Monday, September 29, 2008

No Sanctuary for the Dying

I was in the last semester of nursing school and I was interning on the MICU where I would work after graduation. During the first or second week I observed a code. It was a patient with sepsis. Her blood was too acidic and her heart kept stopping. The team would inject bicarb (basic) and perform chest compressions and her heart would resume beating for a while. A few minutes later it would stop again. Her condition was irreversible.

Experienced nurses were running the code. “Will someone please call the family and tell them it is time to let her go to Jesus!,” one called out. Another had the job of injecting the bicarb – “Can’t….Stop…” He said as he pushed the amp into the patient during the third round. He was registering his distaste.

My preceptor had another idea. She went and got the new chest compression machine the unit was supposed to be trialing. With a little persistence, she overcame the objections of the other nurses. They complained about the interruption that would be necessary to place the machine under the patient.

After the hard board was under the patient and the 10 inch wide nylon strap was secured over her chest, the machine was turned on. On the first try, it did not engage. Then, like something out of Robocop, it came to life. First it moved the nylon strap in and out, measuring the appropriate length, then…. WHAM! WHAM! WHAM! WHAM! The strap tightened and slammed down on the patient’s chest delivering compressions. The compressions were so violent that the patient’s already swollen belly jumped a foot upwards with each contraction. Her body looked like so much bread dough in a kneading machine. It was quite horrible to watch. I asked my preceptor about it – this had to be damaging her body. My preceptor replied that studies had shown that regular chest compressions are not very effective in circulating blood throughout the body. The compressions delivered by the machine would be much more efficient. Ribs are often broken during CPR, even when it is done by hand. The machine might save lives. We had to learn how to use it and this was a good case to try it out on (because we knew she was not going to make it in any case – no harm if something goes wrong).

The other nurses seemed as unhappy as I was with the trial and I never did see the damn machine again. I made sure to give a dirty look to whoever so much as mentioned using it. No sanctuary for the dying.

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