I graduated from 2014 and started working. It has been eight years since I was aware of patients and died, especially when I entered the intensive care unit and worked in .
But every time I experience the patient's rescue and death, that unforgettable night shift appears in my mind like a movie.
Actually, that is one of the usual night shifts I can't remember, but it's so unique. That was the first time I participated in the rescue of patients, the first time I faced the death of patients, and the first time I had zero-distance contact with the deceased.
In college, I studied nursing major , and I was still engaged in clinical nursing during my internship. When I was transferred to the intensive care unit, it was already the fourth department I was internship. I was relatively proficient in basic clinical operations, but I had never encountered any major rescue.
When we came to the intensive care unit to report, the instructor told us that the characteristic here is that the patient is in a serious condition and has many rescues. When I heard this, a hint of excitement flashed through my heart. After all, in terms of rescue, apart from listening to the teacher's theory in class, they were practicing with each other after class, and I always felt that something was missing.
But I always encounter unexpectedly.
As usual, I still arrived at the department at 9:40 that night, changed my clothes, and waited for 10 o'clock to take over with the instructor.
The first patient we handed over was a sixty-year-old aunt. Her condition was stable and the handed over was relatively simple.
But when we walked to the next ward, the teacher who handed over the class said, "This old man is in a serious condition. I wonder if he can survive tonight?" My teacher's face brushed a trace of worry and sighed, but I don't know what this sentence means, without any pressure.
came to the door of the ward. The alarm sounds of ventilators, monitors and various pumps were mixed together and kept ringing, as if calling on medical staff. There were emergency situations in the ward that needed to be dealt with.
walked into the ward. At the beginning, I only saw a neatly tidy bed, but I didn’t see the patient. I saw the head of the bed along the end of the bed, and then I saw a head full of wrinkles on my face. Because I was too thin, I looked particularly small and was half blocked by the inserted tube.
My teacher and I first started to check the medical orders and nursing orders, and saw that those were executed in the previous class, and those were left to us that had not been executed yet.
Then we start handing over the patient. He lay there quietly and motionless, and the tracheal tube in his mouth was connected to the ventilator through the respiratory channel to assist in breathing. A gastric tube was inserted into the nostril, followed by a negative pressure drainage bottle, and half a bottle of yellow-brown liquid was found in the bottle. The tube is well fixed and will not fall off easily.
We uncovered his quilt, leaving a deep vein under the left clavicle, and a blood bag bulged under the membrane that fixed the deep vein. The two joints of the deep vein are connected to several three-way channels, and then many different infusion pipes are looking through those infusion pipes. There is a row of infusion pumps . The green light is flashing and stable. Two kinds of liquids are hanging on infusion stand and slowly intravenous dripping.
My teacher and I walked over and looked carefully at each pump and dripping liquid. We gently untied his medical clothes, and our bodies were covered with scattered bleeding spots and some edema in the skin. My teacher gently pressed his abdomen with his fingers, and the depression could recover quickly. Five electrode pieces were attached to his chest, connected to the monitoring cable, showing his vital signs on the monitor, and each number was normal.
Looking down, there is a urethra, followed by a urine bag, with only a few drops of soy sauce-colored urine inside. When we were about to turn over to look at the skin on our back, we untie the restraint belt and racket fixed on the bed rail, and then we found that our hands were swollen like steamed buns. The same is true for our feet. The teacher who handed over the class said: "He is still very ill and his family is very active, but because the old man is old, he is still hesitant to need hemodialysis."
After handing over the class, the instructor told me about the precautions for handing over serious patients and working. Under the guidance of the teacher, I worked hard to do what I could and carefully learn the operations of my new contacts.
is almost twelve o'clock, and the things in this ward are done almost. The teacher asked me to pay attention to the patient's vital signs and various instruments. She went to the next ward to check it.
I looked at each instrument carefully. Everything was normal and the patient's vital signs were also very stable. Then, I sat down. Looking at the nursing records, you can understand the patient's condition in more detail.
Suddenly, "Dingdong, Dingdong..." The emergency alarm sounded, I quickly followed the sound, and the red light on electrocardiogram monitor kept flashing, and the heart rate dropped rapidly from 50, 47, 45... I was panicked and didn't know what to do.
I quickly came to the next ward and said nervously: "Teacher, the heart rate of that patient has dropped to forty! "
When my teacher heard me, he hurriedly put away his pen, stood up, and went to the ward in three steps. She first touched the patient's carotid artery with her hands, but it shouldn't be touched.
She quickly untied the restraint belt, put down the bed rail, flattened the head of the bed, pulled out the snorkel of the air mattress bed, knelt on the edge of the bed, and carried out chest compressions. While performing these coherent movements, the teacher asked me to ask the doctor and other nurses to assist in the rescue.
I came to the nurse station and told the doctor on duty and the nurse in front of the computer about the serious patient. The doctor on duty The student took the intern doctor to strode towards the ward, and a tall nurse pushed the ambulance and followed closely behind.
I followed them to the ward again. The intern doctor had replaced my teacher to continue the chest compression. The doctor on duty pressed the blood pressure measurement button on the monitor, and the blood pressure measured was 45/25mmHg. My teacher followed the doctor's verbal instructions and adjusted the pumping speed of the blood pressure-raising medicine, and stopped the sedation and analgesics.
t tall nurse put the rescue vehicle and took out the rescue record book to record. The doctor said again: "1mg adrenaline intravenous injection. " "Sister internship, come and give the patient an intravenous injection of 1 mg of adrenaline," the tall nurse told me, taking out an adrenaline and spreading it apart, and using a syringe to suck the medicine inside.
I kept watching this chaotic scene and was at a loss. Finally, I was in a daze. Her call brought me back to my senses. I walked over and checked the adrenaline with the tall nurse again, and then took it to the bedside After intravenous injection, the doctor walked out of the ward. After a while, the doctor on duty came back after talking to the patient's family. The family did not want to give up and continued to rescue.
rescue work has been continuing. Sometimes I take over chest compressions, sometimes suction the patient, and sometimes help find the things needed for rescue... but I was always confused.
Doctor suddenly said, "Don't press it first, it seems that I have recovered my autonomous heart rate. "
The intern was pressing outside the chest. He knelt on the edge of the bed, his hands hanging in the air, and his head was facing the other side of the electrocardiogram monitor. The entire ward suddenly became quiet, and everyone's eyes were focused on the monitor's screen. The heart rate fluctuated about fifty times a minute, beating regularly, and his blood pressure returned to normal, but the three drugs that raised blood pressure were the maximum pumping speed.
My teacher walked to the patient, touched the carotid artery with his hands, and pulsed vigorously. Everyone breathed a sigh of relief. This rescue was successful. I looked up at the clock on the wall. It was almost 1 a.m. I rescued for twenty-five minutes.
Although the patient's heart rate recovered and beat autonomously, the condition was still very serious. The urine bag was still covered with the few drops of soy sauce-colored urine. From the beginning of the rescue to now, the blood potassium analysis has been high. The blood sugar-lowering drugs injected into the intravenous pump did not work. My teacher and I were tidying the hospital bed, and the doctor on duty went to talk to the family about the condition again.
The ward has basically returned to its previous form of rescue, but the rescue vehicle is still in the room, and various machines are also running in a regular manner. I slowly walked out of the tension of rescue.
My teacher and I checked the medications that were pumped. The medications that were about to be pumped were re-packed and placed in the treatment car.
When my teacher was about to write the rescue record, the doctor on duty came back and looked at the patient's condition and said, "The old man is old and his family doesn't want the elderly to suffer too much. He refused hemodialysis, and other basic treatments will continue." After the doctor on duty said that, he went to the nurse station to make a doctor's order. My teacher checked the patient's condition again, and asked me to pay attention to the patient's vital signs and instruments, and went to the nurse station to handle the doctor's orders and make up the rescue record.
Because of the sudden change in the last time, I was still scared. This time I stared at the electrocardiogram monitor intently, listened carefully to the alarm sounds of each instrument, and dealt with it in time.
Time passes by bit by bit, I really hope that the remaining time can pass by quietly like this.
At about two o'clock in the morning, I watched the heart rate on the ECG monitor slow down little by little, from about sixty times per minute to more than fifty times per minute.
I quickly came to the nurse station to talk to my teacher about this situation, and when I quickly returned to the ward, my heart rate had dropped to more than thirty times per minute. I tried to touch the carotid artery, but without touching the pulsation, I immediately placed the head of the bed, pulled down the bed rail, uncovered the quilt and started to press the chest. The others followed me and came to the ward, and another rescue began.
My teacher walked to the ECG monitor and pressed the blood pressure measurement button. It was not measured, but the pump speed of the three blood pressure-raising drugs was already the largest.
The doctor on duty touched the patient's femoral artery with his hands, and said, "Adrenal glands 1mg intravenous injection, and another blood and gas are checked." After that, he walked out of the ward. My hands were already weak, and the intern doctor took over me and continued to press the chest. It was still the tall nurse who made the rescue records. My teacher and another nurse were performing the doctor's verbal instructions.
After a while, the doctor on duty came back and said that the family still insisted on rescuing. He took the blood gas analysis report handed over by my teacher and shook his head, "This blood potassium is so good. All the methods that can be used now are used, but they can't be lowered."
chest compression has not stopped. When one person is tired, he changes to another person. The nurse followed the doctor's verbal doctor's instructions and repeatedly injected adrenaline intravenously, repeatedly draw blood to check blood gas, and then immediately followed the doctor's instructions according to the results of the examination. However, the ECG monitor showed irregular serrated waveforms that were pressed out, and the blood pressure could not be measured.
rescue work is still in full swing. The sound of the doctor giving oral instructions, the sound of the nurse retelling the oral instructions, the rustling sound of walking, and the rapid alarm sound of the ventilator and the electrocardiogram monitor mixed together and echoed in the ward.
"It has been more than half an hour, but I still haven't recovered my autonomous heart rate. It doesn't make much sense to continue like this. I'll talk to my family," the doctor on duty said, and walked out.
ward is still busy in a nervous and orderly manner. Everyone hopes that a miracle will happen and is working hard for it. But it is not a miracle that will give back to every effort.
The doctor on duty walked into the ward and said, "After the family understood the situation, they didn't want to continue to rescue him. They wanted to come in and take a look and say the final farewell." The doctor on duty interrupted everyone's busyness. We stopped the work at hand and sorted out the beds.
Then, seven or eight family members entered the ward, including old men with gray hair, old ladies with legs and feet, middle-aged men with beer belly, and fashionable women, all with sadness and tears on their faces.
They were crying and shouting, some people caressing the old man's already lost face; some people hold the old man's hands that will never move again; some people hold the old man's feet; some are so sad that they can't stand and need other family members to support, as if they are trying to wake up the old man.
But the old man was lying quietly and was not responding. The first time I faced this situation, I stood beside me, not knowing what I should do.
After a while, the doctor on duty came over to comfort the family and asked them to wait outside. At the same time, he asked the family to bring a set of home clothes to the deceased elderly. The medical staff need to deal with the pipes on the deceased elderly before they can be sent to the morgue.
After the family members went out, my teacher explained some things to me, so he went to the nurse station to handle the doctor's orders and make up the nursing records. My intern and I were busy in the ward.
The intern doctor was the first to remove the tracheal intubation. I took the tracheal intubation and the ventilator pipe and threw it into the trash can.
Next, the intern was dealing with the deep vein catheterization. I pulled out the gastric tube and urethra and threw it into the trash can. When I went over to deal with the infusion tube and pump tube, the intern doctor kept pressing the wound at the deep vein insertion tube with gauze because it was bleeding there.
Immediately afterwards, the family members' clothes were delivered, and I was going to change the clothes for the deceased old man. Although the old man died was tall, he was very thin and was basically skinny. I felt that I could handle it alone, so I didn’t ask anyone for help.
I first took off the patient's clothes that were put on the old man's body and prepared to change into my top. I first helped him put on his left arm's clothes, gently bent his left leg, passively let him turn over to the right side, put the clothes under his back, and then assisted him in lying flat, pulled out the clothes and put them on his right arm, buttoned them up, and put them on his top.
I picked up my pants again, gently lifted my right leg, put my pants in, then my left leg, and then lifted my hips a little hard and pulled my pants up. All the clothes were worn, but I always gave me an illusion that his hands and legs could be bent, and he felt that he was cooperating with me. The electrocardiogram did show a straight line, and he did not have any vital signs.
After a while, the people in the morgue came with a flat cart. They first went to the nurse station to hand over the deal, then took the bill to the deceased old man's bed, took out a piece of white cloth to wrap him up, then carried it onto the flat car, and pushed it away. The noise at the door of the intensive care unit also left with the flat car.
I stood alone in the ward, looked up at the clock, it was already half past four, and half of a night shift had passed. I don’t know what the old man is called, but I don’t know him, and I don’t feel sad in my heart. Even if I don’t feel scared in my heart when I first come into contact with someone who died from zero distance, I still feel very uncomfortable and indescribable.
Everyone was exhausted. After finishing the work at hand, they took a short rest, and started the morning nursing and treatment again. They were busy until they handed over the shift. My teacher and I finished our work and went to help other nurses.
After handing over the shift, I returned to the dormitory, and I wanted to have a good sleep. The more I want to fall asleep, the less I can't sleep. The lost face of the deceased old man always appears in my mind.
Later in the internship in the intensive care unit, they also encountered rescue and patients' deaths, especially when they entered work, which was often encountered. However, as time passed, they all became blurred and disappeared in my memory, and that first time was firmly engraved in my mind.
The first time I faced life and death was an experience in my life, a growth.
