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Nurse Shelley: A Day In The Life

April 26, 2011

Shelley didn’t go with us to the party I wrote about last week(https://charleywininger.wordpress.com/2011/04/19/spring-62/). She had to be on call the next day, Saturday, which meant she could be called into work anytime from 7:00 am on. Which of course precluded any chance of partying all night long with me and the Boomer Rumor Gang.

When I finally woke at [censored] pm on Saturday, I found that Shelley had been gone since morning and she didn’t come back ‘till 8 that night.

“It was a ruptured Aortic Aneurysm” she said. “He was just about dead when we got him.”

Shelley works at a local hospital in the PACU (Post Anesthesia Care Unit). That’s a fancy name for the recovery room people get wheeled into directly after an operation. She sees shribbled up old folks who are like vegetables the doctors feed off of; drug addicts with hepatitis and diabetes loudly demanding more Morphine; people still drunk from the anesthesia who thrash and shout expletives and have to be restrained. But this one was a different story.

“He came in and the chart said he was 63. In the past that wouldn’t bother me because that used to feel old to me; and so far away.” But since Shelley’s turned 60 last month, it’s been different. “That could be me! Or you!”

An Aortic Aneurysm is when the Aorta, our major blood vessel, weakens. When it ruptures, the patient can quickly bleed to death internally. Indeed, in the past it was one way people used to die that doctors could do little about. These days, however, you can get a second chance.

But when Shelley got this patient, his blood pressure was plummeting. At one point it slunk to 60/30, This means that his heart wasn’t able to get enough blood to his brain and his other major organs.

The Second Year Resident in the unit looked like she didn’t know quite what to do.

But Shelley knew. After almost 40 years on the job, she’s seen it all. That day, there was blood that needed to be hung, as the patient had lost 3 liters back in the OR and it hadn’t all been replaced. (Our bodies hold a total of about 5-6 liters). But the bag couldn’t drip the unit of blood into the vein fast enough. So Shelley slipped it into a pressure bag, which acts much like a blood pressure cuff does when it’s wrapped around your arm. This squeezed the bag of blood so it could transmit its liquid life more quickly than normal. This technically was breaking the rules, but even in these over-regulated, liability-crazed times, some circumstances overrule the rules.

Earlier, Shelley did something else that no one around her would have known to do. When that same patient was still in the OR, a nurse came running from there into her unit needing a drug stat. For this, they must punch the patient’s name into their dispensary machine (which Shelley says works much like an ATM). But the nurse had come running and had forgotten the man’s name. Shelley, however, knew from past experience that in case of emergency, just punch in “911”. That’s what she did and the drug came out.

Later, with the new blood pouring in, the man’s pressure slowly rose. The doctors realized the case was too precarious even to stay there at the hospital where the emergency surgery was performed, and a specially-equipped ambulance had to be called so that, once Shelley had him stabilized, the patient could be zipped to a place with a better Intensive Care Unit.

Last we heard, the patient was doing well.

“It was a kind of flow I was in, a kind of a zone. I knew exactly what to do, and I had to do it all immediately. So how was the party?”” she asked.

For her, it was just another day; and another opportunity to use gut instinct honed over four decades of experience.

I had a sudden impulse to give her a long back rub. It was the only way I could think of to honor what this unassuming 5’ 1” miracle worker had done. I was in awe.

“Actually, I think I was meant to be on call today.”

After the back rub we lay in the bed and I recalled the time 10 years before when I accompanied her for the first time to visit her folks down in Florida. At one point it was the four of us in her dad’s nursing home, where he was recuperating from a stroke. I had known Shelley for only six months, but when she left the room for a moment, I took the opportunity to tell her parents that their daughter was the best woman I had ever found in my life. “I just want to thank the both of you for the job you did.”

Her mother, never one to ignore a compliment, congratulated herself. Her father, never one to ignore a chance to smile, smiled. Not too long after this, he’d be gone.

Shelley turns to me and says, “You save lives too, you know. The lives of relationships.” I thank her for this, but too often the truth is I feel like a klutz in the therapy room, with couples sometimes bleeding to death before my eyes. I’m just starting to get the hang of it. Shelley, on the other hand, is the kind of nurse you can be damned sure you’d want to be there for you when you’re wheeled out of the Operating Room. I would put my life in her hands.

Another thing I need to say. My wife has seen a lot of changes in her time. Two of them are important to you and I.

The first is, she and her co-workers have perhaps twice the work they had back when I met her a decade ago. Twice the number of patients being whisked out of the O.R. every hour. Twice the pressure to stabilize them and get them out of there to make room for the next batch. (“You’re holding up the OR!” is a refrain they often hear). Probably a hospital’s major profit center, the OR has become an assembly line, with some doctors coming in and performing 10, 12 surgeries before they’re done. (Imagine being your surgeon’s 12th case that day. And who would tell you, anyway?)

The other is, her co-workers have changed in the process. Perhaps reflecting the change in our health care system as a whole, to even more of a high-pressured business than it previously was, her fellow nurses seem to lack the team spirit that used to make Shelley’s job a joy. Petty animosities, toxic personalities, a “that’s-not-my-job” attitude. Almost daily, it leaves her frustrated, angry, and worse, disheartened. (Marx would say, when the bosses pour it on, the workers sometimes tend to take it out on each other. He would be right.)

Last week, Shelley stayed home due to an on-the-job accident when her hand got caught when she opened a bed railing and her thumb got smashed and broken. One morning she awoke after a 10 hour sleep. “Amazing!” she said. Even with her thumb, she didn’t need her usual Ambien or wine. “Nothing!” And why? “I could sleep without the stress of knowing I was going to work in the morning.” Going to work to a job that she used to look forward to.

Now, Shelley and I look forward to her retirement. But when she gets there, one NYC hospital will be minus one hell of a nurse like the kind they don’t make anymore.

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7 Comments leave one →
  1. April 26, 2011 12:35 pm

    ANGELS AND DEMONS—I worked as a chaplain in a hospital for a year. The nurses were clearly the angels, and many of the doctors, particularly surgeons, seemed to behave like cold, uncaring demons; certainly not all of them, of course. And one little secret I learned is that these angels also perform euthanasia behind the scenes, though no one could ever say it out loud: when a patient clearly had absolutely no chance of recovery, was a vegetable and/or suffering intensely and being kept alive on tubes and machines, nurses would often “unofficially” turn up the morphine just enough to slow down their breathing and have them gently fade away. This goes on all the time, thank God. Of course the opposite possibility is also true: a tired, worn-out nurse, especially someone new on the job, can give a patient a deadly dose of a drug that was supposed to be .10 mgs, not 10 mgs–this too happened on my watch. Hospitals are scary places in general. I’m considering elective knee surgery, even though when I worked there I promised myself I’d never do any kind of elective surgery after what I had observed, the worst case being the 30ish newlywed man who came out of a simple carpal tunnel surgery paralyzed from the waist down for life due to a screw-up by the anesthesiologist. Tell Shelley never to retire, the rest of us can’t afford it.

  2. Laurie permalink
    April 26, 2011 1:19 pm

    This should be mandatory reading for hospital administrators, people who work with nurses, people attended to by nurses, and aspiring nurses.

    And I am warmed by your admiration and respect for your wife’s life’s work, so richly deserved.

  3. April 26, 2011 4:25 pm

    Sounds like she’s the original Nurse Jackie — without the drugs.

  4. Weston permalink
    April 26, 2011 8:03 pm

    Lovely

  5. John permalink
    April 27, 2011 2:55 am

    Beautiful story, Charley. It’s good to remember that we all – in some way – have a chance to be heroes each day of our lives.

  6. April 28, 2011 6:45 pm

    I miss Shelley! Not only is she a fantastic nurse, but she’s a REAL friend- the kind that can be counted on one hand over a lifetime. So sorry about the thumb, at least she got a break…. So great to read this beautiful tribute to her!

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