dichotomy

i have a lot of posts mulling around in the draft stage. i don't like to force something i write....what you see is pretty much how it rolls out of my brain. that way you get me at my most raw and honest self, not primped into what i think would be most acceptable to a reader.

so when i start something, and it doesn't flow easily, i let it languish in a draft until it's ready to make itself known. so if i have promised you something, please be patient.

when i woke up this morning, i knew i wanted to write about something i swore i would never write about......being a nurse. becoming a nurse is at once the best, and the worst thing i have ever done. i do not actively practice nursing right now, and probably never will again. i am still trying to mend the split in my heart between the art of nursing, and the business of providing healthcare. i don't know if it can ever be healed.

nursing is one of those things that i can look back now and say i was very good at. i spent a long portion of my career as an icu nurse, where modern medicine and human ethics impacted at lightening speed. i was quick on my feet, good at the skills required, and intuitive to a bigger picture that cardiac monitors and lab results didn't show.

i was also in trouble alot for breaking the Rules. you see, modern medicine has a lot of Rules, some of which i did not agree with. many of these Rules had to do with making money, preventing lawsuits, and meeting standards set by people who were never gonna meet my patients, let alone comfort them when they were sick, or dying.

oh, wait.....neither was i ....... i rarely saw my patients, except to titrate drips and tweak machinery to do it's job. i spent so much of my time following the Rules, (or better yet writing pages of documentation to prove that i was following them) that my patients often suffered or died alone in their beds.

i began to hate what i did. the only saving grace was those moments when i was given an opportunity to step outside the boundaries, and had the courage to do so. sometimes it was not a conscious act---and acting without thinking made all the difference.

our icu had 10 beds. they were separate rooms except for the middle three directly across from the nurses station, an open bay usually reserved for the most critical patients. this night, bed 7 contained a young woman with a brain injury who had been declared brain dead. we were merely supporting basic life functions, waiting for the transplant team to arrive. we had specific instuctions that if her heart stopped, she was a no code....no cpr was to be used to restart her heart.

i was assigned bed 9, a post-op patient on a vent and a dozen iv drips, who was so involved it was my only patient. i was gowned and gloved, in the middle of a sterile procedure, when one of the cardiac monitors went off in the strident pitch reserved for deadly arrythmias, or cardiac arrest.

we are chronically short staffed, but someone is always available to check an alarm. i figured if they called a code, there would be enough folks around that i could at least finish my procedure before going to lend a hand.

the monitor kept shrieking. no one called a code. actually, it was absolutely silent in a unit where there is never silence. but i didn't notice that. all i knew was that i had to break sterile technique and go see where the hell everybody was. furious, i sailed out of that room into the middle bay, ripping off my gloves and my eyeshields.....attila the hun in scrubs.

the whole unit was frozen in place, a dozen people staring at the monitor over bed 7, which showed v-fib, the signal that her heart, and alot of viable organs, were preparing to die. hot, sweaty, and angry at the interruption, i continued to her bedside and in one motion gave a mighty thump to her sternum. in a classic textbook example, her heart slipped immediately into a normal rhythm. i checked her throat.....there was a good pulse.....and turned to the others, some of whom were standing with their mouths open.

sandy hissed at me, her eyes huge, "she was a no code!" it hit me then, what i had just done. i had broken a very Big Rule. i had in essence "coded" a very specifically requested "no code". okay, so a precordial thump is not a full blown code, but by the letter of the law, i was in the wrong. there was nothing i could do or say to change what i did, so i simply turned back to room 9 and started the procedure over from the beginning.

later, i felt bad. i am very big on honoring patients wishes, followed by the wishes of a family. as nurses we are often the last advocates these people have. it's an important role to play in someone's life. but when Those Who Enforce The Rules got ahold of me, my regrets turned to anger. i was written up for my actions that night......not because i had violated an important trust between the family and the caregivers, but because i had brought the spectre of a potential lawsuit down upon the hospital. my supervisor's first words to me in her office the next day were "you will be very lucky if your ass doesn't end up in a depostion over this."

i reacted badly. i speculated that the dozens of people who had recieved organs this day would likely testify in my defense. not to mention their families and loved ones...... one of the men recieving a kidney had three little children. and if i had to make mistakes, please god let them all save as many lives as this mistake did.

my comments got me further written up for insubordination, and a visit to the DON. it wasn't but two weeks later i was busted for sneaking a dying patient's dog into the unit in a backpack, breaking every Germ Rule known to man. but if you had seen the tears run down that man's face, you would have run interference for me the whole way. it was in those moments that i most felt i was answering my calling.