december pages

dear muffin,

hi. remember me?

I feel like a wombat that just crawled out of its cave after a long hibernation, blinking in the crystalline sun & suddenly remembering what wind tastes like. [whether or not wombats actually hibernate is entirely irrelevant.]

the fact of the matter is, nursing school is over. the chapter is closed, every word read. I am now one of those post-grad creatures wandering between the world of textbooks and an ever-growing pile of job applications. I said goodbye to Harper for the last time today & felt just a bit sad. a chapter of my life was lived in those hallways, and I'm always sad when a page turns. no going back.

mostly, though, I miss the ER. I miss Doug & Kate & Chris & Diego & Rachel & Justyna & Kurt & Lori & Ryan & Amber & Dr. Sevier & Adam & the other Adam. I miss the jokes and teasing. I miss the crazy patients, nice patients, frightened patients, grumpy patients. I miss the warm rush of satisfaction when an IV slides into place. I miss feeling like a grown up as we all hang out in the break room, eating our lunches and talking. I’ve grown over the past 8 weeks, and I know I’ll remember these days as some of the best in my life.

* * * *

the ambulance theme song catches my attention from across the nurse’s station. I close my charting and jog over just as Kate, my preceptor, picks up the receiver. “This is Northwest Base, go ahead.”

“Northwest, this is Palatine 25. how do you copy?”

“loud and clear, Palatine. go ahead.”

“alright, we have a 73-year-old man found non-responsive at home after a suspected heart attack. he was PEA on the monitor when we got to him, but since then we’ve been able to feel a carotid a few times. pulse is gone now. we started compressions, put in a King airway, & got a line in him. bringing him in now, ETA 6 minutes…”

someone scrambles to call a Cardiac Alert for room Bravo-2. we pour into the room with a crash cart, clearing the floor, piling equipment and priming bags of fluid. we are ready when the paramedics burst in with the wheeled stretcher, delivering chest compressions as they approach.

a paramedic gives report amidst the flurried activity. “we’ve given him 5 doses of epinephrine but haven’t gotten a pulse back. he’s gone into v-fib a few times, but mostly he’s flat-lining.”

I catch sight of a tech about to draw blood; in a burst of courage I flag him down.

“hey, I’ll start an IV and get blood from that instead.” he nods and pushes the tubes and tourniquet in my direction. I jump in without thinking twice.

the patient’s arm feels like cold wax beneath my fingers; dead weight. there is no twitch when I slide the needle into his vein, no exclamation of pain. his arm jerks rhythmically as someone delivers chest compressions. I calm my breathing and search for the blood flash. bang; got it. the IV is in. I hang a bag of fluid wide open and step back.

“I need a med nurse!” someone calls. I don’t even hesitate.

“got it! what do you want?”

the doctor considers. “epi. let’s try it again.”

I have never set up an epinephrine cartridge before. once, after a simulation, my instructor passed a cartridge around and explained how it works. “you pull off the yellow tab, twist the two parts together, and you’re set.” now, staring at the pieces as I dump them out of the box, it seems more complicated. I jam the cartridge into the injector and double-check with the tech.

“did I do that right?”

he nods. “you’re good to go.”

“Kate!” I call as I scrub an IV port. “first dose of epi is going in... now.” she nods and records the time.

thump, thump, thump. the room is still except for the tech delivering chest compressions. it feels like we’re holding our breath as we wait for the epi to take effect.

flat line.

10 minutes of compressions and 2 doses of epi later, the doctor uses an ultrasound to check for heart activity.

“I got nothing. anyone object if I declare it?”

no one speaks. we know there’s nothing else to be done; 7 doses of epi would jump-start a stone.

“alright,” says the doctor. “I’m calling it at 4:33. you can stop compressions.” the tech steps down from his stool and drags a shaking arm across his forehead. compressions are a workout by anyone’s standard.

“I’ll send the family to the viewing room. go ahead and get the body ready.”

suddenly, the room is quiet. it’s just me, Kate, and a tech. Kate is filling out her time-keeping page, so I turn towards the bed.

the white body lies bare, glaringly pale in the fluorescent light. his chest is extended as though with a deep breath; the ventilator left air in his lungs. I stare for a moment, half-expecting an exhale to relieve the tension. but he lies rigid.

“hey, would you mind…?” the tech points towards the man’s eyes, and I realize I’m the only person still wearing gloves. I step over and gently press the man’s eyes closed, but not before I see the vast emptiness staring up at the ceiling.

“the family is here; I’ll take him over,” announces someone in the doorway. with that, we are alone in the room, left to clean up papers, plastic packaging, and EKG stickers off the floor. to prepare the room for the next patient.

life is a thread. this christmas, look around you at the people you hold dearest. notice each one. because pages turn, & you will never return to this one.

I hope today’s page was beautiful for you. tomorrow, we will share a page. & I am thankful for that.

love always,

rory