.

i'm trying to figure out why i'm so disturbed by what happened tonight. i think that it could be the fact that things happened so fast. Or that i felt completely out of control. or maybe that i knew in my mind what needed to be done, but in practice i froze.

the facts:

1548. vitals: BP 171/91. HR 83. temp 98.7. resps 28. NG to LIS with bilious output. Patient previously verbally abusive, called me an "evil red-headed bitch" last time i was in his room. tech calls me to say the patient is complaining of shortness of breath.

i was busy with another patient. and frankly sick of being verbally abused and of this patient's mental issues (see yesterday's post). so i fully intended to ignore him. i can't for the life of me remember why i went to his room. maybe it was divine intervention, or maybe it was my habit of OCD checking.

1600. in to assess patient. noticed new bright red blood from NG tube in patient with recent history of GI bleed. Immediately went to RN station and got the chief resident to come to bedside. NG manipulated. bright red blood splattering in cannister. i am getting very worried.

1605. attempted to call day RN but stupid phone system will not recognize her name. attempted to call ICU RN that floated to floor to work day shift, but stupid phone system will not recognize his name. look in back room for anyone to help me, find no one. finally find ICU RN in hall and say "i think my patient is GI bleeding".

1610. ICU RN begins to tell me a bunch of things i need to do and my brain can't handle them all, much less prioritize which is most important. someone takes vital signs, i do not think it is me. BP now 81/52, a drop of 90 points systolic over about 20 minutes. this is VERY bad, and i am getting the feeling of impending doom.

1615. I tell the vitals to the chief resident, and she says that we'll get an ICU bed. i get the bag of fluids to bolus. i find the emergency monitor and bring it to the room. more people have appeared to help me, i have no idea where they came from. i can't get the IV bag in the pressure bag to bolus. the emergency monitor is missing the cord to get the patient's heart rhythm. i feel like i'm drowning.

1620. the bolus is going in, someone else is drawing labs. i run to get the connector to draw off the patient's line. we don't have an ICU bed. i don't know if anyone knows that we need one. i call the manager and she says that she'll work on it. the day RN comes in and she says she will call report. people keep asking me questions that i don't know the answer to. do we have a bed? don't know. did we get those labs? well i didn't draw them. is report called? not sure. i feel kind of useless, actually.

1625. we have a bed. report is called. patient is packed up and ready to go. i have essentially done nothing to facilitate this except call for help and then run around like a chicken. we go to the ICU.

1630. we are going very quickly to the ICU. we have to go in a side door because the attending "would rather be in the ICU than in the hall". the fact that the attending thinks my patient is going to code in the hall does nothing to comfort me. we reach the ICU and 4 nurses descend upon my patient and take off all my monitors, then put him on all of their monitors. once again, i stand there doing nothing helpful. at some point someone hands me my monitors back. i proceed to stare at what's going on until gently pried away by the ICU nurse.

1700. as i stalk my patient via the computer, his heart rate is 150 and his BP is 65/40. he is dying.

1800. apparently my patient is going to IR to get his bleed embolized.

1830. code is called to IR. i know that it's for my patient.

1900. my patient still has vitals in the computer, therefore i know he's alive

2000. someone writes a note. patient required 10 minutes of CPR. needed to be shocked 3 times.

2030. EKG comes back as acute MI. my patient has apparently had a heart attack.

2100. chief resident comes to floor, tells me all about everything that i already know. my patient is in the ICU. he is in bad shape. "good pickup" she said, followed by "there's nothing that we could have done to prevent this".

i know she's right. now i just wish that it would feel like the truth.