By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

If I had a crystal ball, I might have called in sick. Or at least gotten more sleep.

They brought the patient up at the start of our shift, and he was a ‘train wreck.’ He’d been shot many times and he was bleeding out before our eyes. I don’t know how much blood we gave him—I can only say it seemed endless . . . blood and fresh frozen plasma and platelets, volume expanders and fluids. The room was packed with trauma surgeons and nurses and jammed with equipment: the rapid transfuser, ventilator, Bair Hugger, pressure bags, pumps and coolers.

Our tech must have covered miles, running to the blood bank for one cooler after another full of blood products.

From the outside, the melee must have looked like chaos. But it was actually a calculated and very effective frenzy, for a while. Amidst the rushing and crowding, the shouting and alarms, amongst people and equipment, spills and blood splatters, we were staying ahead of the game. He was perfusing and his blood pressure was adequate. But it wasn’t long before his pressure was barely adequate, and he was just barely maintaining, and then, despite our urgency and expertise, despite science and wings and prayers, we were losing. His blood pressure was dropping, no matter what we did. And we lost, in the end.

Time of death was called and we took a collective breath and looked around. It was like emerging from a cellar after a terrible storm has passed. We were stunned that hours had gone by. The quiet was abrupt and surreal. The room was a disaster.

And outside, on that day, like today, it looked like a Seurat painting. There’s a haze that softens the air and the outlines of trees and buildings. The sky looks faded, and puffy clouds float lazily in the pale blue sky.

By Seurat/ via Wikimedia Commons

At a glance, it’s lovely. But the impression is deceiving. In reality, the heat is oppressive and the air so thick with humidity it’s hard to breathe. There’s a sharp quality to the light that makes it impossible not to squint, even in the shade. Everything outside the hospital seems to be moving in slow motion, but if the ICU census is a reliable indicator, violent crime and suicide attempts are not only immune to the torpor brought on by this heat, they thrive on it.

The members of the trauma team are immune to the torpor, as well. We stay busy, secluded among bright lights, cold air, and a group of patients we protect with aliases as we try to nurse them back to health. We don’t cloud-gaze, and we don’t kid ourselves; we know the puffy clouds will build into thunderheads. Lightning will crack and tempers will snap, and the dog days of summer are stretching long ahead of us, like the track for a slow and heavy train.

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