The Worst

There are lots of stinky, drippy, oozy, things in my day. Most of them I barely register before moving on. Some register more than others, though. I used to think the worst thing I'd ever felt was the sensation of being buried elbows deep in the abdominal fat tissue of a patient. Tucking Kerlix (total: 6) into the far recesses of the subcutaneous tissues while the skin and fat lapped over my gloves onto my forearm was horrifying. I learned very quickly to wear the blue, plastic isolation gowns and sterile gloves, since they're longer than the nitrile for dressing changes.

But I was recently reacquainted with the feeling of an unstable chest. Long ago and far away, I had my first code blue. I'd been a part of a good many before this one, but this one was mine. Since it was my patient I felt, all in one moment, ashamed that I'd missed the warning signs, the shot of adrenaline that comes with the ohshit moment, and eager to prove my worthiness as a nurse. So I bounded into the room, cape flying, and purposed to give the best possible compressions that had ever been given in the history of CPR. On all 80lbs of my patient. The first crunches that accompanied my first compression are marked indelibly in my memory. The room spun and my vision narrowed momentarily. But I yanked on my bootstraps and kept compressing, tears running down my face. That patient didn't make it and I forever swore off compressions. I didn't know then that effective compressions, about 1.5 or so inches in depth, will often break ribs. I didn't know how to modify the force of my compressions to suit the individual. I certainly didn't know that at a future point I would be throwing my entire body weight into compressions, actually lifting my feet off the stepstool, and barely making a dent in the body habitus I was endeavoring to "save." I just knew when I got home after that shift, I spent a long time crying.

I was the recipient of someone post CPR the other day. The code was prolonged and bystander CPR was ineffective (it usually is). There was a high probability of irreversible damage to the brain and so all medications that might sedate were held for a period of time to see what, if any, neurological function was preserved. Eyelid opening did nothing, neither did nailbed pressure. I casually went to sternal rub my patient and immediate flashback. Unstable chest. Fractured ribs from compressions. Once again horrified, ashamed, de-caped as it were. I couldn't bring myself to inflict any more pain on someone who'd been through so much.

As bad as being inside that belly was, being outside those chest walls was the worst.