Adult Swim and I have an interesting relationship. I’ve been working in ICU on and off for a few years now. I spent my first four years working nights. Nights are often slower, with fewer family members, managers, doctors and ancillary staff. During a quiet night, there’d be nothing better than firing up some Cartoon Network and letting Adult Swim ride. It helped me pass the time and took me away from the suffering I saw. One of my favorite times during the night would be when it was time to bathe the patients, as it meant I got to spend about twenty minutes in a room listening to Family Guy, American Dad, Robot Chicken, or King of the Hill. All the other nurses would laugh as anyone could tell who my patients were… if they were confused or on a ventilator, Adult Swim was on in their room.
Most of those nights were good nights. Hell, they were often slow nights. You’d be taking care of your people and doing your charting while ‘toons blared away in the background. Those shifts kind of bridged the gap between the nostalgia and immaturity of my youth with that of my Adult/Professional life. In short, they were great.
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A few weeks ago I was working on a med-surg floor. One of my patient’s didn’t seem a bit right. She was confused and agitated. Her blood pressure was low, so I couldn’t give her too much medicine to calm her down (as it would subsequently lower her blood pressure). I also didn’t want to go through the hassle of getting orders to place her in restraints. Besides, she was pleasantly confused – she could be convinced to lay back down and put her clothes on. Plus, she wasn’t throwing anything or pulling her IV, so I was content to bring my computer in with her and sit at her bedside.
At times, it was annoying, but my group of patients were easy to manage and I had loads of charting to catch up on. So I turned on Adult Swim. My favorite shows of yore were on and I listened to them in the background as I did my charting. The on-screen antics occasionally got a chuckle from me. And the whole thing was nice. It brought me back… to my early days of nursing. There was a certain nostalgia to it all. I was content.
As the night went on, I became increasingly convinced something was wrong with my patient. Her vitals were stable, but her blood pressure was low compared to the trends over the past few days. But her labs looked fine, her blood sugar was good, and her O2 sats were stellar. She sounded fine, looked fine, and aside from being pretty damn confused (there was a HUGE black snake next to me all night), there wasn’t anything I could tell that was wrong. The only thing that stood out, which I noticed at the beginning of the shift, was that the patient had been intubated due to seizures the day before. When she had seized, she had large ventricular pauses. What seemed very wrong to me was that she had been extubated and sent to the floor four hours prior to my arrival that night. That seemed way too short a time to come off the vent and get transferred to the floor. But I don’t have MD behind my name, so I can’t make such decisions. Regardless, my spider sense was going off. As the night waned, I became convinced the patient would be having another trip to the ICU at some point. Something seemed wrong, but I couldn’t tell if what I was seeing was Sundowner’s or something more nefarious (or both).
As my shift came to a close, the patient finally settled into an easy sleep and I felt comfortable to leave her on her own. I joined the rest of the staff at the central nursing station. Then I got a call from telemetry, telling me that my patient was having large ventricular pauses with a heart rate in the 20s. “FUCK,” I muttered, then sprinted down the hall. Entering the room, I found my patient to be unresponsive with agonal breaths. By this point, other staff were streaming into the room. I couldn’t find a pulse and we called a code blue.
What ensued was probably one of the best codes I’ve ever run. The nurses I worked with were rock solid. By the time the code team arrived, we had things in textbook order. We hopped between stabilizing her and getting a pulse, to doing chest compressions all over again as we lost it or had to defibrillate her.
Finally, after fifty minutes, she was stable enough to get to the Unit. I looked about the room, totally wrecked from our efforts. I shambled up to the central nurses’ station and sat down. As the adrenaline drained from my body, I heard another code blue called overhead – it was the room in the ICU my patient had been transferred to. I shook my head and said a little prayer for her.
For the next twenty minutes, I just sat and relaxed. We did what we could. I wasn’t shaken up, as I’ve seen the same thing probably hundreds of times before. But I felt sad for my patient. I hope she didn’t suffer.
Before all that though, I remembered that feeling of contentment. It had been a good night, sitting with my patient and hearing Adult Swim drone away in the background. There was a certain comfort to the whole thing.
In a way, it was almost like old times.
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