on walking away.

i have always practiced nursing a certain way.  obsessive.  controlling, at times.  vigilant.  i sense impending doom regularly.  i rely on my gut to tell me when i need to worry, which it tells me is quite often.  i have never been one who can ignore labs that are off, or who accepts "it's a chronic problem, don't worry about it" as an answer.  i have no use for timelines...if my patient starts doing something weird a half hour after my shift i don't care that i should go home, i'll be there until we figure out what's going on or until the night nurse pushes me out the door.

but we've been under the microscope lately, and overtime isn't cheap.  and after an hour long meeting with the bosses, you start to try to figure out what to cut to get out on time.  and it's actually kind of nice to have the ok to pass some problems along, to be able to walk away and say 'your turn now'.  and when management is telling you "you need to say NO", you start to think that maybe everyone else has the right idea.  walk away.  your shift is done.  what's the worst thing that could happen?

tonight i had a very stable rib fracture patient.  he was walking, talking, eating, and his pain was well controlled.  i gave him pain meds at 2205, and tucked him in.  i reported off and was finishing some charting when i heard another nurse tell Very Capable Night Nurse that the patient was saying he had chest tightness.  it was 2235, and i am supposed to be punching out at 2300.  the last half hour of my shift is supposed to be dedicated to charting, and i'm supposed to be off the floor.  the old me would have gone down to his room.  the new me thought that nights should handle it.  the night nurse asked me if i had heard about the chest tightness, to which i replied, "he's FINE.  he just has rib fractures".  

so she took her time finishing report, and i punched out 3 minutes early and waited for a coworker.  until i heard someone scream to call a code.  

wouldn't you know?  

i ran to the room and things were flying and compressions were going and everyone was running, and for once instead of jumping in i walked away.  i made all the calls, and i pointed the code team in the right direction, and i ran supplies back and forth.  but i didn't do it to be a team player, i did it because i couldn't stand to see the patient.  

why?  because i failed him.  i turned off my instincts and i toed the party line.  and now i know for sure what i always thought, there is no NO.  you do not loosen up, you do not relax.  it does not matter that there are three shifts.  Very Capable Night Nurse will go home tomorrow and sleep well, knowing that she did a good job.  and here i am, (not) sleeping in the bed that i made for myself by being a sell-out.  

so to escape my guilt, i ran as far away as i could, which turned out to be to the stat lab with a vial of blood for a code panel.  and just as the labs were done, my patient came rolling down the hall to the ICU.  i followed the bed in and stood in the corner while they hooked him up, looking like a crazy catatonic person, i'm sure.  they sat him up, and he was able to tell them his name and where he was.  

it is because he is awake and alive that i can function at all.

Very Capable Night Nurse is going to call me with an update when they figure out what happened.  i'm sure i'll still be here, awake, turning everything over and over in my head.  thinking about how i really CAN'T ever let my guard down, and i can't lighten up, and i can't ever forget what the magnitude of this job really is...that people's lives do literally depend on me every single day.  

because this is what happens when i do.  

***

Very Capable Night Nurse just called.  the patient died overnight in the ICU.  at this point we have no idea why, every test they ran up there came back fine.

and i know these things are going to happen.  and i know that this outcome isn't because of anything that i did, or anything that i didn't do.  in my head i know.  in my head.