Wednesday, July 30, 2008

blue light, part deux

There I was sitting at the back of the ambulance - the only time I was actually chilled, after a really busy night drawing up drugs, chasing up blood results and doctor referrals. Then there’s the most challenging bit, I think. Reassuring family at bedside. You wouldn’t send a family home when there is a possibility of ‘movement forward’ to another facility, need for involvement in a significant decision making process and quite possibly termination of therapy if deemed futile.

I felt weird (I always do, anyway) that there I was running around pushing drugs and fluids to preserve or keep organ function stable and restoring a family member’s confidence every time the machine beeps, but at the same time painting a rather bleak picture as quite often, it is better to offer little or no hope to prepare them for any negative outcome. You would have to continuously assess the family's emotional stability and intellectual capacity to understand the situation obviously.

It is during these times (early morning) when Consultants are hard to come by and decisions become really slow. The family have also decided to go home at this point which I thought was fair enough since they were practically up the whole night. We haven’t heard from the London hospital and dispiritedly, I was looking after a patient with a very unstable blood pressure and not blowing off his carbon dioxide despite of all the tweaks done on the ventilator. A high CO2 concentration on a head injured patient is basically, a ticking time bomb.

So I was quite happy that by six in the morning, we were whizzing our way to London. I didn’t mind that I had to catch a syringe flying in my direction from an ever so sprightly young doctor who can’t be bothered with her seat belts. These things happen. Once not so long ago, it was a sickie bowl.

I phoned up the patient's wife explaining to her that they might place a bolt through her husband’s skull to monitor the pressures inside and they may or may not operate on his brain depending on the degree of the damage. And that he may or may not survive the operation. I really felt sorry for her and she was really grateful for all the care and the honesty. I have omitted that part where we ask if the patient is on the organ donor register.

I apologized extravagantly when I handed over to a colleague. I know, I passed the buck.



Blogger may said...

we can't help but pass the buck, can we? i know, we must be sick to ove this job.

8:36 PM  
Blogger may said...

love, not "ove" :)

8:37 PM  
Blogger Keith, RN said...

Passed the buck? Well, you did your job and had to let the next person take over the patient's care, no?

After all, you made the difficult call to the wife.....

1:39 AM  
Blogger howling said...

yeah may, it's a little bit debauched to love this really gooey job hahaha!

4:27 AM  
Blogger howling said...

thanks, keith! i know. the issue of organ donation is one of those routine stuff that i'm not often comfortable to discuss with the next of kin but we really have to these days... bearing in mind that the patient is a potential brain stem dead donor with possibly lots of transplantable organs esp kidneys where there are a lot of people out there desperate for them.

4:42 AM  
Anonymous Anonymous said...

I can imagine the emotional stress you have to go through with a situation like this. It is tough to handle to speak to a family member when you tell things frankly and at the same time be sensitive to their emotions.

I guess at some point in time you learn how to isolate your emotions so you can perform your job better.

3:20 PM  
Anonymous acey said...

you must be strong to handle this kind of job... i don't think i'd be able to tell some1 that her husband might die and stuff.

stay strong, howling! :D i think you did a good job.

2:09 AM  
Blogger howling said...

i agree with you bw... it's quite stressful on your part and it's even more so for the family but it's your job to help them cope. It helps if you just stay cool and be completely honest as they would cling to every little positive detail from you and would always hope as you would if it's a member of your family.

8:25 AM  
Blogger howling said...

cheers acey!!! you have to detach yourself emotionally to stay in control and that gets easier with experience. sometimes you can't help yourself buckling up and it can get a bit too much... but you can always get someone to deal with it if you're not coping well. some of the guys in our team are brilliant and quite supportive..

8:27 AM  
Blogger Bryan Anthony the First said...

very greys howling huh!

4:24 AM  
Anonymous pining said...

I didn't know that talking to relatives about a rather sensitive/sad news is a nurse' job, but hats off to you; you handled that very well indeed :-)
does that mean your colleague has to ask the relative about the organ donation?

5:07 AM  

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