A few weeks ago, after feeding my face with rich, dense chocolate cake brought by a truly awesome nurse (for no particular reason other than a warm and generous spirit), I walked back into a room to check on a post-cardiac arrest patient.
After surveying his vitals on the monitor, I turned my attention to two nurses and a pharmacist who were discussing the management of his six drips. He was on three pressors, fluids, antibiotics, Protonix, and blood was on the way. I looked at the tangle of tubes running from the subclavian central line I had placed and traced them back to the scrolling green characters on the IV pump screens. And then I realized: I have no idea how to run these things!
I have never programmed an IV pump. I have paused alarms, and shut them off. But, I have never programmed milligrams/kilogram/minute using those stiff little buttons.
It got me thinking of all of the tasks, kindnesses, and skills I sometimes take for granted.
IVs. IV placements are like intubations. Most aren’t hard, but some are. Successful IV placements are most difficult on patients whose vessels are damaged (dialysis patients and IV drug users for example). The nurses I work with are so awesome; I haven’t even had to attempt an ultrasound guided peripheral IV since I finished residency.
Thank you, skilled colleagues! For EJs (IVs in the external jugular vein/neck) and delicately threaded 22-gauges in thumbs/feet!
Medications. Nurses have to calculate the volume of every IV medication doctors order because orders are entered in milligrams and given by milliliters. Math is hard, y’all.
And every once in a while I have an exchange that goes like this:
Patient: I need some more pain medication.
Me: It’s ordered. I’ll let your nurse know.
Patient: Well, why don’t you get it for me?
I have never actually given the most honest answer which is: “Because I can’t! I can’t get into the fancy drug safe thingy!”
Most drugs are stored in a “Pyxis.” Doctors don’t have codes for these dispensaries. We enter orders for drugs and can push drugs, but we truly have to rely on nurses to actually get them.
Team spirit. On a particularly busy shift, I had a constipated patient just waiting to be disimpacted. I was running around doing other things and had put his poop-problem on my low-priority list. A nurse (who may now be one of my favorite nurses ever) came to me and offered to do it. Talk about taking one for the team.
Food for sharing. Walk into any hospital break room in the country, and you will likely find a central table laden with half-eaten boxes of donuts and platters of homemade Pinterest deliciousness. Vendors drop off “thank you for your patronage” edibles, doctors buy takeout, and drug reps bring meals, but nurses “take the cake” when it comes to bringing/sharing food.
Holidays, of course, bring out the crockpots en masse, and there’s also mini-feasting for co-worker birthdays, showers, retirements and going away parties. But sharing food in healthcare is not just for special occasions, it’s part of the everyday culture (thanks to nurses).
If I had a Chuck-E-Cheese token for every time I heard a nurse say, “I brought [some homemade yummy thing] to share,” my kids could play skee ball every day, all summer, until they graduate from high school.
Inexplicable generosity. When I delivered my children during residency, nurse friends decorated my hospital door and surprised me with gifts including homemade blankets and bibs. After starting this blog, nurses I have worked with (even from as far back as when I was a hapless ob/gyn intern) have been some of my most encouraging supporters.
All of these thoughts/memories came flooding back while I looked at those little IV pump screens.
I felt overwhelmed. I have truly worked with some of the best of the best.
I thought: How can I honor their generosity, kindness, sacrifice, friendship, and skill?
Poetry! I thought: I will write an ode, and it will be great.
And then I started trying to rhyme, and it came out more like a limerick than a sonnet.
But I went with it. Here goes:
Stick, flash, draw, flush, no hesitation
You get prompt IV access for medication
You calculate grams to liters in your heads
Wrestle combative patients to their beds
Run multiple drips on a patient who’s dying
Comfort the lonely, dry tears for the crying
You recognize stories full of bullpucky
Answer call lights, do tasks, even if they’re sucky
You handle stressful situations with finesse
Reassure helicopter parents with tirelessness
You tolerate the splitting of histrionics
Listen to the rants of florid psychotics
But even patients who holler and patients who groan
Are so much better than the interpreter phone
Patient to Pyxis and Pyxis to desk
You hustle and hustle without any rest
You have a tolerant nose, a stomach of steel
Wipe pee, poop, and blood, then go eat a meal
The break room has food; there’s enough to share
Hurry — you’ve only got a moment to spare
Thinking of home, you check the clock
Down the hall, they administer a shock
The sigh in your chest is heavy and deep
But you have a thousand more steps before you can sleep
A thousand more steps before you can sleep
Alas, Shakespeare, I am not. The last lines are a play on lines from Robert Frost’s “Stopping by Woods on a Snowy Evening.”
But, hopefully, through my clumsy rhymes, you will still hear a heartfelt, “Thank you.”
I am grateful to work alongside you, to know you, to call you friends.
Kristin Prentiss Ott is an emergency physician who blogs at her self-titled site, Kristin Prentiss Ott.
Image credit: Shutterstock.com