Saturday, January 10, 2009

Cath Lab

I found shelter from floating for a month or two in the Cardiac Cath Lab. They had just lost some senior staff and needed someone to fill holes while they were training the new people. For the sake of stability, I traded my precious three twelve’s for four tens (shifts a week). I worked in the holding room where I prepped the patient’s for their procedures and recovered them when they came out again. If you are interested we had generally between 20 to 30 or more procedures a day at somewhere around 20K a pop.

About a third of the patients had had heart transplants. These patients get a heart biopsy every week for the first 6 months or so after transplantation. It was a refreshing change to see so many healthy transplant patients leading essentially normal lives, a few of them even ten years out form transplantation. There were also some whose transplants had started to go bad. While still in good health, their terror could be compared to that of a person who has jumped out of an airplane to find the parachute will not open. You cannot get back to the plane and your old heart is in the garbage heap.

The biopsy patients did not need IVs – the tiny pieces of heart muscle were collected with a straight shot down the jugular to the heart. The procedure was simple and low risk and did not require sedation. The patients could come in at 7:30 am and be home by noon if everything went well.

The rest of the patients needed IVs, which gave me the opportunity to brush up on one of my weaker and least favorite nursing skills. I like putting them in about as much as the patients like getting them. Subsequently I have not become very good at it and that does not help matters. For two months I tried for as many as I could and I did get better at it, although Jay (a hard stick) would probably still be better served to ask for someone else.

Recovering the patients was all about pulling out “sheaths” (large bore ‘IVs’ that protect the blood vessels when the catheters are passed through) from necks and groins. One day I may do a post about the built in discrepancies between what is done and what is documented. Sheath pulling will be a classic example – we documented that we were checking the pulses on the patient’s feet every five minutes while at the same time documenting that we were holding pressure with both hands on the groin.

If the patient is nice, holding pressure on their groin for fifteen minutes to stop them from exsanguinating (bleeding out), provides a good opportunity to chat. Most of the patients were focused on getting out of the hospital as soon as possible, so jokes about how they could always stay for the night if they wanted usually went over well. Once I joked like this with a male patient in his early 70’s and his wife. The joke fell flat, but it started a conversation. He had been hospitalized after a cardiac procedure (I do not remember what) and had had a rough time over several months. “It took us a full year to get the sore on his bottom healed,” said his wife. It had been all the way to the bone. Still I was thinking that he was lucky in a relative way. He had returned to his normal life in the end. The odds must have been against him.

But that was just the beginning. His wife began to tell me the story of her bypass (or “cabbage” as we say on the inside –CABG coronary artery bypass graft). There had been a bad batch of heparin or something and of four patients that were operated on that day; she was the only one who had survived. The others had died slowly over months, losing limbs piece by piece on the way. She had lost only one and a half fingers in the end. The doctors had told her never to let anyone give her heparin again. Her face and voice were calm and only a little weary and sad. She held out her hand for a moment to show her missing fingers and I noticed also a metal allergy bracelet. I looked at her face again. Her eyes were big. She was shaking like a leaf.


Jay said...

This poor couple - they've both been through the wringer. A sore that extended to the bone, then a bad batch of meds that led to losing a finger and a half? That the wife lived when three other people died - holy crap, no wonder she shook. Makes you wonder where they find the courage to show up for the next medical procedure.

(And if I'm the 'hard-stick' Jay you referred to, you're absolutely correct. If a nurse or tech isn't completely comfortable drawing blood, I just hope he or she decides that I'm too much trouble and then calls over someone with more experience!)

Happy New Year!


Devadeva Mirel said...

leo, your blog is compelling but also makes me want to barf. i don't have the stomach for nursing, although i know it is a reliable, steady job.

i better stick to cooking.

keep up the blogging!

Anonymous said...

I left nursing in 1989 because of "Reaganomics". I was sick of being floated to areas where I had no experience (hey, you know how to take a BP and temp don't you?) nor expertise. It all came down to profit and the bottom line. I couldn't fathom working a 12 hour shift. It's insane and I don't care if it's worth the extra day off. What other profession works those long hours? OK, so it saves the hospitals from having to staff three eight hour shifts but it would seem to increase mistakes due to fatigue. Under staffing is another factor for mistakes. I would hope that a single payer system becomes reality and soon.