My ICU Today

I’ve been a critical care nurse for years with a few years diversion to Aeromedicine as an emergency flight nurse (6 years). There’s not a lot I haven’t seen before but this week has been rough even for me. It’s been a 50% mortality week and the dying has been the easy part. I actually like helping families decide to choose DNR and withdraw care allowing their loved one to die with a little dignity. As a nurse I think it’s our strength it’s where we shine and the families think we’re angles. I get all kinds of wow cards from these families and it’s effortless for me, crazy but I like it. I should work hospice I’d be able to sleep at night every night.

The real challenge comes from patients like Todd. 40 years old he suffered a gunshot wound to the spine in 1995 that left him a paraplegic. He has been in and out of the hospital for years with various ailments, osteomyelitis urinary tract infections, sepsis. Stage 4 pressure sores to both lower extremities and the entire sacral area; I mean the largest nastiest pressure sores I’ve ever seen in my life. He’s had numerous surgeries over the years, refuses amputation.  He also has a urostomy and a colostomy. All made worse by his noncompliance. He suffers mental illnesses including personality narcissistic disorder, plus he is manipulative rude and a HUGH pain in the ass.

He was discharged 7 days ago following a 2 month hospital stay to his sister’s house because no facility will take him anymore. He has burned every bridge. He is now septic again from his wounds probably; his sister calls 911 and tells them not to bring him back. I talked to her and she is done with him.

So this is what I have all day. He’s hypotensive on a dopamine drip. When we first meet at the beginning of my 12 hour shift his urostomy bag is full (he wouldn’t allow the night shift nurse to empty it) he pulls both the colostomy and urostomy bags off and throws them on the floor, the bed is a mess and so is he. I find myself getting annoyed with him and then feeling extreme sadness for him. He’s lonely and scared and his mental illness is profound. He has no patience he yells and screams at everyone and then he’ll ask you to sit and watch TV with him and is a sweet child for a while. He’s sad and lost and hopeless. The wounds when he allowed me to  redress and clean them where so bad and full of maggots which is probably the only reason he’s alive.

I don’t know how he’s alive or where he’ll go next but he is one of the most pathetic characters I’ve ever met in my life. I can’t help him because he won’t meet me half way and help himself. Society has given up on him. This is not living.

Worse than Todd I spent 3 12 hour shifts with Ms C. a 44 year old who has suffered from Crohns Disease for most of her adult life. This is a manageable disease, but poverty and ignorance led to noncompliance and depression which all spiraled out of control for this woman. She had refused to eat and her main caregiver was her 16 year old daughter, a dim child with limited education but sweet. Also living with her was her 26 year old 450 lb plus son. He’s a piece of work doesn’t drive or work and visits the hospital rarely because he doesn’t have a ride. Most communication is by phone.

Miss C had been found unresponsive by a visiting social worker in a filthy diaper; it’s unknown how long she had been in this state. Her admitting albumin less than 1 and all labs crazy off the chart. Full on ICU support including gallons of blood products and fluids. When it’s clear she’s not going to respond, she’s in multisystem organ failure and her condition is grave, her son insists on more. Threatening to sue, talking like we can pull miracles out of a hat, where’s Dr House when you need him? She is on a cocktail of vasopressors with a systolic blood pressure of 60, MAP 30 and he wants us to try Adderall…he heard that was good for low blood pressure. Lord have mercy you sit around on your big fat ass and watch too much TV I want to scream at him. Are you looking at your mother here rotting in this bed? Look at her skin sloughing off blistered weeping so bad we can’t keep her dry. It’s insane we allow such ignorance to prevail because Doctors and hospitals have to cover their ass against such vermin. Does anyone have any balls here and do what’s right for this misfortunate woman? Of course not. It’s unethical, we needed an Ethics Consult but it wasn't going to change anything.

This is for me the worse part of the American Healthcare System. Somebody should have been able to allow this woman to die with a little dignity without the risk of being sued by her family. Forget the cost to the taxpayer for all this, as bad as that bugs me it’s not the main issue. We are not GOD we cannot save you if you don’t take care of yourself and help yourself. We did the best we could and it wasn’t enough. End of story.  

Dora Meulman RN