Drag Me to Hell
Posted by realityrounds on June 5, 2009
Seasoned NICU nurse who has done it all and seen it all reports to duty for a 12 hour night shift. Charge nurse: “You are being floated to the PICU (pediatric intensive care unit) tonight.” NOOOOOOOOOOOOOOO!
DRAG ME TO HELL
I creep slowly through the halls to get to the PICU, wary of the unknown. No, I have not received any orientation to this godforsaken unit. Hell hath no orientation protocols for float RN’s. I am greeted at the gates unit by Beelzebub, the PICU charge nurse.
“Hi. Welcome to the Hotel California PICU. You have the fresh heart transplant patient in room 1. Your charge nurse said you were familiar with this patient because you cared for him pre-transplant. He needs a blood transfusion, but we were unable to start a peripheral IV. We knew a NICU nurse was being floated here so we waited for you to start it. He needed that IV, like yesterday, so please start it now before report.”
This is a trap, but I am commanded to go. I walk into the room. Lying on the radiant warmer is a paralyzed and sedated newborn, with arms and legs stretched out as if in sacrifice. He has more tubes and drips and lines than he has body surface area. He now needs a peripheral IV from me for a blood transfusion. His chest is wide open, with only a thin transparent dressing covering his heart. You can see the tiny new heart beating beneath the dressing. The tiny heart that was too big to be transplanted in the patient’s even tinier body, but was transplanted anyway. Gotta keep those transplant statistics up.
The baby’s body is hugely swollen. He looks like he could burst if I touch him. But, I do as I am commanded. I shave part of the infants head, insert a needle into his scalp, and thread a cannula the size of a hair into a vein in his head. I start the blood transfusion. For what purpose? I’m not sure. I overhear the staff in report say there is no way the surgeons will ever be able to close this infant’s chest again. He either has to wait for another smaller heart to transplant, or he will be taken off all support.
It will be the parent’s decision. What kind of decision is that for a parent to make? It is a hellish decision.
I take care of this baby for the next 12 hours. I titrate drips, push meds, give that blood transfusion. The baby lies there, quiet, swollen, motionless. Except for his new heart. It beats on and on, in his open chest, underneath that transparent dressing.
RR
pinky said
Wow. Why do we do this? Is it because after years of doing it, you become really really skilled at it. Then maybe you feel like, hey somebody has to do it. We can’t have nobody do it. So I should probably do it?
realityrounds said
Some times I honestly do not know why we do this. I actually filter a lot of my posts. If I wrote what really, really goes on, I do not think anyone would believe me. I am a NICU nurse because I feel like it is my calling (sappy, but true). More times than not I am serving a benefit to humanity, and then there are times like the above story, where you almost feel like a partner in crime. But those times are few and far between.
RN-ish said
Great story. It goes to show that a nurse is not just a nurse and can float anywhere without an orientation. I have read about the ethics of transplantation. Surgeons will transplant patients who are not appropriate just to fill their statistics. So sad.
Trying to get stuff done, and a reply turned post « Mom’s Tinfoil Hat said
[...] volunteer in a pediatric intensive care unit (PICU) sometime if you want to see some horrifying procedures. Physicians don’t throw fetuses in the [...]
Eileen said
I saw this on an e-mail signature (can’t think of originator to credit) but find it apropos to all of you courageous NICU (or any ICU) nurses’ out there.
“This is not life in the fast lane…this is life in oncoming traffic”
PaedsRN said
PICU nurse here, I don’t think I get to be called “veteran” yet, but getting close
Here is my list of “why on earth” questions:
1. Why on earth did they transplant into a neonate? “Because they can” is not a good enough reason in my part of the world, thank god.
2. Why would they transplant an oversize heart into said neonate? (See above rationale).
3. Why on earth was a new post-op cardiac relying on a peripheral cannula for blood when he or she ought to have ample central access?
Bizarre. Come and work outside of the US, we’re not quite as insane. I hope
realityrounds said
Let me try and answer your “why on earth” questions:
1. They transplanted because they could.
2. They transplanted the over sized heart because it became available.
3. The baby had multiple lines, all occupied with various drips and fluids. They could not stop any of the drips for the 3 hours needed to complete the blood transfusion.
There are so many ethics involved in transplant programs, especially ones that are relatively new and experimental. Transplanting neonates was relatively new in this story.
I would love to travel outside the good ole USA to nurse. I would have to drag my two kids and husband with however
Reply turned post, why not one more Tiller one style « Mom’s Tinfoil Hat said
[...] resuscitative techniques and medical treatments can be torture, especially on a newborn who is only receiving futile treatment because its chances of surviving [...]
Just a social worker said
Since I’m not a nurse, I have no idea why transplant statistics have to be kept up. I’m sure it has something to do with $ and numbers, but can you enlighten me? This is tragic!!!!
realityrounds said
There was actually an article about transplants in the NY times (?) awhile ago. Transplant programs have to do a certain number of transplants every year or the program will be shut down by the state. Also, the more transplants you do, the better skilled the surgeon becomes, and (sadly) it is good advertising for the hospital. The pediatric transplant program in the hospital I used to work down has since been shut down (not because of this incident) but because numbers were low.