Success Being Relative

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

blood bags/ by montuno, via flickr

We trouped in from the parking garage through the fading starlight of early dawn to find most of night shift gathered in one room. Portable surgical lights added to the overhead fluorescence, casting a striking glare on the scene. The patient was ominously flat: his positioning and pallor an instant indicator of his perfusion status, which was confirmed by a quick glance at the monitor. His blood pressure, we said among ourselves, was “in the toilet.”

He’d been in a motor vehicle accident and had suffered a prolonged extrication. There’d been a fatality at the scene. He wasn’t my patient (although he was everyone’s patient, really), so I’m not the one who got the long report. I didn’t know each and every one of his injuries, but I knew the only one that was relevant at the time—his liver was badly fractured and he was bleeding out. His abdomen was hugely distended and firm. He was cold to the touch, and his skin bore the expected pallor of a man in shock.

2016-11-21T13:09:30-05:00August 8th, 2012|nursing perspective, nursing stories|2 Comments
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The Kiss: Hope in the ICU

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

by limegreeen9, via flickr creative commons

I always look forward to interdisciplinary rounds. I’ve worked with most of the team members for years and enjoy the differing perspectives and collaboration. Today is no exception; I know my patient very well, as he’s been in the ICU for months. As the interdisciplinary team moves through the ICU like a small mingling mob, pausing at each room for a brief nursing report and lingering for discussion, I stand in anticipation, ready to present my patient’s case.

My report, though, is politely cut short by the medical director.

“What’s changed?” he wants to know.

And I feel pressed to produce some crumb of improvement. 

“Well…” I say. “He kisses his wife. His GCS* remains eight, but he kisses his wife.”

A few people smile, and I hear a few chuckles.

“It’s a reflex!” I hear someone say as they move away.

I know, of course, how little the kisses mean from a medical standpoint. His initial injury was neurologic, and his neuro status is quite compromised, but stable. His cardiovascular, gastrointestinal, and genitourinary systems are stable, as well. It’s respiratory insufficiency that keeps him in the unit. Puckering his lips in response to his wife leaning towards him is not significant […]

2016-11-21T13:09:58-05:00June 4th, 2012|Nursing, nursing perspective, nursing stories, Patients|4 Comments
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We’re Not Going to Lie to You

By D’Arcy Norman, via Flickr

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

“Hgb 4.1,” the lab tech said, and we jumped as though someone had fired a starter pistol. While one nurse called the on-call trauma doctor, the rest of us mobilized in preparation for the interventions we anticipated.

The “critical results” call wasn’t a surprise. The teenager’s pelvis had been crushed when he was run over by a delivery truck. His blood pressure was holding fairly steady, but we didn’t put much faith in that. In cases of hemorrhagic shock, young patients tend to compensate until the very last second, and we knew that.

His heart rate was soaring and his color was terrible. In the 15 minutes since he’d been wheeled into the unit, flat and flaccid on a stretcher, he’d gone from barely arousable to completely nonresponsive. Aside from his shallow, even respirations, he looked strikingly dead.

A good nursing team functions like a choreographed troupe, and we were at our best that day, moving with staccato precision. Massive transfusions can do wonders; still, it was amazing how quickly he improved. He lost the gray-white pallor and his heart rate stabilized. Then his lashes fluttered and he opened his eyes.

He regarded us working over him for several minutes. The air of urgency remained, and the gravity of his condition was no secret.

“This is bad, isn’t it?” he asked.

And it wasn’t a time for platitudes.

“We’re […]

2016-11-21T13:12:12-05:00August 8th, 2011|nursing perspective, nursing stories, Patients|3 Comments
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Neither Crime Nor Demeanor

By Marcy Phipps. Marcy is an RN in St. Petersburg, Florida. Her essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN, and she has contributed several thoughtful posts to this blog in recent months (here’s the previous one).

My patient’s ICU stay was short, as his injuries were fairly unremarkable. Far more striking were the circumstances of his admission; he’d been injured while committing an appalling act of grisly violence. An armed police officer stood sentry at his bedside, and the nature of his crimes gave him a sinister notoriety among the medical staff.

“Alleged” crimes, I should say.

But it was difficult to give him the benefit of the doubt. I’d read the paper and seen the crime scene photos on the news.  The media’s case against him made his innocence hard to fathom, and as a police officer’s daughter I found myself inclined to prejudice. I not only planned on, but also counted on disliking him, at least on some level. Although I would certainly provide care to this man, I exempted myself from caring about him as an individual.

I was surprised to find his demeanor dramatically different than my expectations. He was soft-spoken and retiring, exceedingly polite and appreciative.

I don’t mean to imply that we chatted. Our conversations were limited to his physical condition and general plan of care. He never acknowledged the officer at the bedside or spoke of his alleged crimes, and neither did I.

It’s possible […]

2016-11-21T13:15:59-05:00August 25th, 2010|Nursing, nursing stories|2 Comments
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