Diary of an intensive care nurse

Diary of an intensive care nurse

Have just read an article first posted in December 2013 as “Diary of an intensive care nurse”, but now on Facebook. The author, Kristen McConnell highlights how above all, intensive care nurses will do all they can to avoid getting resuscitated, or admitted to an intensive care (ICU) unit, citing :

“Intensive care is at best a temporary detour during which a patient’s instability is monitored, analyzed and corrected, but it is at worst a high-tech torture chamber, a taste of hell during a person’s last days on earth.”

Having worked in ICU’s since the early 1970’s, there is a big difference in the care level over that time, and here in Australia they are mostly for resuscitative measures, aimed initially at saving them, then stabilising them for the rest of their journey, at which time it can be decided on continuation of the care. Considering the number of successes I have seen, and especially the hundreds of ‘Thank you’ letters received from the units I worked in (including the last 15 years at Westmead Hospital), I have to stress that if ever you or a relative or friend ever have a major injury, accident, medical event, from simple infections to major trauma, or post-operative issues, then intensive care becomes a simple lifeline that is literally the deciding factor between life or death. The staff fight heaven and hell to drag you back to earth at times.
True, the risk is always there for an adverse event during the resuscitation, but then you must realise that a) you were dead anyway, and b) you had a high risk of death anyway, and thus are not really worse off. In my own recent (over-rated) heart attack, I considered that I was lucky. I did not have a VF (ventricular fibrillation) arrest, where all output stops on the spot and you are basically dead as you hit the floor. I did state that I considered this due to my vitamin and lifestyle regime, whereby I regularly took supplements of co-enzyme Q-10 (1), alpha lipoic acid(2), vitamin D (in addition to sunlight), magnesium, calcium, and a few others. The possibility that I could have a cardiac arrest were always in my mind (seen it hundreds of time), and having daughter Lieselle at the bedside to see this happen wasn’t on the plans. Because of my age (62) I know that the risk of death increases with age. We all head for that wall, after all. However, I have seen thousands of people resuscitated over those decades, and some of the most spectacular were in these last 15 years at Westmead, where the amazing teams of medical, nursing, surgical, neuro and technical personnel work what can only be termed as magic (let’s not forget that none of this was possible without the ambulance/paramedics and the emergency department interventions during the journey to ICU).
Since there are so many comments on social media about the irritating call-centres ringing us all at home, especially those horrible Indians (‘from India’), let me stress that for about 15 years I have joked with the regular force of Indian doctors at Westmead. They beat the nurses regularly at social cricket matches too! The majority are people I would trust the life of my children with, so remember that we probably have as many irritating Aussie sharks as people may think there are other nationals.
Back to the topic of intensive care though, I remember having received once a 90-year old patient from a nursing home, with severe contractures, bedsores, tube-fed, severe Alzheimers, and the rest. They were sent to the hospital for a ‘change of pacemaker battery’, to keep them alive, simply because the family had to keep them alive (a fight over the money). Sometimes family members don’t believe they will die, or believe that they will get better. The intensive care team regularly discuss the appropriateness of continuation of care, and discuss numerous options with the family. At times the delay gives the family the extra moments to arrive to ‘say goodbye’, and trust me in this, that small difference counts for everything quite frequently. My father-in-law was a great man. At age 60 he drove to work, smiling, but when we received a call that he was in hospital, and ‘could we come quickly, he broke his nose in a fall’, all we were met with was someone who had had a VF arrest, died at the scene, without ever being able to say goodbye to his wife and two daughters, or the grand-children. They could never get to say “I love you” to his face again.
Going further in the article, mention is made of the indignity ICU patients suffer, such as being unable to talk, to swallow, to clear phlegm etc, and how suction tubes are used, feeding tubes inserted. I understand this and am sure most ICU nurses do as well. For this reason we explain procedures to the patient, even if they are unconscious. We restrain patients at times, but explain that it is to protect them from accidentally or deliberately pulling tubes out, but that we will have restraints loose while we are at the bedside if possible. Propofol (or other calming agents) is always good if there is an issue! I would love to use this as a spray in the emergency departments!
We explain all we can to the family, often before they even enter the unit. We mention that the abdomen or chest may still be opened (with saline soaked dressings and glad-wrap dressings) as the initial resuscitation was to save their life, to give us time to take them back to theatre as they get stronger. We tell them all we can to allay fears, and give hope, and HOPE is what they look for, but always let them know that guarantees can never be given. That relies on the patient, and for those that believe in miracles, to whatever gods they believe in.
The author continues on with the diarrhoea, skin damage, and poor outcome, but frustration and disenchantment with the reality of an employer facility, overwork, or understaffing make a huge impact. Having a great team makes a huge difference, and for that there is one answer. Too bad governments make a habit of closing down ‘great teams’.
Ultimately, if you can make that one minute of difference where the patient receives great care, attention, and you give all you can to support the family, that they realise someone actually cares, then you will make that difference. Eight hours is even better. To me there was only ever one choice, and that was to work in intensive care. I of course have to add that I also work in emergency, oncology and all other areas (doing 50 to 80 hours a week made that easy!) and have noted the effects of empathy and understanding everywhere. Even in the Birth Unit, a 23-year old said to me : ”are you here in case I drop dead?” (she had a history of Ventricular Tachycardia events). My answer was that I had been doing CPR for 40 years, so would guarantee if anything happened to keep her alive for the ICU and Maternity crew to do the rest. That was all she wanted, and then she offered me some chocolates. That was a boring shift.

Bernhard Racz

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