Saturday, July 07, 2007

The Mountain and the Molehill

We do deliveries of medications on the half hours every night (i.e. 12:30, 1:30, etc.). Tuesday night, a child who was in the pediatric hospital died. There were some meds for the kid waiting to be delivered at around 5:45 that morning. They had just missed the 5:30 delivery. When I took them on the 6:30 delivery, I was told to take them back to the pharmacy as the child did not need them anymore. That really got to me. I don't believe in a miracle pill or miracle elixir or anything, but it did make me wonder what difference that one med would have made had the order made it to the pharmacy 15 minutes earlier.

Tonight, we had another pediatric patient to code. I literally ran the bolus over as quickly as my out of shape twenty-five year old arthritically kneed legs could carry me. I can barely run without wheezing as is and peds is all the way across the hospital (approximately a whole fucking shitload of feet away). I only quit smoking again on Tuesday. Twelve years of damage couldn't even be partially repaired in that little time afterall.

I made it to PICU, somewhat slightly winded, and looked for the action. There were doctors and nurses and respiratory therapists and gawkers and sodium bicarb and epinephrine and needles and notes and two beds tucked away in the back corner of the PICU. I jogged to the baby's bedside just outside the tornado of people and drugs and told them I had his/her medication. No one heard me, so I said it a little louder. Still nothing. I was about to grab a nurse and hand off the bag, when another nurse peeked her head up through the crowd long enough to say, "That's for him," with a nod before being sucked back under. It was then that I noticed the morbidly obese teen in the next bed. I had not realized that both were coding. I knew there was a lot of motion swirling around the two children, but they had only announced one code. I assumed the extra people were all there to watch the whole spectacle. I thought the teen, who I had not even payed attention to at first, was just catching the gawker runoff. The two beds beside one another at the farthest end of the pediatric intensive care unit both had children coding in them, a first for me after seven years in the hospital.

I found it bizarrely surreal watching them work on the two. The tiniest handful of a baby and the gargantuan teen. A million thoughts flashed through my head in the 1.5 seconds it took for me to toss the i.v. bag across the teenager to his nurse. Is this a test? Is it because I lost one earlier this week? How loud am I wheezing right now? Is that his scrotum? What's wrong with him? What's wrong with the baby? Why are so many people up here? Why is that nurse laughing? Are the couple I ran past in the waiting area the parents? Did my earrings fall out of my back pocket? Was it the epinephrine or the ativan drawer that he said would not open? My lungs seem to have cleared up a little after that run. I've never seen two codes happen simultaneously and side by side like this. Do I smell like sweat now? Are they going to make it? That nurse is still laughing.

I briskly walked out of the PICU and thru the waiting area trying to avoid eye contact. As soon as I was out of view of the families, I began to run again. Past surgery. Past the ATMs. Past the lab, the ICU waiting room, and the old gift shop. Down the stairwell. Past the restrooms. Down the corridor. Back into pharmacy.

"Here's the second bag," said one of my pharmacists, handing it off to me as I ran back out the doors. Up the corridor. Past the restrooms. Up the stairwell. Past the old gift shop, the ICU waiting room, and the lab. Past the ATMs. Past surgery. Up to the corner of the PICU waiting area where I slowed to a huffing, puffing, wheezing brisk walk. I made my way back to the mountain and the molehill and handed off the next bag of fluid.

"Call pharmacy and tell them...oh, Preston, good. We're out of bicarb and epi push," called one of the teen's nurses.

"Rie...," I breathed in response before heading back out. This time as I passed thru the waiting family members, I noticed that I was being watched by them all. I knew I was starting to sweat. I know that I sweat buckets. I knew that they could not be that stupid as to not realize that something is going on. Yet, I still waited to get around the corner, out of eyeshot, before breaking into my sprint. This time as I ran, my mind began again to wander. Is my back sweating? God, my shins are killing me. Would it be faster to cut thru surgery? I hope they make it. ATMs. How much money do I make? God, my lungs hurt. Lab. Bicarb. Waiting room. Epinephrine. Old gift shop. Push. Down the stairwell. Almost there. Restrooms. God, my ankles hurt. Down the corridor. Where's my name badge? Back into pharmacy.

"They... need... bicarb... and... epi... ... push..."

"They don't have any?"

"They just... said that... they ran... ... out..."

One pharmacist ran to the bulk medication stock room. The other ran to the crash cart restock shelves. I stood in the middle catching my breath for a moment.

"How can we not have bicarb and epi on the cart shelves?!"

I ran to the bulk room. The pharmacist stood in the i.v. row of shelves looking around anxiously like a cat following a laser pointer.

"Epi and bicarb," I said as I grabbed the two. He glanced to make sure they were correct before I headed for the door. I stopped and asked, "Is there anything else that needs to go over there right now while I am going." It is not that I would have refused to make another trip, but I wasn't sure how much longer I could last at that pace. Very sad, but very true. Another bag of iv fluid was thrown on top of the boxes of epinephrine and out I went.

Corridor. Forehead sweat. Restrooms. Tight calves. Stairwell. Snapped thighs. Gift shop. Pinched forearm. Waiting room. Burning lungs. Lab. Screaming ankles. ATMs. Watery eyes. Surgery. Almost there. Waiting area. Just keep running. PICU. Wait, I'm coming.

"He... ... ... bic... ... ... ep... ..."

"Hang on. That's his mother," whispered one of the gawkers to me. She tapped a man I assumed was the teenager's doctor. "Where should he put this?"

He turned to look at me, drenched with sweat and gasping for air, looked down at the boxes I was carrying and sighed, "Just leave them there."

I did not realize it then, but the mother was called in to say goodbye. They knew he wasn't going to make it and were, at this point, keeping him going long enough for her to see him one last time technically alive. Then, he died.

I was told later that the baby had not made it either, but found out that it was a mistake. There was another code in PICU earlier in the evening that did not survive. My little baby at least lived.

So what is the point of this whole thing? Well, I guess I just remembered tonight that I am dealing with actual human life. I mean yea, I know that in a hospital there are people who need help, but working in the pharmacy in the middle of the night in the basement away from most human contact, it is easy to forget. My point is, I am ready to be a nurse now more than ever. If there were any doubts about whether I would be able to actually do it or want to do it, those have been laid to rest. I rarely get a chance to do anything even remotely hands on as far as patient care. While running back and forth across a hospital is not that big of a deal in the grand scheme of things, it was at least something. The nurses and doctors thanked me later that night for getting their stuff to them so quickly while they dealt with the actual codes. I want to thank them for solidifying my decision about school. So, while I doubt any of them will ever be reading this, thank you all.

Later Consuela.

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