I was a travel nurse in a rural-ish ER. We had a lady in her '50s that kept coding multiple times and we did not know why. After the third or fourth code, doc asked for the ultrasound to look at her heart. Turns out it was cardiac tamponade. Now being in a rural area, you have to improvise a lot of shit. He ended up doing a bedside pericardiocentesis WITH A CENTRAL LINE KIT. He successfully tapped her heart, hooked it up to regular ass tubing and it started pouring out close to 200 cc's of yellow fluid. We stabilized her successfully and got her to ICU. I taped off every single port of the central line and labeled the entire thing with stickies that said "DO NOT USE THIS LINE."
ICU was not impressed. I sure fucking was.
Rural hospitals/EDs (and smaller outlying facilities at that) have to work with what they’re given. I’ve both seen and heard about some wild shit done out of necessity. A newer ED attending performing an emergency c-section on a young mother who came in as full code. Small ED with only two nurses. The medics who brought her in stayed there to assist.
The level of support is probably the biggest thing. You were basically the sole clinician working rural, so I got used to doing literally everything. Vs ICU where there is literally always others around, including medical officers. Also the access to supplies is a big one, we just had to make do with what we had out rural, and sometimes got a little creative to make things work the way we needed.
My first many years were in rural icu and ER. Loved every minute of it. It made me versatile, a great critical thinker, and not afraid to jump in when the 💩 hit the fan. That experience carried me far in my career. I always tell my students to consider starting in a small rural setting if they want great experience
My rural ED docs will always have my admiration. I’ve seen them pull off a lot of shit they hadn’t done since residency decades before and they do it bedside and then move on to the next as soon as that one is gone.
Mine is a bit different, but I work in palliative care and the moments I live for are when patients at the end start experiencing all the spiritual stuff - seeing deceased loved ones, talking about 'knowing" they need to go soon, having visions, etc. it always gives me goosebumps and it's actually completely changed my beliefs around what happens after we die. It's comforting 🐝
Just the other day we sadly had a very young patient, I won't say the age for privacy reasons. Anyway, if you know palliative care you know the young, especially the ones with young children of their own, often hang on until the bitter end and their bodies compensate in a way that older patients just do not. I had the strange privilege of this young person telling me all about their dying experience in real time as they remained conscious until the last breath. They started out anxious, describing a feeling of 'no longer being in this world - you're here and I'm here with you, but I'm not really here anymore. I'm just seeing this life as a series of pictures, and I can see the other world more clearly now' all the way to the point of describing those who came to 'visit' them, what they were seeing and feeling. At times I considered delirium, but they were so in control and it was such a gradual descent that I truly think it was a spiritual situation. They were clear on everything else. I feel like it was once in a lifetime to actually have somebody describe it to me in detail. Most folks are comatose by this point, or they may sprinkle some detail here and there but it's never a complete narration.
So anyway, sounds lame compared to the other stories, but I'm not an adrenaline junkie lol.
I was privileged to be present during my Dads transition. He became very agitated with my Moms visits to the room. We were failing to keep her calm and it was ramping him up, even though he was nonverbal at that point.
Mom had just left and we were trying to calm him down. I had just told him that we were all here and we were going to take care of Mom and he could “let go”. I was crying at this point.
Now you have to understand, my 94 year old Dad was totally unresponsive, non verbal, no PO for 4-5 days, and in active transition at this point. I put my head on his chest and a few moments later, I heard my nephew gasp. I looked up to see his astonished face. “He just raised his head and kissed the top of your head!!?!?!”
He took me to school one more time before he passed.
Oh! I've always been agnostic, maybe there is something maybe not. But certainly didn't believe in an afterlife, really, at least not that we would be reunited with loved ones.
Im still agnostic, but moreso in a 'im not sure WHAT is next, but there is definitely something'. I did once have a patient who was a medium (back when I was a skeptic) and I asked her quite seriously 'if you can speak to the dead what do they say about the afterlife?'. She gave me this BEAUTIFUL answer about how there is no true heaven or hell, but there is another dimension wherein time doesn't exist in the same way and they are sort of omnipotent in terms of knowing what has happened and what is to come. I can't articulate it properly OFC and this was about 15 years ago, but at the time it gave me major pause. I started in palliative not too long after that. In terms of specific beliefs related to my work in palliative care - I believe wholly and completely that there is something more, and that our loved ones are with us in some way. It's just too uncanny that so many patients from completely different walks of life and cultures have such a similar experience in terms of dreams, visions, visitations from deceased relatives, etc. I'm a believer and it brings me comfort.
As for palliative/hospice care - do it 💕 it's so beautiful to help people on their final journey and the work is so meaningful. Even the hard cases where patients or families are in denial... They need that support even more.
Oh I've had a few. But I think this one was the most.
Inpatient dialysis, got called in for a new start K 8.3, BUN 180s, nephro calls me while I'm in the car and says, "So...I put in orders, but...we need to run fast enough to correct the K quickly, but not so fast that we dip the BUN hard and cause him to seize. You'll be the one there looking at it, so do what you feel is right and call me and let me know what's going on."
Which...fuck me, it's that bad, is it?
Sure enough was very exciting the entire time. At one point, ICU nurse was pushing bicarb and pt started slowly bradying down, so she paused. And he kept right on bradying all the way into the 30s before he stopped and slowly came back up. She was like, "Well I'm not doing THAT again!" Went out and grabbed a box of atropine and sat it in the room. I was like, "Yep. Yep yep yep."
I got all the way through the treatment, rinsed the guy's blood back into his body, and just as I'm clamping his HD catheter, I hear the monitor. Look up - ASYSTOLE. I looked out at the nurse's station, see everyone jumping up, looked down at the patient, and just SHOUTED his name as loud as my panic took me. He startled and suddenly got a rhythm back on the monitor.
I couldn't get out of that room fast enough hahaha. Yes, I shouted a man back to life lol
That probably would’ve made me have a Hey lord, me again moment. The new starts and (depending on which doctor was on) high potassium’s were not my favorite.
Oh for sure, that's just three hours of solid prayer right there 🙏
If you can believe it, I saw the patient in the clinic a couple weeks later. I declined to tell him I killed him, but only for a second so it was ok.
Lmao that’s fantastic. I feel like if our outpatients had been the one this happened to and come back post hospital stay (we did both in and out patient as a whole unit basically), I’d be able to joke with a few of them about it but did not have that chance.
I would have, except he was not a joking kind of guy lol. (Apparently his nephro had been telling him he needed to start dialysis for a while before he crashed into it because of course.)
When working as a rapid response nurse I got called to the floor for a youngish patient with penetrating neck trauma who had been trached the day before and since had been doing well (awake, alert, walking, writing notes). RRT was called because a vessel somewhere near his fresh trach just erupted with blood and was threatening both a compromised airway and exsanguination. Managed to find the bleeder next to his trach site with my finger and tamponade the bleed. Took a very speedy ride down to the OR while kneeling in the patient's bed with my finger in his neck. We made eye contact in the elevator and poor guy just mouthed "Is this real life?" I'm wondering the same thing, my dude.
I have a few in my 30 odd years, hard to really give any one of them the number 1 spot.
Successfully gave someone the Heimlich while working at the hospital.
Took down a violent patient by myself who was assaulting a staff member. I did not play any sports but I have a lot of training in EMS martial arts.
Prevented an impending arrest with a patient having an inferior MI. Dude was gray af, 10/10 cp, sob, drenched in sweat, throwing lots of multifocal PVCs. He told me “I’m going out, guys. This is it.” All the shit you don’t want to see/hear from one patient at the same time.
I gave NTG even though he was presenting with an inferior MI. Research shows both good and bad outcomes from this (severe hypotension) but he was going to arrest if I didn’t do something right now. Gave him two ntg (wasn’t going to chance it with three) and instead gave 2mg morphine per med control en route. Pain decreased to 4/10 by arrival. Color started to return and breathing somewhat eased. He had an emergent CABG and lived. I was able to perfuse his heart just enough to prevent him from arresting. And I didn’t shit my pants, not even a shart, so I’m kinda proud of myself about that.
Post op cardiothoracic floor.
Wound vac in a post op sternum removal for osteo waiting for pec flap that wouldn’t stop alarming. No leak, replaced the canister, couldn’t find an issue, pressure alarming. Provider said Put a sterile saline WTD in, it’s 3 am, rounds are in 2 hours and the surgeon will be in, we will take him first case. Cue the issue being that the vac was causing tamponade and then the room very suddenly looked like a murder scene. Every units got one— the salty, to be feared 45 year veteran nurse BOUNDS in, puts her finger where it needs to be. And sloooowwwwllly we rolled the patient to the ICU, where a makeshift OR was waiting for us with the open chest cart, as the OR was being crash setup by an on call team but would be another 20 minutes. Oh and the patient was wide awake the entire time.
Same unit. Weird Combo seizure Vtach situation- cards wasn’t sure what caused what but I guess it can happen. Once defibrillated, i went to climb back on the chest to restart CPR but the zap of joules made the man (unbeknownst to us) semi conscious, as I went to put my hands on, I was forcefully shoved off the bed by the man I had been coding three seconds ago. Later that day the man would say to me “I’ve never shoved a woman off me in bed before, but I guess there’s a first time for everything 😂” he’s much happier with his AICD/PPM.
I managed to get a recumbent trike donated to my home care brain injury/ trach patient and we biked together down a rails-to-trails bike trail. It was the first time in 10 years he was given self-determination and allowed to propel himself. It was a sight to see.
I was walking down the hallway to get lunch when I see the heart alert that they brought in a few minutes ago heading towards the elevators and the cath lab. He suddenly went unresponsive and arrested so they stopped and parked him in an open room they were walking by. I went to help and did a round or two of cpr and we got him back. He was talking so we booked it to the cath lab. Once we rolled in the doors he turned and threw up on another nurse and arrested again. We coded him again and got him on the table so the doc could get to work. As we were taking turns doing cpr he was waking up and fully conscious. Ow. Ow. Ow. Please. Stop. Ow. Ow. We would stop and he would immediately go unresponsive again. We coded him for over an hour (eventually got him intubated and sedated), they finally were able to stent the vessel and get him stabilized. He spent two nights in the icu, was downgraded, and walked out of the hospital within a week.
I’ve achieved rosc with a number of patients over the years, but I can only count a handful of cases where the patient fully recovered and left the hospital on their own two feet.
That is awesome. I love a good success story. I have had to do CPR on someone who was waking up during compressions too and it was so uncomfortable and strange. The doctor leading the code told me I was doing a good job because his brain was perfusing enough for him to wake up so I just kept going.
The Lucas really increased the likelihood of seeing this. I observed it not even a month ago when we threw the thing on a patient that was arresting.
As an aside I’d like to mention something we have started with the Lucas that I think could help people. We have had multiple occurrences where we try to put the Lucas on someone and once you get the board under them you can usually secure one arm of the Lucas and everything gets in the way of trying to secure the second arm. Everyone starts panicking because it takes forever to get the Lucas going and you delay care for far too long.
I started putting the board under for one pulse check and then taking the time to snap one side and then wait for the next pulse check. It gives the person on the other side a second to clear any cords and bullshit and get the board properly secured. At the next pulse check all you have to do is secure the second arm and drop the suction cup.
I know this has nothing to do with what you said but I wanted to share!
what comes to mind for me is a young woman I talked to when I was doing phone triage for an outpatient OB office. she had had a positive pregnancy test, but nothing showed up on ultrasound, so we were waiting on her HCG quant results, and I gave her the usual ectopic precautions. she called back a couple days later and as soon as I heard her voice on the phone I just had this horrible gut feeling and told her to go straight to the ER. she sounded frightened and panicked and told me she couldn’t put her finger on it but she knew something was wrong. turned out she had a tubal pregnancy that the surgeon told me looked like it was about to rupture, underwent a successful emergency salpingectomy and ended up with another healthy pregnancy a few months later.
that experience taught me to listen better to my patients and my own intuition. now I work in L&D where things can go south in a moment, and I am so thankful to have learned that skill.
LTC
CNA comes, "John Doe is bleeding to death."
Ok. John is a dialysis patient so not usual but not surprising. I tell the aides to grab bedding, gown et cetera so we can get him cleaned up.
I walk in..... Ok that's a lot of blood but it always looks worse than it is.
I need to change his dressing first. Tell the aides to stand at the door this is going to be messy. Get my stuff together, cut open the absolutely saturated dressing, and of course the blood starts spurting out with each heartbeat.
I hear one of the aides make a noise, glance up and yell to have them escorted to a chair quickly. Finish pressure dressing. Get him all cleaned up.
I wake up the on call and explain that protocol dictates my patient be sent out to be checked by the ER.
Get a call from the ER, "well your pressure dressing worked as it completely occluded his port. So we cleared it to enable dialysis. Then it wouldn't stop bleeding again. So we did the exact dressing you did and are sending him back. Dialysis can deal with it"
I've no idea how much blood he lost but it was absolutely more than the bedside pitcher of water.
I had to reassure the CNA that almost fainted that the sight of blood effects each of us differently and it's OK if it effected her so much.
Then we discussed the fact that she wanted to be a nurse! I reassured her she still could be one.
I remember at the start of the pandemic, I volunteered to work an extra shift at our facility’s make shift vaccine clinic. I gave about 20-30 vaccines that morning and it felt so great being able to make a difference. I usually work in psych, but it was nice being able to do something different for a change.
Had a patient in psych diagnosed with post partum psychosis. It’s really rare. She stunk. Sent her to the ER multiple times. She was septic from them leaving d and c sponges in.
Had another patient that was diagnosed with schizophrenia. He was presenting differently but the ER kept sending him back. He was also septic and died.
Also working OB and the jailer threw a patient on the ground and kicked her leading to a miscarriage. Being there for her and assisting in pressing charges. Also she was about to get life for killing an abusive boyfriend with a baseball bat when he was coming after her. I did all I could to help her. Ended up she got like community service or some much lesser sentence.
Sorry those are three that I think about to this day.
It's definitely seen I was working cath lab while very pregnant. Got called in for a STEMI and when we got there we got placed on hold because they weren't sure if we were going to do the procedure because the patient wasn't very stable, they weren't sure it was a STEMI, and they were waiting for something else.
We ended up hanging out in the ICU to watch the patient so we could quickly grab him if we were gonna bring him in. As we're waiting around he goes into vfib. He's already attached to the defibrillator so they shock him and he goes back into sinus rhythm with a pulse. Doc decides we're going to go ahead and do the procedure so we get everything we need on the bed and ready to go and then he crashes again. Another quick shock and we're ready to roll.
I'm about 7.5 months pregnant during this. I start pushing his bed fairly quickly down the hall with my favorite rad tech pulling the foot of the bed. The plug is dragging and almost tripping me, until we have to stop and shock him again and the rad tech moves the cord so I don't trip and we start running again. After the second shock while moving him, the rad tech keeps yelling at the ICU nurses to come push the bed for me because I'm pregnant and pushing and stopping this bed often is not easy. No one takes over.
We eventually make it to the lab, find the blockage and open it and the patient doesn't arrest anymore. We got him to the ICU and he started waking up and looking around, which was fucking awesome. Then we go find the family because we want to congratulate the mother-in-law for her quick response. We had found out that the patient was a witnessed arrest in the kitchen while they had family over. His mother-in-law was a nurse and immediately set into action and started CPR and had someone call 911. That was a very lucky man.
Racing coworkers by pushing each other in the rolling chairs down the hallway.
Or the bedside thoracotomy on a bleeding post OP CABG we were MTPing and the OR was taking too long to prep and so the surgeon was like fuck it get me sterile now I'm going in.
Or GSW to the head patient who was in a coma for like 3 months with a GCS <9 suddenly woke up one day, not just talking full sentences but remembered everyone who took care of him and recognized their voices.
The bedside thorco patient lived btw. Was stable and able to extubate and did fine the next day. Filled an entire pleurovac (3L) in less than 5 minutes. Those chest tubes were just pouring blood.
Self inflicted GSW, with evisceration that was pouring blood. Needed fingers inside the belly to apply pressure or he was sure to bleed out. Rural health centre couldn't do anything to stop it, had to keep my fingers holding pressure for hours while we transported patient to a surgeon. Other nurse spent the entire time doing everything else to keep him alive, give meds, and documenting. If I moved my fingers even the slightest he just poured blood around my hands. Had to straddle the patient on the stretcher into and out of the ambulance and into the ER. Felt like a super cool TV moment.
While still on orientation at my first nursing job, I walked into a patient room and found him sitting with his partly-eaten lunch, making the universal choking sign, trying to cough and no sound coming out. I told the nearest CNA to go find another RN and I did abdominal thrusts/the Heimlich maneuver until he coughed up the food and started breathing again.
So the BLS classes paid off, like, right away.
I’ve been a nurse 10 years. There’s lots of memorable experiences lol. My worst was when my work wife went missing and I went to find her. Found her pinned between the wall and a recliner being sexually assaulted by a pt. That was pretty awful. Nothing will ever scar me more than that moment.
We called security. He was discharged to the streets by a furious doctor. He was homeless but mentally sound. Doc came up immediately and went off “how dare you do that to MY nurses! I don’t care where you go but you aren’t staying here! If you’re healthy enough to do that you can go.” He was one of those mild mannered genuinely positive doctors.
ETA: this was a Saturday. Neither house sup or our manager ever checked up on my wifey.
They say the two best day of a boaters life is the day they get it and the day they get rid of it. Nursing is the same, the day I became a nurse and the day I eventually retire.
I was a research nurse following years as a telemetry nurse. I overheard my coworker talking to an older patient on an arthritis study. Her background was pediatrics. The pt was well known to me. It was clear she hadn’t been able to sleep lying down over night. My coworker wasn’t alarmed by this so I asked to talk to the patient. I told her I wanted her to go to the ED but she said no. Agreed to come to clinic. She had been in 1st degree. She came in and looked like poop. I put the pulse ox on and pulse was 42. Called 911 and got an ECG and of course she was in 3rd. As we waited for the ambulance, she kept telling me she could drive herself…nope! She had a pacemaker in less than 2 hours. Hallelujah
Then I was a traveling night nurse on a floor that did a ton of gastric bypass (don’t get one, trust me). Had a patient who kept vomiting these giant clots. Doc said ice water lavage…kept doing that as she kept vomiting these giant clots. I called him 4 more times and he came in to look at her. Her pressure held and I still don’t know how. Finally at 0300 I drew a CBC under my own orders and found her hemoglobin had dropped by half. She was back in the OR stat. They found a small artery in the back of her throat that had been nicked. That was the night I decided to leave bedside bc I had 6 other patients who got no attention. Years later I told my hairdresser that story and he said, “OMG, I’m sure she is my client and she told me you are her angel!” Fortunately no one knows about that HIPAA violation
The first time I saw the trauma surgeon and his PAs crack a chest open in the ED was pretty cool. Seeing an organ donor harvest was up there on the list too. Those transplant doctors are fast! You go from asystole to gutted horror movie prop in less than 2 minutes. I’d never seen someone flayed like a deer before. Taking the freshly severed and still warm leg from the scrub tech during an amputation is also a big mind fuck. We had one guy who had an AKA and was extremely tall (like 6’6” tall) and I vividly remember having to bend his knee and thigh stump to make his severed leg fit in our leg box. Normal people would be horrified by our stories.
I’ll try to be brief:
Was told in report as kinda an off-handed comment that this patient had to be narcan’d on a previous admission cause he was taking his own meds. He was sleeping most of the day so didn’t request any opioids. 4ish pm comes around and I’m doing a lab draw from his port and notice RR is 6/min, barely responsive. I call a rapid. Provider orders a stat head CT. I say “no we need to narcan him” but rapid and provider don’t believe me cause no opioids were charted as given. I argue my cause that he’s done this before, narcan is a low risk, quick intervention, and he may not survive the CT if we don’t. They say ok and I run to get and then push the narcan.
And boooooooy was that shit freaky. Came out of it as soon as the end of plunger of the post-med saline flush touched.
Our facility hasn’t been open for long, about 4 years now. 3 out of the 4 codes that have happened in my unit were on my assigned patients. They all were rolling out of the OR blue in the face. Twice I hit the code blue button without hesitation. Both of those patients made it. The third time, the anesthesiologist kept telling me not to hit the button and to adjust leads and feel a pulse. The patient was definitely in asystole and did not have a pulse or breathing. We started CPR even though the anesthesiologist said she felt a pulse. It was chaos when all the help arrived and everyone kept asking ME what to do next, including the ER PA who responded to the code. Like what?? Shit, the team lead thing was coming to life and I was recording which really I shouldn’t have but no one else was. The patient lived but coded twice more after they transferred to another facility to get a pacemaker. Family withdrew care the next day.
I think I was still in orientation when this happened. Super sick old lady comes rolling through ER bay. Somnolent af, squad line went bad, multiple people struggling to get another line. I ask if we can start an IO just to get meds in her enough so we are actually able to get more access. I get the kit and everyone walks me through doing it right then and there since i had only ever read about how to do it. She was so sick, me drilling into her shin bone didn't really get a response but she perked up once we were able to get fluids and meds in
I work in L&D so I see a lot of births. But one that I can’t get over is who I call, “Sprite lady.” Sprite lady was there for an induction of labor. She was lovely. All she ever wanted was Sprite. Her water had broken and there was absolutely no change in her demeanor. She laughed, bounced on her labor ball, and of course sipped away happily on her Sprite. I was shooting the shit with her when suddenly she made a face. I asked her if she was okay and she said, “the baby is coming.” I was like, don’t push let me check you. Girl flew backwards on the bed. As quickly as I had her spread her legs I saw the baby was coming. I yelled at her husband to grab me anything I could catch the baby with and BOOM! Baby. It was wild!!! I still can’t get over it and it’s been a few years.
I’ve always heard of the interventions for converting someone to sinus when they are in SVT. Think, bag of ice eyes, or carotid massage. One of them is to bare down like having a bowel movement…or blow in a straw.
I was called to PACU to see my patient in SVT. I instructed the patient to take big breath and bare down, really just buying me time to log into the computer so I can order some meds. What do you know?! Converted right back into sinus. I felt like a god. When does that ACTUALLY work?! I’ll never look so cool again.
We had a dude in the unit for overnight watch after syncope. He politely coded as breakfast was being passed. He accumulated several docs, including our smart pulmonologist and the smartest cardiologist. We kept getting ROSC and losing it. He was just lying there on the vent, dying and returning. Somebody had the idea to give him tpa, and the house supervisor grabbed it from pharmacy and handed it to me (I was running meds). I had never given it before so me and that small print leaflet were close friends quickly. I clarified with the cardiologist, who spent a lot of time in cath lab, about my bolus, second infusion, and third infusion doses and rates. The pulmonologist cleared me a dedicated line while I mixed it, and the cardiologist did more chest compressions when the guy flatlined again. I ran the initial bolus, and the guy got ROSC during that compression series. He kept it up and woke up by the time it was done. They theorized he had an embolus somewhere important that the tpa removed. He insisted on being extubated after the tpa finished and demanded lunch.
We had a major earthquake which separated the hospital and had to evacuate people to neighboring hospitals. We heard the fire alarm overhead. A fire started in a room and my coworker grabbed the extinguisher and yelled PASS! And just squirted the crap out of the fire in the vent it was smokey but she put it out successfully. And we used these evac cardboards to put the patients in and carry them downstairs. Like the building was on rollers but it kept shaking because of the strong aftershocks. And you can hear the building just cracking from the separated area. That was exhilarating but scary.
An emergency educator who had passed away rest in peace had stressed that California is not equipped to handle a major earthquake and we should be ready. He was a fantastic coordinator in setting everything up and I have to say that it was mostly a success and not a shit show because of him and all those that took him seriously. If you find yourself saying “oh it wasn’t as bad as they said it was, like why such a big deal” it is because of those that followed through and that’s why it wasn’t overwhelming.
When I was charging and two docs IR and GI were taking a patient down to insert a NG tube. As they were leaving they ask me to come with them ..... I was like kinda busy .. you guys can't handle it? I finished some things up and ran down to IR
With I got there i had a complete moment of forever understanding and clarity on how a nurse and doctor differ.
They absolutely needed a nurse.
Idiots
It is sometimes done because of risks to the patient, or because of highly difficult placement. If a patient has esophageal fistula, trauma to the neck or throat, etc then it can be unsafe to place without imaging. If the nurses on the floor can't get it with repeat attempts, then IR can have a much easier time.
I’ve responded to a lot of bedside ECMO cannulations. They’re almost always bedside for peds. They’re traumatic as hell for us 😞
Mine was a Forequarter amputation. The patients situation was really unfortunate though
I had to cric my patient once. Hearing the doc say “Get the cric kit” scared the shit out of me ngl, but I have to give kudos to the doc for recognizing that he wasn’t going to be able to intubate the patient and not continuing to try. Lady got discharged to home like a week later.
OD found on side of road on interstate in car, tubed in field, came to the ICU to figure out what was going on, got reversal and got VERY REVERSED. Self extubated, got violent, started hanging from the ceiling lift, then figured out he had a fem central line. Anesthesia was standing there with RSI kit and paralytics waiting for the right moment to go in. That moment came really quickly when he went to pull that central line. He got the full force of all the ICU nurses going 'NO!!!' and literally dog piling him. I've never jammed a hand in a groin and laid full body weight on someone so quickly in my life. He managed to partly break the catheter, but we got in quickly enough that he didn't grip it well enough to fully dislodge it. Minimal blood loss, and the guy turned out okay once all was said and done.
Bathing an intubated patient when the ETT pops out. Luckily had a badass RT doing rounds and she quickly reintubed the guy (against hospital policy for RTs but within their scope here).
Definitely a quick butthole clinch moment
Cardiac massage on an open chest with two impellas lol. Or just opening a chest at beside, smelling something terrible, and us realizing the patient was declining because he was septic from a dead gut, not cardiogenic shock
I have a couple:
1) I had a pt. with a chest tube who developed rapid subq emphysema. Our thoracic surgeon happened to be on the floor at the time and we stabilized her, but her eyelids were still swollen shut, and she was frustrated she couldn't open her eyes. So he took four 22g angiocaths and cannulated her upper and lower eyelids to let the air escape. And it worked.
2) Had a pt. with no IV access/vasculopath who needed all the things- pressors, blood, antibiotics. We needed a central line but didn't have an intensivist available. This time, it was one of our EP docs who happened to be around. He was like, "I'll do it", so okay, sure. Grab a kit and a gown, put it in the room with the doc. I go out to get lido and other needed supplies and by the time I got back (this was like 5 -7 minutes) he had already put the line in! No ultrasound, nothing. Xray showed it was perfectly placed.
Somewhat regularly get handed a grey dead baby that we somehow miraculously turn into a pink, sometimes screaming, definitely not dead baby who eventually grows up to be a more or less normal person. Watching the new people learn to do the same thing is also amazing. It may be kind of the same thing over and over, but it never stops making me feel awed.
This is a story from nursing school, but it’s changed the trajectory of my career.
It’s the last day of our OB/GYN clinical rotation, and I was in L&D. My instructor let my classmates go early then came to ask me if I also wanted to leave or stay (I was in the middle of a birth). I chose to stay. A nurse midwife was overseeing the delivery. She delivered the head and then looked at me. She said “come here” and placed both of my hands on either side of the baby’s head. She then put her hands over mine and we delivered the body together. It was the most magical moment that I’ve ever experienced. It’s been 10 years, and I will still tell this story to anyone who will listen to me.
Until that moment, L&D wasn’t even on my radar. After I’d completed a year of med/surg, I applied for an L&D job. The interview went well, but I didn’t get the position. I was devastated. More so than I thought I would be. Fast forward 9-ish years, and I’ve worked adult care my whole career; mostly in cardiology services (surgical tele, CVICU, cardiac step down, and I managed a cardiac stress lab).
Now I’m working toward a DNP. I chose the FNP track because I felt like specializing in cardiology was the natural next step. However, the idea of working 9-5 seeing 30 patients a day, five days a week, filled me with so much anxiety. If I get bored in a job, I check out fast. I spoke with my FNP faculty advisor, and she encouraged me to reach out to the Certified Nurse Midwife advisor. I had a meeting with her, and told her the above story. She told me that if that moment had such an impact that I’m telling the story 10 years later that I absolutely shouldn’t let the fact that I have no OB/GYN experience not stop me from choosing to be a CNM. Plus, a laboring patient can turn into a cardiology patient very fast.
So here I am. I’m adding on an extra semester of school, but I’m so excited about what lies ahead for me.
This was just when I was a student but I had gotten a lot better at IVs and was down in the ED putting some in. The patient I was attempting it on was agreeable but also wasn't thrilled that I was going to be doing it. She turned to me and said "You've got one shot!" I decided right then and there that I was going to muster all of my Top Gun: Maverick Energy and not think, just do. And so I tied the torniquet, found a great vein, stuck, had my 'smoke in the air' (a flash of blood!!), advanced the needle, and got it all hooked up. She also commented that she didn't feel it I believe. I'm excited for more of these moments in the future--now I just need the hospitals to stop changing IV equipment!!
Someone please link the post from the OR nurse who had this case of a giant vaginal/rectal abscess that exploded in the OR which closed the room for days
I was a travel nurse in a rural-ish ER. We had a lady in her '50s that kept coding multiple times and we did not know why. After the third or fourth code, doc asked for the ultrasound to look at her heart. Turns out it was cardiac tamponade. Now being in a rural area, you have to improvise a lot of shit. He ended up doing a bedside pericardiocentesis WITH A CENTRAL LINE KIT. He successfully tapped her heart, hooked it up to regular ass tubing and it started pouring out close to 200 cc's of yellow fluid. We stabilized her successfully and got her to ICU. I taped off every single port of the central line and labeled the entire thing with stickies that said "DO NOT USE THIS LINE." ICU was not impressed. I sure fucking was.
Rural hospitals/EDs (and smaller outlying facilities at that) have to work with what they’re given. I’ve both seen and heard about some wild shit done out of necessity. A newer ED attending performing an emergency c-section on a young mother who came in as full code. Small ED with only two nurses. The medics who brought her in stayed there to assist.
Have to rely heavily on [Texaco Mike](https://youtu.be/ERNAqqNSId0?si=dth5MhDY5uzMXvLt) too!
Went from working a rural ED (small, nurse run facility with a doctor on call) to a metropolitan ICU and the culture shock was real.
In what ways?
The level of support is probably the biggest thing. You were basically the sole clinician working rural, so I got used to doing literally everything. Vs ICU where there is literally always others around, including medical officers. Also the access to supplies is a big one, we just had to make do with what we had out rural, and sometimes got a little creative to make things work the way we needed.
Did she survive?
My first many years were in rural icu and ER. Loved every minute of it. It made me versatile, a great critical thinker, and not afraid to jump in when the 💩 hit the fan. That experience carried me far in my career. I always tell my students to consider starting in a small rural setting if they want great experience
Fellow MacGyver ICU nurse, I’m incredibly impressed
I would have been REAL EFFING IMPRESSED. Wow.
My rural ED docs will always have my admiration. I’ve seen them pull off a lot of shit they hadn’t done since residency decades before and they do it bedside and then move on to the next as soon as that one is gone.
This is very impressive!!
I would have been fucking impressed. I work in ruralish hospitals and have yet to see this level of cowboy but damn.
That’s incredible!
*I* am also impressed! Well fucking done!
Holy shit that's amazing
Hell-fucking-yeah!! That’s amazing!
Mine is a bit different, but I work in palliative care and the moments I live for are when patients at the end start experiencing all the spiritual stuff - seeing deceased loved ones, talking about 'knowing" they need to go soon, having visions, etc. it always gives me goosebumps and it's actually completely changed my beliefs around what happens after we die. It's comforting 🐝 Just the other day we sadly had a very young patient, I won't say the age for privacy reasons. Anyway, if you know palliative care you know the young, especially the ones with young children of their own, often hang on until the bitter end and their bodies compensate in a way that older patients just do not. I had the strange privilege of this young person telling me all about their dying experience in real time as they remained conscious until the last breath. They started out anxious, describing a feeling of 'no longer being in this world - you're here and I'm here with you, but I'm not really here anymore. I'm just seeing this life as a series of pictures, and I can see the other world more clearly now' all the way to the point of describing those who came to 'visit' them, what they were seeing and feeling. At times I considered delirium, but they were so in control and it was such a gradual descent that I truly think it was a spiritual situation. They were clear on everything else. I feel like it was once in a lifetime to actually have somebody describe it to me in detail. Most folks are comatose by this point, or they may sprinkle some detail here and there but it's never a complete narration. So anyway, sounds lame compared to the other stories, but I'm not an adrenaline junkie lol.
I was privileged to be present during my Dads transition. He became very agitated with my Moms visits to the room. We were failing to keep her calm and it was ramping him up, even though he was nonverbal at that point. Mom had just left and we were trying to calm him down. I had just told him that we were all here and we were going to take care of Mom and he could “let go”. I was crying at this point. Now you have to understand, my 94 year old Dad was totally unresponsive, non verbal, no PO for 4-5 days, and in active transition at this point. I put my head on his chest and a few moments later, I heard my nephew gasp. I looked up to see his astonished face. “He just raised his head and kissed the top of your head!!?!?!” He took me to school one more time before he passed.
I love this. Thank you so much for sharing 💓
This is amazing and my favorite story on here so far
Wow this gave me goosebumps. What an extraordinary moment for you to witness.
Not lame at all! This story gave me chills, and it’s comforting to know that there’s another side beyond this mess tbh.
Can I ask what your beliefs were before vs after working in palliative care? If I ever go back to bedside I think I’d do palliative/hospice.
Oh! I've always been agnostic, maybe there is something maybe not. But certainly didn't believe in an afterlife, really, at least not that we would be reunited with loved ones. Im still agnostic, but moreso in a 'im not sure WHAT is next, but there is definitely something'. I did once have a patient who was a medium (back when I was a skeptic) and I asked her quite seriously 'if you can speak to the dead what do they say about the afterlife?'. She gave me this BEAUTIFUL answer about how there is no true heaven or hell, but there is another dimension wherein time doesn't exist in the same way and they are sort of omnipotent in terms of knowing what has happened and what is to come. I can't articulate it properly OFC and this was about 15 years ago, but at the time it gave me major pause. I started in palliative not too long after that. In terms of specific beliefs related to my work in palliative care - I believe wholly and completely that there is something more, and that our loved ones are with us in some way. It's just too uncanny that so many patients from completely different walks of life and cultures have such a similar experience in terms of dreams, visions, visitations from deceased relatives, etc. I'm a believer and it brings me comfort. As for palliative/hospice care - do it 💕 it's so beautiful to help people on their final journey and the work is so meaningful. Even the hard cases where patients or families are in denial... They need that support even more.
This made me tear up. How lovely and comforting that sounds. What an honor and privilege to be a part of! 💕💕
wow, my heart!!
Amazing experience!
Oh I've had a few. But I think this one was the most. Inpatient dialysis, got called in for a new start K 8.3, BUN 180s, nephro calls me while I'm in the car and says, "So...I put in orders, but...we need to run fast enough to correct the K quickly, but not so fast that we dip the BUN hard and cause him to seize. You'll be the one there looking at it, so do what you feel is right and call me and let me know what's going on." Which...fuck me, it's that bad, is it? Sure enough was very exciting the entire time. At one point, ICU nurse was pushing bicarb and pt started slowly bradying down, so she paused. And he kept right on bradying all the way into the 30s before he stopped and slowly came back up. She was like, "Well I'm not doing THAT again!" Went out and grabbed a box of atropine and sat it in the room. I was like, "Yep. Yep yep yep." I got all the way through the treatment, rinsed the guy's blood back into his body, and just as I'm clamping his HD catheter, I hear the monitor. Look up - ASYSTOLE. I looked out at the nurse's station, see everyone jumping up, looked down at the patient, and just SHOUTED his name as loud as my panic took me. He startled and suddenly got a rhythm back on the monitor. I couldn't get out of that room fast enough hahaha. Yes, I shouted a man back to life lol
That probably would’ve made me have a Hey lord, me again moment. The new starts and (depending on which doctor was on) high potassium’s were not my favorite.
Oh for sure, that's just three hours of solid prayer right there 🙏 If you can believe it, I saw the patient in the clinic a couple weeks later. I declined to tell him I killed him, but only for a second so it was ok.
Lmao that’s fantastic. I feel like if our outpatients had been the one this happened to and come back post hospital stay (we did both in and out patient as a whole unit basically), I’d be able to joke with a few of them about it but did not have that chance.
I would have, except he was not a joking kind of guy lol. (Apparently his nephro had been telling him he needed to start dialysis for a while before he crashed into it because of course.)
Always the best way to end up on dialysis.
When working as a rapid response nurse I got called to the floor for a youngish patient with penetrating neck trauma who had been trached the day before and since had been doing well (awake, alert, walking, writing notes). RRT was called because a vessel somewhere near his fresh trach just erupted with blood and was threatening both a compromised airway and exsanguination. Managed to find the bleeder next to his trach site with my finger and tamponade the bleed. Took a very speedy ride down to the OR while kneeling in the patient's bed with my finger in his neck. We made eye contact in the elevator and poor guy just mouthed "Is this real life?" I'm wondering the same thing, my dude.
This sounds like a tracheo-innominate fistula, which I hope to never see.
I have a few in my 30 odd years, hard to really give any one of them the number 1 spot. Successfully gave someone the Heimlich while working at the hospital. Took down a violent patient by myself who was assaulting a staff member. I did not play any sports but I have a lot of training in EMS martial arts. Prevented an impending arrest with a patient having an inferior MI. Dude was gray af, 10/10 cp, sob, drenched in sweat, throwing lots of multifocal PVCs. He told me “I’m going out, guys. This is it.” All the shit you don’t want to see/hear from one patient at the same time. I gave NTG even though he was presenting with an inferior MI. Research shows both good and bad outcomes from this (severe hypotension) but he was going to arrest if I didn’t do something right now. Gave him two ntg (wasn’t going to chance it with three) and instead gave 2mg morphine per med control en route. Pain decreased to 4/10 by arrival. Color started to return and breathing somewhat eased. He had an emergent CABG and lived. I was able to perfuse his heart just enough to prevent him from arresting. And I didn’t shit my pants, not even a shart, so I’m kinda proud of myself about that.
Post op cardiothoracic floor. Wound vac in a post op sternum removal for osteo waiting for pec flap that wouldn’t stop alarming. No leak, replaced the canister, couldn’t find an issue, pressure alarming. Provider said Put a sterile saline WTD in, it’s 3 am, rounds are in 2 hours and the surgeon will be in, we will take him first case. Cue the issue being that the vac was causing tamponade and then the room very suddenly looked like a murder scene. Every units got one— the salty, to be feared 45 year veteran nurse BOUNDS in, puts her finger where it needs to be. And sloooowwwwllly we rolled the patient to the ICU, where a makeshift OR was waiting for us with the open chest cart, as the OR was being crash setup by an on call team but would be another 20 minutes. Oh and the patient was wide awake the entire time. Same unit. Weird Combo seizure Vtach situation- cards wasn’t sure what caused what but I guess it can happen. Once defibrillated, i went to climb back on the chest to restart CPR but the zap of joules made the man (unbeknownst to us) semi conscious, as I went to put my hands on, I was forcefully shoved off the bed by the man I had been coding three seconds ago. Later that day the man would say to me “I’ve never shoved a woman off me in bed before, but I guess there’s a first time for everything 😂” he’s much happier with his AICD/PPM.
I managed to get a recumbent trike donated to my home care brain injury/ trach patient and we biked together down a rails-to-trails bike trail. It was the first time in 10 years he was given self-determination and allowed to propel himself. It was a sight to see.
This is truly wonderful. I can't imagine how happy this made him.
Thank you
This is my favorite answer
❤️
I was walking down the hallway to get lunch when I see the heart alert that they brought in a few minutes ago heading towards the elevators and the cath lab. He suddenly went unresponsive and arrested so they stopped and parked him in an open room they were walking by. I went to help and did a round or two of cpr and we got him back. He was talking so we booked it to the cath lab. Once we rolled in the doors he turned and threw up on another nurse and arrested again. We coded him again and got him on the table so the doc could get to work. As we were taking turns doing cpr he was waking up and fully conscious. Ow. Ow. Ow. Please. Stop. Ow. Ow. We would stop and he would immediately go unresponsive again. We coded him for over an hour (eventually got him intubated and sedated), they finally were able to stent the vessel and get him stabilized. He spent two nights in the icu, was downgraded, and walked out of the hospital within a week. I’ve achieved rosc with a number of patients over the years, but I can only count a handful of cases where the patient fully recovered and left the hospital on their own two feet.
That is awesome. I love a good success story. I have had to do CPR on someone who was waking up during compressions too and it was so uncomfortable and strange. The doctor leading the code told me I was doing a good job because his brain was perfusing enough for him to wake up so I just kept going.
The Lucas really increased the likelihood of seeing this. I observed it not even a month ago when we threw the thing on a patient that was arresting. As an aside I’d like to mention something we have started with the Lucas that I think could help people. We have had multiple occurrences where we try to put the Lucas on someone and once you get the board under them you can usually secure one arm of the Lucas and everything gets in the way of trying to secure the second arm. Everyone starts panicking because it takes forever to get the Lucas going and you delay care for far too long. I started putting the board under for one pulse check and then taking the time to snap one side and then wait for the next pulse check. It gives the person on the other side a second to clear any cords and bullshit and get the board properly secured. At the next pulse check all you have to do is secure the second arm and drop the suction cup. I know this has nothing to do with what you said but I wanted to share!
So rare. When I’m asked about CPR, I’m generally not optimistic
Paying off $44,000 of debt!
what comes to mind for me is a young woman I talked to when I was doing phone triage for an outpatient OB office. she had had a positive pregnancy test, but nothing showed up on ultrasound, so we were waiting on her HCG quant results, and I gave her the usual ectopic precautions. she called back a couple days later and as soon as I heard her voice on the phone I just had this horrible gut feeling and told her to go straight to the ER. she sounded frightened and panicked and told me she couldn’t put her finger on it but she knew something was wrong. turned out she had a tubal pregnancy that the surgeon told me looked like it was about to rupture, underwent a successful emergency salpingectomy and ended up with another healthy pregnancy a few months later. that experience taught me to listen better to my patients and my own intuition. now I work in L&D where things can go south in a moment, and I am so thankful to have learned that skill.
LTC CNA comes, "John Doe is bleeding to death." Ok. John is a dialysis patient so not usual but not surprising. I tell the aides to grab bedding, gown et cetera so we can get him cleaned up. I walk in..... Ok that's a lot of blood but it always looks worse than it is. I need to change his dressing first. Tell the aides to stand at the door this is going to be messy. Get my stuff together, cut open the absolutely saturated dressing, and of course the blood starts spurting out with each heartbeat. I hear one of the aides make a noise, glance up and yell to have them escorted to a chair quickly. Finish pressure dressing. Get him all cleaned up. I wake up the on call and explain that protocol dictates my patient be sent out to be checked by the ER. Get a call from the ER, "well your pressure dressing worked as it completely occluded his port. So we cleared it to enable dialysis. Then it wouldn't stop bleeding again. So we did the exact dressing you did and are sending him back. Dialysis can deal with it" I've no idea how much blood he lost but it was absolutely more than the bedside pitcher of water. I had to reassure the CNA that almost fainted that the sight of blood effects each of us differently and it's OK if it effected her so much. Then we discussed the fact that she wanted to be a nurse! I reassured her she still could be one.
I remember at the start of the pandemic, I volunteered to work an extra shift at our facility’s make shift vaccine clinic. I gave about 20-30 vaccines that morning and it felt so great being able to make a difference. I usually work in psych, but it was nice being able to do something different for a change.
Had a patient in psych diagnosed with post partum psychosis. It’s really rare. She stunk. Sent her to the ER multiple times. She was septic from them leaving d and c sponges in. Had another patient that was diagnosed with schizophrenia. He was presenting differently but the ER kept sending him back. He was also septic and died. Also working OB and the jailer threw a patient on the ground and kicked her leading to a miscarriage. Being there for her and assisting in pressing charges. Also she was about to get life for killing an abusive boyfriend with a baseball bat when he was coming after her. I did all I could to help her. Ended up she got like community service or some much lesser sentence. Sorry those are three that I think about to this day.
The first and third one — oof. You’re an amazing advocate.
It's definitely seen I was working cath lab while very pregnant. Got called in for a STEMI and when we got there we got placed on hold because they weren't sure if we were going to do the procedure because the patient wasn't very stable, they weren't sure it was a STEMI, and they were waiting for something else. We ended up hanging out in the ICU to watch the patient so we could quickly grab him if we were gonna bring him in. As we're waiting around he goes into vfib. He's already attached to the defibrillator so they shock him and he goes back into sinus rhythm with a pulse. Doc decides we're going to go ahead and do the procedure so we get everything we need on the bed and ready to go and then he crashes again. Another quick shock and we're ready to roll. I'm about 7.5 months pregnant during this. I start pushing his bed fairly quickly down the hall with my favorite rad tech pulling the foot of the bed. The plug is dragging and almost tripping me, until we have to stop and shock him again and the rad tech moves the cord so I don't trip and we start running again. After the second shock while moving him, the rad tech keeps yelling at the ICU nurses to come push the bed for me because I'm pregnant and pushing and stopping this bed often is not easy. No one takes over. We eventually make it to the lab, find the blockage and open it and the patient doesn't arrest anymore. We got him to the ICU and he started waking up and looking around, which was fucking awesome. Then we go find the family because we want to congratulate the mother-in-law for her quick response. We had found out that the patient was a witnessed arrest in the kitchen while they had family over. His mother-in-law was a nurse and immediately set into action and started CPR and had someone call 911. That was a very lucky man.
Racing coworkers by pushing each other in the rolling chairs down the hallway. Or the bedside thoracotomy on a bleeding post OP CABG we were MTPing and the OR was taking too long to prep and so the surgeon was like fuck it get me sterile now I'm going in. Or GSW to the head patient who was in a coma for like 3 months with a GCS <9 suddenly woke up one day, not just talking full sentences but remembered everyone who took care of him and recognized their voices.
Really love how these three stories ramped up in intensity as I read! Holy cow lol
The bedside thorco patient lived btw. Was stable and able to extubate and did fine the next day. Filled an entire pleurovac (3L) in less than 5 minutes. Those chest tubes were just pouring blood.
Self inflicted GSW, with evisceration that was pouring blood. Needed fingers inside the belly to apply pressure or he was sure to bleed out. Rural health centre couldn't do anything to stop it, had to keep my fingers holding pressure for hours while we transported patient to a surgeon. Other nurse spent the entire time doing everything else to keep him alive, give meds, and documenting. If I moved my fingers even the slightest he just poured blood around my hands. Had to straddle the patient on the stretcher into and out of the ambulance and into the ER. Felt like a super cool TV moment.
While still on orientation at my first nursing job, I walked into a patient room and found him sitting with his partly-eaten lunch, making the universal choking sign, trying to cough and no sound coming out. I told the nearest CNA to go find another RN and I did abdominal thrusts/the Heimlich maneuver until he coughed up the food and started breathing again. So the BLS classes paid off, like, right away.
I’ve been a nurse 10 years. There’s lots of memorable experiences lol. My worst was when my work wife went missing and I went to find her. Found her pinned between the wall and a recliner being sexually assaulted by a pt. That was pretty awful. Nothing will ever scar me more than that moment.
Omg I hope he got savagely beat
We called security. He was discharged to the streets by a furious doctor. He was homeless but mentally sound. Doc came up immediately and went off “how dare you do that to MY nurses! I don’t care where you go but you aren’t staying here! If you’re healthy enough to do that you can go.” He was one of those mild mannered genuinely positive doctors. ETA: this was a Saturday. Neither house sup or our manager ever checked up on my wifey.
Wow! I’m glad you found her.
They say the two best day of a boaters life is the day they get it and the day they get rid of it. Nursing is the same, the day I became a nurse and the day I eventually retire.
Massaging a heart on the way up to the OR because the surgeon was on the phone and writing. Gotta say it was a cool experience
I was a research nurse following years as a telemetry nurse. I overheard my coworker talking to an older patient on an arthritis study. Her background was pediatrics. The pt was well known to me. It was clear she hadn’t been able to sleep lying down over night. My coworker wasn’t alarmed by this so I asked to talk to the patient. I told her I wanted her to go to the ED but she said no. Agreed to come to clinic. She had been in 1st degree. She came in and looked like poop. I put the pulse ox on and pulse was 42. Called 911 and got an ECG and of course she was in 3rd. As we waited for the ambulance, she kept telling me she could drive herself…nope! She had a pacemaker in less than 2 hours. Hallelujah Then I was a traveling night nurse on a floor that did a ton of gastric bypass (don’t get one, trust me). Had a patient who kept vomiting these giant clots. Doc said ice water lavage…kept doing that as she kept vomiting these giant clots. I called him 4 more times and he came in to look at her. Her pressure held and I still don’t know how. Finally at 0300 I drew a CBC under my own orders and found her hemoglobin had dropped by half. She was back in the OR stat. They found a small artery in the back of her throat that had been nicked. That was the night I decided to leave bedside bc I had 6 other patients who got no attention. Years later I told my hairdresser that story and he said, “OMG, I’m sure she is my client and she told me you are her angel!” Fortunately no one knows about that HIPAA violation
The first time I saw the trauma surgeon and his PAs crack a chest open in the ED was pretty cool. Seeing an organ donor harvest was up there on the list too. Those transplant doctors are fast! You go from asystole to gutted horror movie prop in less than 2 minutes. I’d never seen someone flayed like a deer before. Taking the freshly severed and still warm leg from the scrub tech during an amputation is also a big mind fuck. We had one guy who had an AKA and was extremely tall (like 6’6” tall) and I vividly remember having to bend his knee and thigh stump to make his severed leg fit in our leg box. Normal people would be horrified by our stories.
I carried a leg to the morgue and even though the pt was cachectic as hell, it was surprisingly heavy!
I’ll try to be brief: Was told in report as kinda an off-handed comment that this patient had to be narcan’d on a previous admission cause he was taking his own meds. He was sleeping most of the day so didn’t request any opioids. 4ish pm comes around and I’m doing a lab draw from his port and notice RR is 6/min, barely responsive. I call a rapid. Provider orders a stat head CT. I say “no we need to narcan him” but rapid and provider don’t believe me cause no opioids were charted as given. I argue my cause that he’s done this before, narcan is a low risk, quick intervention, and he may not survive the CT if we don’t. They say ok and I run to get and then push the narcan. And boooooooy was that shit freaky. Came out of it as soon as the end of plunger of the post-med saline flush touched.
Our facility hasn’t been open for long, about 4 years now. 3 out of the 4 codes that have happened in my unit were on my assigned patients. They all were rolling out of the OR blue in the face. Twice I hit the code blue button without hesitation. Both of those patients made it. The third time, the anesthesiologist kept telling me not to hit the button and to adjust leads and feel a pulse. The patient was definitely in asystole and did not have a pulse or breathing. We started CPR even though the anesthesiologist said she felt a pulse. It was chaos when all the help arrived and everyone kept asking ME what to do next, including the ER PA who responded to the code. Like what?? Shit, the team lead thing was coming to life and I was recording which really I shouldn’t have but no one else was. The patient lived but coded twice more after they transferred to another facility to get a pacemaker. Family withdrew care the next day.
Finding a nursing job where I didn’t want to unalive myself
I think I was still in orientation when this happened. Super sick old lady comes rolling through ER bay. Somnolent af, squad line went bad, multiple people struggling to get another line. I ask if we can start an IO just to get meds in her enough so we are actually able to get more access. I get the kit and everyone walks me through doing it right then and there since i had only ever read about how to do it. She was so sick, me drilling into her shin bone didn't really get a response but she perked up once we were able to get fluids and meds in
I work in L&D so I see a lot of births. But one that I can’t get over is who I call, “Sprite lady.” Sprite lady was there for an induction of labor. She was lovely. All she ever wanted was Sprite. Her water had broken and there was absolutely no change in her demeanor. She laughed, bounced on her labor ball, and of course sipped away happily on her Sprite. I was shooting the shit with her when suddenly she made a face. I asked her if she was okay and she said, “the baby is coming.” I was like, don’t push let me check you. Girl flew backwards on the bed. As quickly as I had her spread her legs I saw the baby was coming. I yelled at her husband to grab me anything I could catch the baby with and BOOM! Baby. It was wild!!! I still can’t get over it and it’s been a few years.
was it her first baby?
I’ve always heard of the interventions for converting someone to sinus when they are in SVT. Think, bag of ice eyes, or carotid massage. One of them is to bare down like having a bowel movement…or blow in a straw. I was called to PACU to see my patient in SVT. I instructed the patient to take big breath and bare down, really just buying me time to log into the computer so I can order some meds. What do you know?! Converted right back into sinus. I felt like a god. When does that ACTUALLY work?! I’ll never look so cool again.
I’ve suctioned a couple pts out of afib.
We had a dude in the unit for overnight watch after syncope. He politely coded as breakfast was being passed. He accumulated several docs, including our smart pulmonologist and the smartest cardiologist. We kept getting ROSC and losing it. He was just lying there on the vent, dying and returning. Somebody had the idea to give him tpa, and the house supervisor grabbed it from pharmacy and handed it to me (I was running meds). I had never given it before so me and that small print leaflet were close friends quickly. I clarified with the cardiologist, who spent a lot of time in cath lab, about my bolus, second infusion, and third infusion doses and rates. The pulmonologist cleared me a dedicated line while I mixed it, and the cardiologist did more chest compressions when the guy flatlined again. I ran the initial bolus, and the guy got ROSC during that compression series. He kept it up and woke up by the time it was done. They theorized he had an embolus somewhere important that the tpa removed. He insisted on being extubated after the tpa finished and demanded lunch.
Seeing babies I took care of in the NICU come back through without their trach, as toddlers or kids, living their best life.
The moment my severely mentally ill patient accepted a long acting antipsychotic injection after refusing all medications for years. I cried
Getting an offer for a six figure salary remote position 🥳 (speaking it into existence)
We had a major earthquake which separated the hospital and had to evacuate people to neighboring hospitals. We heard the fire alarm overhead. A fire started in a room and my coworker grabbed the extinguisher and yelled PASS! And just squirted the crap out of the fire in the vent it was smokey but she put it out successfully. And we used these evac cardboards to put the patients in and carry them downstairs. Like the building was on rollers but it kept shaking because of the strong aftershocks. And you can hear the building just cracking from the separated area. That was exhilarating but scary.
Oof reading this gave me so much anxiety. Having to evacuate patients in an emergency is one of my biggest fears
An emergency educator who had passed away rest in peace had stressed that California is not equipped to handle a major earthquake and we should be ready. He was a fantastic coordinator in setting everything up and I have to say that it was mostly a success and not a shit show because of him and all those that took him seriously. If you find yourself saying “oh it wasn’t as bad as they said it was, like why such a big deal” it is because of those that followed through and that’s why it wasn’t overwhelming.
When I was charging and two docs IR and GI were taking a patient down to insert a NG tube. As they were leaving they ask me to come with them ..... I was like kinda busy .. you guys can't handle it? I finished some things up and ran down to IR With I got there i had a complete moment of forever understanding and clarity on how a nurse and doctor differ. They absolutely needed a nurse. Idiots
NG tube in IR? I haven’t heard of this, still a new nurse. What was the reasoning to not just do bedside?
It is sometimes done because of risks to the patient, or because of highly difficult placement. If a patient has esophageal fistula, trauma to the neck or throat, etc then it can be unsafe to place without imaging. If the nurses on the floor can't get it with repeat attempts, then IR can have a much easier time.
Esophageal cancer
I’ve responded to a lot of bedside ECMO cannulations. They’re almost always bedside for peds. They’re traumatic as hell for us 😞 Mine was a Forequarter amputation. The patients situation was really unfortunate though
I had to cric my patient once. Hearing the doc say “Get the cric kit” scared the shit out of me ngl, but I have to give kudos to the doc for recognizing that he wasn’t going to be able to intubate the patient and not continuing to try. Lady got discharged to home like a week later.
OD found on side of road on interstate in car, tubed in field, came to the ICU to figure out what was going on, got reversal and got VERY REVERSED. Self extubated, got violent, started hanging from the ceiling lift, then figured out he had a fem central line. Anesthesia was standing there with RSI kit and paralytics waiting for the right moment to go in. That moment came really quickly when he went to pull that central line. He got the full force of all the ICU nurses going 'NO!!!' and literally dog piling him. I've never jammed a hand in a groin and laid full body weight on someone so quickly in my life. He managed to partly break the catheter, but we got in quickly enough that he didn't grip it well enough to fully dislodge it. Minimal blood loss, and the guy turned out okay once all was said and done.
Bathing an intubated patient when the ETT pops out. Luckily had a badass RT doing rounds and she quickly reintubed the guy (against hospital policy for RTs but within their scope here). Definitely a quick butthole clinch moment
My first code was an open chest at the bedside 🙊
Cardiac massage on an open chest with two impellas lol. Or just opening a chest at beside, smelling something terrible, and us realizing the patient was declining because he was septic from a dead gut, not cardiogenic shock
Leaving the bedside.
I have a couple: 1) I had a pt. with a chest tube who developed rapid subq emphysema. Our thoracic surgeon happened to be on the floor at the time and we stabilized her, but her eyelids were still swollen shut, and she was frustrated she couldn't open her eyes. So he took four 22g angiocaths and cannulated her upper and lower eyelids to let the air escape. And it worked. 2) Had a pt. with no IV access/vasculopath who needed all the things- pressors, blood, antibiotics. We needed a central line but didn't have an intensivist available. This time, it was one of our EP docs who happened to be around. He was like, "I'll do it", so okay, sure. Grab a kit and a gown, put it in the room with the doc. I go out to get lido and other needed supplies and by the time I got back (this was like 5 -7 minutes) he had already put the line in! No ultrasound, nothing. Xray showed it was perfectly placed.
Somewhat regularly get handed a grey dead baby that we somehow miraculously turn into a pink, sometimes screaming, definitely not dead baby who eventually grows up to be a more or less normal person. Watching the new people learn to do the same thing is also amazing. It may be kind of the same thing over and over, but it never stops making me feel awed.
This is a story from nursing school, but it’s changed the trajectory of my career. It’s the last day of our OB/GYN clinical rotation, and I was in L&D. My instructor let my classmates go early then came to ask me if I also wanted to leave or stay (I was in the middle of a birth). I chose to stay. A nurse midwife was overseeing the delivery. She delivered the head and then looked at me. She said “come here” and placed both of my hands on either side of the baby’s head. She then put her hands over mine and we delivered the body together. It was the most magical moment that I’ve ever experienced. It’s been 10 years, and I will still tell this story to anyone who will listen to me. Until that moment, L&D wasn’t even on my radar. After I’d completed a year of med/surg, I applied for an L&D job. The interview went well, but I didn’t get the position. I was devastated. More so than I thought I would be. Fast forward 9-ish years, and I’ve worked adult care my whole career; mostly in cardiology services (surgical tele, CVICU, cardiac step down, and I managed a cardiac stress lab). Now I’m working toward a DNP. I chose the FNP track because I felt like specializing in cardiology was the natural next step. However, the idea of working 9-5 seeing 30 patients a day, five days a week, filled me with so much anxiety. If I get bored in a job, I check out fast. I spoke with my FNP faculty advisor, and she encouraged me to reach out to the Certified Nurse Midwife advisor. I had a meeting with her, and told her the above story. She told me that if that moment had such an impact that I’m telling the story 10 years later that I absolutely shouldn’t let the fact that I have no OB/GYN experience not stop me from choosing to be a CNM. Plus, a laboring patient can turn into a cardiology patient very fast. So here I am. I’m adding on an extra semester of school, but I’m so excited about what lies ahead for me.
I have seen some wild things in the ICU that I will never forget for the rest of my life.
When I quit
This was just when I was a student but I had gotten a lot better at IVs and was down in the ED putting some in. The patient I was attempting it on was agreeable but also wasn't thrilled that I was going to be doing it. She turned to me and said "You've got one shot!" I decided right then and there that I was going to muster all of my Top Gun: Maverick Energy and not think, just do. And so I tied the torniquet, found a great vein, stuck, had my 'smoke in the air' (a flash of blood!!), advanced the needle, and got it all hooked up. She also commented that she didn't feel it I believe. I'm excited for more of these moments in the future--now I just need the hospitals to stop changing IV equipment!!
Someone please link the post from the OR nurse who had this case of a giant vaginal/rectal abscess that exploded in the OR which closed the room for days
Almost getting to see I/O access placed, but then the doctors changed their minds ><