Thursday, December 29, 2005

Fresh Coffee

Every spring there was a kind of minor population reversal that took place in the mountains. The locals, all screaming-bonkers with cabin fever, would head out for warmer climes, while vacationers would trickle into the bed-and-breakfast places and hotel resorts.

The lakes would have thawed well enough for boating and fishing, the trails just patchy with ice and snow could be hiked before bug season took hold, and the south-facing cliffs so prominant around there would attract early-season climbers.

Local doctors especially would take off, kids out of school, so the operating room did few electives. One surgeon, my very favorite Dr. Riley, always stayed around because he was from John Hopkins and life was slow and vacation-like for him here just about all the time.

It was a weeknight and there were only three patients in our little eight-bed intensive-care unit. I had a fresh carotid endarterectomy done by Dr. Riley, and she was having some of the usual blood-pressure concerns. I was watching her arterial line and giving her the occasional dose of hydralazine or labetolol.

Nikki had a vent patient with pneumonia who wasn't doing great, but hanging on well enough.

My other patient was riding his bicycle down the highway hill by town hall when a local drove by towing his fishing boat. The trailer hitch failed and the boat swung out and struck the bicyclist. He had a fractured pelvis and some other breaks, and he'd lost some blood so I was giving him transfusions. But he was basically okay. Okay for a bicyclist that got hit by a boat, that is.

Nikki and I cruised through the early evening hours of the night shift, chatting a lot about this and that. We had actually worked together at another hospital years earlier, when I was a nurse aide, so we often talked about those days.

Once in a while Jane, the night nurse supervisor, came through to see how we were doing and to tell us that the emergency room was as quiet as expected. That was good, because if we got loaded up with new arrivals there weren't any additional nurses to come in. People were out of town, and in that remote region there just were no such animals as agency nurses who could be called in if demand required more working bodies in nurse uniforms. We weren't much worried about it, though.

Janie called at about 10:30 to tell us that there was a crash and patients were coming in. A family of five from Canada had a head-on collision into a pickup with an elderly local couple in it. When they hit the ER she'd have a better idea of who would go where, but we could expect a little action.

A little action. In a few hours the unit would be full.

The father/driver smacked his chest into the steering column and his R-waves were tiny, plus the chest scan showed maybe a little tamponade so he needed to be monitored. There were three girls, a teen with a fractured clavicle and some bad cuts, a twelve-year-old who would need to be C-spine cleared but not until morning, and an eight-year-old with a broken arm and some bruising, also clavicular. They were all wearing their safety belts. You could tell from the bruises. Like stripes.

The mother had a nasty broken leg and enough blood loss to require monitoring. Nikki took the mother and the oldest girl, and I took the father and the two little ones. They weren't really "critical" but Janie thought it would be better to keep them with their parents.

Our little hospital had no pediatric unit. Just us. A kid shows up, and presto! You're a peds nurse. None of the floor nurses had taken a PALS course, probably anyways.

The husband and wife in the pickup died at the scene. They were unrestrained and they also had a bunch of unsecured stuff in the back of their truck. Like a chainsaw, some cut wood, and a plastic container of kerosene. The saw had smashed through the back window of the truck cab, and the kerosene tank had ruptured and its smell was all over.

There's no trauma like head trauma. It was probably pretty quick for them.

But it was a little rough on the squads that came out. They're all volunteers. People you see at the grocery store. People you buy furniture from. Not hard people.

We did our transfusions and gave pain meds and dealt with the shock of it all. The twelve-year-old kept asking me if "the police were going to take her dad away for killing those old people," and I just said "no, it was an accident." But Janie said he would probably be cited for some violation or other. Lane crossing.

The eight-year-old asked me to sign her arm cast.

The hours flew by. Nikki and I were exhausted, but doing okay, a little proud of our efforts really. This is my "once I had five patients assigned to me in the ICU so stop your whining" story. We sort of liked the stress of it all.

Morning approached. Time for coffee, but neither of us had drank much of the last pot, and it had been hours. The coffee at the bottom of the glass carafe had evaporated down to a syrupy brown sludge. I couldn't stop to make more because I was so busy going from patient to patient, and neither did Nikki, but she was desperate.

It was after 5 a.m. and she couldn't go on without an immediate caffeine fix. I was bleary, too, but I did not imagine what she did next. It was as real as the chair I'm sitting in right now.

Nikki ran the hot water from the sink, and swirled a little into the muddy bottom of the coffee carafe, reconstituting the remains. She poured this into a cup as I looked on, stunned.

"You're not going to do that," I said hopefully, and she said "Oh yeah, well just watch me!" and she stirred in some sugar and creamer.

The cup contents turned ashen gray, like some chalky volcanic drool. Then Nikki took a long hard drink of it.

"Not so bad," she said.

"Liar," I replied. Back to work.

Janie had persuaded a couple day shift nurses to come in a little early to help us out. We were so glad to see them come rolling in. We were tired and hungry. The first thing Anne did when she arrived was to put on a fresh pot of coffee.

She took a whiff from the carafe and said "Yuck, this stuff is disgusting. How old is this?" and I said that Nikki had just made it.


MEC said...

I am convinced, just from reading the way you write about your work, that you're a damned good nurse.

It's a job that takes everything you've got. I hope you have enough happy endings to keep you going in it.

gail said...

Wonderful story ... not that people were hurt, but they way you tell it.

Nurse Mia said...

What a great story. I love the parallel story-line about the coffee. That makes it so real and everyday-like for "the life of an ICU nurse."

HypnoKitten said...

I hate to say I did that coffee thing for a patient once who said they hated the coffee the other nurse brought them because it was so nasty. I went back to the pot the nurses would gladly drink from and mixed about 2/3 cup coffee with 1/3 hot water and brought it to him (he said it was much better). The nurses LIKED it that dark. Sane, reasonable people do not... lol!

PaedsRN said...

I have only once been that desperate for coffee. Couldn't drink it though!

Jeneiene Schaffer said...

What a cool story! I don't usually read blogs that are as long is this entry, but it was a very very good read. You should write a book-have you ever thought of doing that? Happy New Year, Mr. Shrimplate!

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