter in each forearm and hung saline at a too-keep-open (TKO) rate. During the IV start process I drew a rainbow. For you non-medical folks, that means I started a large enough bore needle so we could give fluid rapidly, if needed. A rainbow is drawing a tube of each standard color so you don’t have to go back and redraw more blood if the doctor adds orders.

Mr. White Power was one of those skuzzy neo-nazi white supremacist types and was covered head-to-toe in the ugliest prison tattoos I’ve ever seen. Ignoring the multiple racial slurs and swastikas adorning his fetid flesh, I focused on the WHITE POWER tattoo, displayed prominently in an arc from side-to-side, and following his anterior lower rib margin. There were multiple small puncture wounds in his abdomen, most of them in either the word WHITE or POWER.

The patient went to x-ray and returned and we all waited for the results of the labs and x-rays. I monitored the patient and kept tabs on his vital signs. His heart rate remained stable, but his blood pressure kept creeping down. I began to open the saline IV’s up a little to help keep his pressure stable. Time went by and I had to keep opening the IV up a little more, and more, to keep his pressure up. His heart rate was still unchanged after 2 liters of saline and I reported this to the doctor who was arguing on the phone with her soon to be ex. Yea, ok, whatever, she responded, not ever really hearing me.

Several hours go by. We’re still waiting for the x-ray read. The blind radiologist was on that night and it always took him forever to read an x-ray. Blind you say? Yes, legally blind, white cane and all. His wife would drive him to work everyday and he would walk in with his white cane in one hand and his giant magnifying glass in the other. I once watched him read an x-ray. He would start in one corner and systematically cover the entire x-ray. And he had never been sued.

The initial lab work came back and the hematocrit and hemoglobin were normal. I kept complaining to the doctor I couldn’t keep the patients pressure up any longer and his heart rate was beginning to rise. Yea, whatever, she mumbled as she continued to argue into the phone.

Five and one-half hours go by. At this point all you out there with a clue are calling me a complete idiot, and rightfully so. Where was the seasoned nurse who should have slapped me and given me a clue? The seasoned nurse who was on duty with me that night was even more clueless than I. She was a touchy-feely nurse who avoided any cardiac, critical, or trauma patients, and had even less a clue than me. The patient was bleeding to death you idiot. Well, yes, that was the problem and I was so new and stupid I missed it. The unit secretary however, had taken it upon herself to order a type and cross two units. By the time Dr. Divorce woke up and realized she had a crashing patient, we at least had two units of blood to transfuse, and more readily available.

I should have taken the initiative to get the doctors attention. Something is wrong with the patient and you need to get off the phone and assess this problem. This was my job and I screwed it up big time. I could have ordered a CBC myself without the doctor becoming upset. It was in our protocols and I just was too new to know it. It was my job to make sure the patient was safe. It’s not the doctor’s job to monitor the patient, that is my responsibility. My job is to alert the doctor and make sure they understand the gravity of the situation when a patient I am monitoring is going south.

Fortunately the patient lived, thanks to the surgeon, anesthesiologist, and surgical crew, who were there in record time. One priceless moment occurred when the Mexican surgeon and the Black anesthesiologist stood at the bedside and told this patient he was going to be just fine.

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