6. Chapter 6
Chapter 6
Morgan
T he best thing about working as a nurse in the emergency room is that you never know what you’re going to get. Some days are tough. Hell, some weeks are tough, but that doesn’t make me love my job any less. Sure, I could leave the floor for a cushy nine-to-five in a plastic surgeon’s office where I give Botox all day, but where’s the fun in that?
Some people might say I’m a glutton for punishment, or that I have masochistic tendencies because the painful parts of my job just hurt so good. But that’s what all ER nurses are, in one way or another—depraved, chaos-loving wildcards.
“Can we go?” my patient’s teenage son whines to his mom. “Travis asked if I could sleep over.”
“Ooo, a sleepover. Do teenage dudes watch movies and gossip too?” Claire quips, her comment lightening the mood and momentarily distracting everyone from my feeble attempt at listening to my patient’s abdomen. Realistically, there’s no chance I’ll hear anything other than gas, but I do my due diligence here just in case.
In retrospect, Claire should have been paired with literally any other coworker of mine today because I have a hard time focusing when she’s around. We’re like two damn peas in a pod, and while I love having her by my side, I’m starting to get a little nervous about this situation.
When my patient came in, he looked completely fine from the outside. He was walking normally, talking normally, and only had one major complaint—crushing chest pain that ripped through to his back. Now, I recognize to the general population that description might just sound like indigestion, but to an ER nurse, it sounds like a problem. There are certain words that make you move just a little bit quicker, and this gentleman has already used several of them.
As soon as we got him to his room, I asked Claire to go tell Cass that I would need her to watch my patients. While she was gone, I hooked the patient up to telemetry, a device we use to monitor a patient’s heart rate and rhythm. Then, I started two lines with the largest gauge needles I could find. Call it nurse’s intuition, but something tells me we’re going to need them.
“No,” the son scoffs at Claire, trying to look cool as he runs his fingers through his dirty blonde hair. “We play Xbox and hang.”
His mom glances over at me, as if she’s asking permission to allow her son to leave.
“You’ll be here for a while,” I state simply, not wanting to elaborate until I have more information.
She reaches into her overstuffed purse and grabs a set of house keys, tossing them to her son. “Go on. Just please feed the dog on your walk over, and text me when you get there.”
My patient chuckles, his oversized belly rippling with the sound. “Not worried about your dear ol’ dad?”
His son rolls his gray eyes, identical in color to his father. “You’re fine, Dad. Travis just broke up with his girlfriend. He needs me.”
But when he turns to leave the room, he looks back for a moment with a flicker of hesitation on his acne-covered face. “Love you.”
After I finish my focused physical assessment, I draw a set of stat labs, inverting the tubes a few times to ensure that the blood doesn’t hemolyze before it can be tested.
“Hey, Claire,” I state calmly as I stand from the ground. “Can you please walk this to the lab?”
She’s been happily talking to the patient and his wife about their plans for the weekend . . . I think. I honestly couldn’t tell you because I’ve been running through a mental checklist of everything I need to do.
While I appreciate her enthusiasm, and love that she’s the kind of person who likes to intimately know everyone she meets, I learned long ago that you have to set boundaries if you want to continue doing this job and not have a complete mental breakdown—one day she’ll learn that too.
“Walk?” Claire’s baby-blue eyes, the same color as my scrubs, meet mine with confusion. “Why can’t I just tube it?”
She’s referencing the station near the nurses’ desk that looks similar to Mission Space at Disney World. It allows us to send things through the hospital in capsules, rather than having to physically bring them somewhere. In theory, it’s a more efficient system because you can use it for anything that will fit in the pod, but there are occasions where the samples will get lost in hospital space, for lack of a better analogy. And because these labs need to be run as soon as possible, I can’t afford to hope they make it to their destination . . . I need to know they’re going to make it.
“Because I asked you to walk them there,” I snap. “Ask Cass how to get to the lab if you’re not sure, and when you’re back, go help her with my other patients.”
She looks at me suspiciously but nods. “Aye, aye, Captain.”
Once she leaves the room, I recheck my patient’s vital signs and excuse myself to go find the doctor on call.
The floor has been bonkers today because of the weather. A few snow flurries in Atlanta means that everyone forgets how to drive and ends up in the emergency room. The overflow and weather would be fine in any other situation, but I have a nagging feeling it’s going to be a problem for this patient if my suspicions are correct.
“Did you see what we just got in bay two?” I ask the brunette doctor sitting at the desk in the middle of the ER. She’s focused on her computer screen, but I know she’s listening, so I continue, “Fourty-eight-year-old male with crushing chest pain radiating to the lower back. Came in with stable vitals. History of smoking and hypertension. I got two sixteen gauges in him, drew labs, and started tele. Couldn’t hear shit on physical abdominal exam though.”
Her brown eyes go wide at my summary before she looks back down at the screen to open the patient’s chart. Technically, I’m supposed to go to the resident first with updates or requests, but I don’t bother in this situation. I need someone who isn’t fresh out of medical school to put their eyes on this case.
“When did it start?” she asks, quickly scrolling through the patient’s information.
She just got back from maternity leave last month, and I’m happy to see her back. I’m sure it’s hard for her to work in a male-dominated specialty, but she’s a badass and one of the only physicians that I genuinely like. Most ER doctors are weirdos who like to rock climb and use words like chill and dope . While there’s nothing wrong with that, sometimes I just want to shake them and tell them to shut the fuck up.
I lean over the desk to peek at her screen.
“According to the wife, around noon. They were out to lunch when the chest pain started, and he ignored it. But I guess it got worse, and she made him come since they live around the corner.”
“Thank God she did.” Dr. Averill’s concerned eyes flick up to mine momentarily. “Get him to CT. I’ll make some calls.”
She must be thinking the same thing—a ruptured abdominal aortic aneurysm. Depending on the size and stability of the clot, you can sometimes use a “watch and wait” approach. However, since our patient is already symptomatic, the chance of rupture is pretty high.
I might not believe in marriage, but in cases like this, I can see the benefits—his wife might have saved his life by making him come in today.
“You don’t want the lab results first?” I ask, thinking through my next steps. “They should be back soon because I had them run down.”
“His ability to tolerate contrast doesn’t really matter if he’s actively bleeding into his abdomen.”
Valid point.
She picks up a phone, presumably to call CT and inform them that I’m on the way. Normally you don’t need to go with a patient to imaging—it’s a task that can be delegated to a medical assistant—but in situations where a patient is unstable, you have to be physically present in case you have to run a code.
“Alright, Mr. Morningside, let’s get you hooked back up to that IV,” I say when we make it back to the room after the CT.
Once the scan results come back and confirm the rupture, we’ll likely get this guy into surgery to remove the aneurysm and stabilize the bleed. Fortunately, everything has gone smoothly so far, and my nurse radar is starting to calm down. He’s not out of the woods yet, but at least we have a plan in motion to save his life.
My patient sways slightly as he stands from the wheelchair. I hold him steady while he takes two heavy steps to the bed. His face has substantially paled in the short time it took me to wheel him back from the scan, and a thin sheen of sweat is now covering his brow despite the ever-present chill of the ER.
The radar starts beeping again.
I grab the blood pressure cuff from the wall once he’s settled on the bed and quickly wrap it around his upper arm. We already have a pulse oximeter, a device to check blood oxygenation and heart rate, connected to our central monitoring, and considering no one has run in here, I know he’s not in serioustrouble . . . yet.
“Everything okay?” his wife asks, watching me intently.
I can tell she’s nervous because her hands are clenched tightly in her lap, like the pressure is holding them steady. And I don’t blame her—I’m nervous too.
I plaster on a fake smile. “Yep. Standard to get another set of vitals after a scan.”
The automatic blood pressure reads 82/56, a value which could be acceptable depending on the circumstances, but in this situation, it makes my stomach flip. I pull my stethoscope out of my scrub pants and check the blood pressure manually. Sometimes our machines act wonky and give inaccurate readings, which is what I’m hoping for.
The manual reading is even worse at 76/52, so I leave the cuff on and restart his fluids at a faster rate. Part of my scope of practice allows me to make certain clinical decisions based on my nursing judgment, fluid rate being one of them. The increased flow should help stabilize his pressure while I go get the doctor.
Looking down at my patient, I explain what’s happening as calmly as I can. “Your blood pressure is just a little low, Mr. Morningside. I added more fluids, and I’m gonna grab the doctor to come check you out.”
He brushes the sweat-soaked hair off his forehead. “Do you know what’s wrong?”
I swallow hard. “We think you have a ruptured clot in your stomach. If that’s the case, we’ll just go in and surgically remove it. Hopefully, the scan will confirm that soon, but I want the doctor to see you while we wait.”
There’s no use lying to him. If I’ve learned anything over the past five years, it’s the importance of clear communication with families. Not only does it provide them with updates on the care their loved ones are receiving, but it also helps keep them as calm as possible throughout the chaos. Not everyone has the same level of understanding when it comes to healthcare, so simple details can make all of the difference in the world.
“Will he be okay?” The wife’s lower lip is trembling now.
“You’re in good hands,” I promise, unable to confidently say anything else. “We see this kind of thing all of the time, and we have a great team of doctors who can fix the clot.”
I’m telling a partial truth.
I’ve seen clots before, but I’ve never personally encountered a ruptured abdominal aortic aneurysm firsthand because cases like this usually get sent to the trauma hospital fifteen minutes away. I also still have no idea if it can even be treated surgically, but I’m making my best educated guess based on the knowledge that I have of other emergencies.
Sometimes being a nurse requires you to speak with unwavering confidence, even when you have absolutely no clue what you’re talking about. This is especially true when you’re barely taller than five feet and have to assert your competence just to get anyone to take you seriously. If you waffle, even for a second, you immediately lose any credibility you had. And right now, I need all of the trust that I can get because I have a feeling things are about to get bad . . . very bad.
“Be right back,” I tell them before stepping out of the room.
“His BP is dropping,” I say as soon as Dr. Averill is within earshot, skipping formalities. She’s already heading toward me like she somehow knew I needed her. “I increased the fluids, but think you should go in there and update them.”
She nods. “I let blood bank know we needed O-neg. Go grab them. I’ll meet you back in there.”
I pause, confused by her instructions. If she already confirmed the rupture, we should be rushing the patient to the OR, not giving him a transfusion at the bedside. “No surgery?”
The bags under her eyes have somehow deepened in the hour since I last saw her. “Who would do it?”
“I don’t know. How about any of the egotistical asshats on call? Surely there’s one who wants to get in on this case.”
She sighs and starts walking toward the patient’s room. “Midtown Memorial doesn’t have any vascular surgeons on staff.”
I grab her arm, holding her back. “Send him to Grady then,” I demand, hearing my tone sharpening. “Life flight would get him there in less than five minutes. ”
“You have no idea how much I’d like to do that, Morgan, but they stopped all flights thirty minutes ago because of the weather.”
I can feel my throat closing up as I process her words. I don’t like feeling helpless. It’s one of the reasons I became a nurse—to help people who are helpless—not to feel that way myself.
My eyes dart around the ER, searching for a solution because it shouldn’t be this hard. “Have Blue over there drive him,” I plead, pointing at a paramedic whose name is momentarily escaping me. “He’s not busy.”
My grip on my favorite doctor’s arm tightens as she tries to pull away, resignation written on her long face. “There’s no bus. All of the ice has everything backed up.”
“There’s not even any ice left,” I argue, feeling my chin wobble in frustration. “People just can’t fucking drive.”
“Let’s go,” she says. “We’re going to do everything we can.”
I’ve heard that phrase more times than I can count, and I hate it. It’s just a platitude that we use to make ourselves feel better when deep down, we already know what the outcome will be—death.