It was night three, about 3am. I had just gone down to the cafeteria to get something fried and salty to satisfy the ravenous beast in my gut. I had about 5 of the fries while still warm as I walked into near pandemonium. It was like someone turned the crazy on the minute I left the floor.
Compared to the previous two nights, this one hadn’t been too bad. While earlier in the week it had been “grab your ankles and hold on!” tonight was a little better controlled chaos. Instead of a rapid response we calmly sent the patient with a pH of 7.19 and a pCO2 of 95 to ICU for BiPAP. Instead of getting hit with a CVA admit with no orders at shift change, the only patient we admitted came with orders and hours after shift change. It was better. Kind of.
While technically we weren’t short, we were. We had two floats filling in for the one we were short and the one we floated away to step-down, but strong they were not. They had the easiest patients on the floor, but were barely keeping head above water. In essence we were short as they couldn’t help the rest of us. And the scheduled aide? Yeah, stuck in close observation with the paranoid, impulsive, delirious ICU transfer out.
I don’t remember a whole lot after 3am, it’s just a blur as we ran putting out one fire after another. Your previously calm patient is now fucking nuts? Hey isn’t that your patient trying to escape out the fire door? Hey, my patient sounds like a stridorous 3 year old and has that “oh shit” look in her eyes as she uses every muscle in her body to breathe. Bed alarms to my left, call lights to my right and I’m stuck in the middle with you all.
Our only saving grace was the 3 of us left from our core staff formed a tight team, picking up where each left off, answering call lights and bed alarms without the petty stuff that gets in the way. What, you need meds on 97? Got it. Can you tuck 93 back into bed? No problem. Tight teamwork saved the night and got us through until 0705.
No falls, no restraints and chaos reigned in by the time day shift rolled in the door. It’s how we do it. It’s how we did it.