Mr. Black Cloud

Yes, that’s me.  A little black cloud of despair that casts a pall of shadow across any bright and sunlit unit.  It follows me, but only when I am in charge.  I’m still not one hundred percent sure of it, there may be other variables to the equation, but the only constant is me.   Let me explain.

The very first night I was flying solo as charge started with a bang.  OK, well, kind of a whimper, but as I am the superstitious type it was a bad omen.  It was innocuous.  Simple problem.  The copier wouldn’t work.  I’m sitting in the copy room, the walls closing in on my as the seconds count down until my staff arrives and I don’t have their assignments ready. I’m sweating like a hooker in church and ready to blow chunks.  Anxiety attack?  Only a small one.  And over what? A copier that I can’t seem to get to work.  Yes, blown waaaaaay out of proportion, but I really wanted things to be smooth.  Yeah right.  The silver lining was that all the patients ended up with nurses.  No harm done really.  Until 2am.

Report had it that she was circling, but no one knew how fast she would go.  Fast.  Six hours after changing her code status to DNR she was gone.  So what do I get to do my first shift?  Yep, post-postmortem paperwork, which incidentally I did not even know the location of.  But with help it got done.  “OK,” I said, “I can handle this.”  Second night, not so bad.  Just juggling beds and nurses.  Not a big deal.  Not that big of a black cloud.  Maybe partly cloudy.  The other relief charge nurses told me that having a patient expire on your first charge shift is almost like a right of passage:  nearly all had it happen to them.  Small solace that.

But it was the last weekend that my true status was cemented.

The night started off well enough.  We were full.  Usually when I go to bed rounds to let the supervisor know my open beds, the number is large and no one else has beds.  I usually have to come back and tell the nurses that, “Guess what?  We have the only open beds.  We’re the admit bitch, anything that comes in is ours.”  Not tonight.  I had one bed.  Female.  And all the admits were male.  I like that, makes life easy.  Gives me time to help out my nurses.

Then I hear the call for help echoing out of one of the rooms.  Patient is unresponsive.  RRT is called.  Then something weird happened:  time slowed down.  Not because we were moving fast, but because nothing was being done.  The resident was ordering squat.  Nothing.  Nothing was really being done, we’re all waiting with baited breath for something, anything.  Labs?  Meds?  We have extra O2 on.  Anything?  Finally then, “OK, I don’t like what’s going on with her airway.  Let’s get her to the Unit.”  “Thank God!” I say, more for the relief of something actually being decided, but also for the floor nurses’ Code credo, “Get them off my floor!”

Off to the Unit we go.  Nothing like a brisk walk in the morning to get the blood flowing.  We’re almost to the pod the patient is destined for when what comes overhead but, “Rapid Response to Wanderer’s floor!”   Crap, another one?  Sure enough as I head into the room I hear, “Yeah, her CBG is 12.”

Not good.  D50 is pushed, nothing.  No change.  Then narcan is given.  And surprise, the patient wakes up.  Crisis averted.  We have the resident write orders for PRN Narcan, just in case.  You see, with altered liver and kidney function all those wonderful little opiate molecules were just recirculating round and round.  Thru the night more narcan was given as its effects did not outlast the drugs.  So every time they would drift off to unresponsive-land, they got more narcan.  And they woke up.  Go figure.

So yes, reputation beginning.   I knew from the start that the next night wasn’t going to be a fun ride either when my fortune cookie with dinner read:

“Do not unexpected situations ‘throw’ you.” (in bed)

And what do you know?  Another RRT.  Another trip to the Unit.  Same nurse as the first the night before.  Hmmm, so it’s either her or me, hard to tell.  All told, 3 RRTs in 2 nights.  More than the previous 2 months combined.  I think I have  black cloud indeed.  Did I mention the copier crapped out on me the night of the double RRT?

I think I do have a black cloud.

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5 Comments

  1. LOL…yah…the new charge nurse curse! It strikes hard and brutally!

    My first night as charge was a fluke. I hadn’t been trained or oriented for it at all. On that particular night, I just happened to have the most experience. So, there I was, charge by default.

    Of course, I had two codes through the night. One that just needed a MASSIVE dose of narcan…the other went into respiratory distress and was quickly intubated and whisked to ICU.

    I stayed charge for the rest of the week–I figured I may as well get some experience at it while I had the chance. Things didn’t really change all week! LOL

    From then on, charge was no problem….

    Reply

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