LJIDOL intersection '"AGAINST THE ODDS"

WARNING: A little more graphic than usual. One of the saddest and most ridiculous family situations I had to deal with in trauma.

The weekend after chaos and incompetence Paula and I arrived to the usual controlled chaos that is trauma; however, neither of our names were on the ICU schedule.

Our boss came around the corner and motioned for us to follow. In the quiet of his office Paula was told she would charge Step-down and I was informed I would charge the regular trauma floor for the next three weekends (Our punishment for the weekend before.) I was told in no uncertain terms, even if the president was brought into the ICU and ask for me; I was NOT to set one toe into ICU and with a whip of his head to glare at Paula that included her too.

When you are a charge nurse in the ICU your duties are too numerous to detail, but you are not only responsible for your “work” but have to make certain all souls on your unit receive the best care to keep them alive whether fresh from surgery or coming in through triage. You need to monitor nurses, Carepartners, ancillary staff, and keep an eye on the residents. It is usually nonstop fast-paced, adrenaline pumping place to be. Then, there is Step-down where patients are critical but stable. Finally, the trauma floor is where they are stable and preparing to go home what we call "walkie,talkies."

Anyway this was my punishment for his being reamed out by the Trauma Attending.

I had twelve patients and three nurses. Most were simple bandage changes and medication administration. I made assignments and settled in to clean up charts. My boss, David, came around and dropped a stack of folders on my desk. “Since things will be slower for you than you are accustomed, you can do chart checks in your spare time. If you finish with these, there are more in my office.”

By ten o’clock, the other nurses settled their patients for he night and were on the internet or reading. I sighed and opened another chart to check. I jumped when a chair rolled next to me and a big male arm looped over my shoulders.

“Sorry, I got you sent to no man’s land,” the Trauma Attending's voice rumbled into my ear.

“I just thought when David told me, ‘Oh please don’t throw me into the brier patch.’ This will be like a vacation.”

“You’ll go crazy by midnight, but if its any consolation he took it to administration.”

“Against YOU? Is he crazy?”

“His arrogance rivals my own. Needless to say while floor managers are a dime a dozen, Trauma Attendings are not.”

“Especially one with your credentials and experience, not to feed your ego. Why are you still here, tonight?”

“Staying most of the night, new batch of first year, the fourth year has a temper and the last is the one you call Dr. Idiot.”

“I didn’t know you knew that.”

He smirked and stood. "I know everything that happens on the floor."

"Pompous, too"

"Eleven, you'll be crazy by eleven."

“Don't you forget, Doctor, I’ve been threatened with serious repercussions if I step onto the TIC-U. Don‘t come running to me when the new charge nurse crashes and burns or the new triage nurse cowers in the corner.”

"David cuts his nose off to spite his face."

“David is an idiot,“ and he left me to my charts.

* * *
She was driving too fast because she was late. It was nearly ten and she was suppose to be at her mother-in-law’s house by eight but had gotten involved with her mother and lost track of time. She was still over ten minutes away.

The baby kicked inside her, perhaps feeling her agitation. Her husband would, of course side, with his mother.

It happened in an instant. The SUV beside her misjudged and clipped the front end of her Taurus sending her into a wild spin. The car hit the concrete divider flipped and bounced back into the path of an oncoming tractor-trailer whose air brakes screamed into the night mingling with the crunching and grinding of metal against metal. Her seat belt snapped, the airbag, which had been turned off at her mother-in-law’s insistence for the safety of her grandchild, did not deploy. So Jenna first hit the roof of her car as it flipped, her necked snapped back before she went forward, her face scraped over the steering wheel obliterating it. The top of her head hit the windshield; her eight month pregnant belly the only thing that kept her inside the vehicle.

Her last conscious thought had been, “At least now I have an excuse she’ll have to accept.”
CENTER>***********
The radio crackled, "15 minutes out, pregnant 26 year old female massive head injuries, crushing chest injuries. BP bottoming out, pulse weak and thready, respirations shallow--fetal heartbeat strong. Took us five to get here and twenty for the jaws to free her.”

The Trauma Attending took over the call, “Can you keep her zoetic to give the child a chance.”

“Affirmative on that.”

He looked at the Charge, “I need an OB resident and a NIC-U team (Neonatal). STAT.”

“How is that my job? Shouldn’t you call.”

“Just do it,” his voice thundered around the hallways.

Twenty minutes later, LifeFlight landed and disembarked with its gurney. Jenna’s upper body was shredded and her skull crushed. Both her pupils were blown and non-reactive. Jenna was attached to monitors for her heart and for the baby. An RT had an AMBUBAG at the trach site that had been placed in the field and steadily pumped oxygen into her battered lungs.

“We’ve got good vitals on the baby.”

“She’s got a hyperkalemic rhythm (high potassium--this means she can not be revived.) Let’s see if we can keep her viable long enough to get this baby out.”

“Doctor, the family has arrived. They are demanding to see you before anything is done.”

“Send the charge nurse.”

The OB resident informed the Attending, “All the P.A.’s are locked in surgeries downstairs. I’ve got to have some experienced assistance.”

“Doctor, the Charge Nurse tried to talk with the family but she came back crying and is in the break room refusing to come out. The family is still demanding to speak to you or the OB doctor.

He looked over at the new triage nurse cringing in the corner as she stared at the shattered woman on the gurney and her swollen belly.

He rattled off orders to the fourth year resident and snapped his bloodied gloves off...he tossed them into the red waste disposal unit and strode from the room.

He came around the corner of the trauma floor, a man on a mission dragging the ICU charge nurse. He pulled me up out of the chair and shoved the near hysterical nurse into it.

He pulled me down the hall and into triage. A look at the woman was all I needed to know she was gone and only the machines were keeping her alive. That wouldn’t hold for long. Her heart was going to give out but with her chest shredded and bloodied made the compressions impossible.

“I need the family dealt with first, then I need you to assist the OB surgeon.” He held up a finger at the doctor, “She’s a licensed P.A.”

“Not in OB,” I hissed at him.

The left carotid blew spewing blood like a fire hydrant. The Attending held out a hand for the hemostat I had already dug out of my pocket. Sterile didn’t matter nor the clampo off of blood supply to her brain.

“I’ll go deal with the family, send someone to get Paula to help you with her.”

The Trauma waiting room is the nicest in the hospital...providing recliner bed chairs, blankets, coffee, a refrigerator full of drinks and three large flat screens.

I knew right away which family members belong to Jenna. The husband looked grief-stricken sitting and staring at nothing but his mother verbally attacked me. Then the young woman’s mother tried to find out what her daughter’s status was. She was shoved back by the mother-in-law demanding to know about her grandchild.

I tried, I promise I did, to gain some control over the women but they were screaming at me and each other. Finally, I had enough and yelled, “Quiet, there are other people with loved ones in trauma. If you do not control yourself, I will have security forcibly remove you.”

The mother-in-law blustered about did I know who she was and she’d have my job. But I ignored her and dropped down on my heels beside Jenna’s husband.

“Mr. G., I’m sorry there was nothing we could do to save your wife.”

Pandemonium broke out around me. I focused only on him, just looking into his eyes and holding his hand.

“Your baby is still alive, and the OB is going to do C-section to try to save the child. Would you come with me now to see your child born and say good-bye to Jenna.”

He rose and followed me like a zombie. At the doorway I had to physically block the Mother-in-law from entering, Pushing him forward I pushed her back and shoved the door closed in her face. It locked automatically. She stood outside swearing at me and beating on the window.

Her husband signed a consent for the C-section though they could still have done it without one. I had him prepped to go into triage.

Triage is not the greatest place to do surgery. It’s not sterile though that really didn’t matter, now. The husband held his wife’s hand and cried, her face so destroyed he could only kiss her hand and whisper into her palm.

Jenna’s heart stopped, she was gone. Now it was a race with the clock. I gave him into Paula’s capable hands and the OB Resident made the incision. This was no bikini line cut but midsection of the uterus. With both our hands we pulled back skin, muscle, uterine walls and as I held the wound open, he cut and amniotic fluid flowed out and over the sides of the gurney. I held on as he searched for and removed the three pound silent premature boy. The cord was cut. The NIC-U nurses took the child and after suction and feet smacked a weak cry that grew stronger had everyone sighing in relief.

They took off at a run with the warmer, (I’m sure that thing has a fancy name but I don’t do OB). Paula headed the father after them but he stopped beside me, “Do I need to call a funeral home?”

“No, she will have to be seen by the Metro Coroner. They will contact you. Go with your son. There’s nothing you can do for Jenna, now.”

He nodded and Paula led him away.

I’m sure the family followed them to the NIC-U where they got locked out again. I never heard.

Per law the placenta and cord are left inside the mother. I packed the open wounds and helped the Carepartner to cleanse away what blood we could without taking bone or brain matter. We usually put the victim in a room after cleaning for a family viewing, but she was so damaged it would take a talented mortician to get her prepared to view.

Two Carepartners took her to the morgue. I went back to the Trauma Floor.

The ICU Charge Nurse met David at the door at 6:30 a.m. but I was ready when he called me into his office. As I started to step inside, I held my hand up at the approaching grim Trauma Attending and stepped into the lion's den. I didn’t need his help, today.

I let David rant at me for about five minutes and as he finished with, “So this is what’s going to happen...”

I slapped a piece of paper on his desk, “No, this is what is going to happen.”

“RESIGNATION. YOU CAN’T RESIGN.”

“Of course I can. I have five weeks of vacation, so I’ll take that in lieu of working out the usual two weeks.”

He started to chase me out of the office when Paula walked in blocking him and handed him her resignation, “To save you wasting time chewing me out.”

As we walked out of the unit, David yelled across it, “I refuse to accept your resignations.”

I heard the Trauma Attending’s deep dangerous tone, “What resignations?”

I looked down at my friend, “And you call me a smart ass.”

“You realize this time we’re playing against the odds?”

“I’m not working three weeks on the trauma floor because he got his ass chewed. If David doesn’t back down and we crap out; he’s done us a favor. We’ll take our act on the road like we’ve been talking about for years. Traveling the U.S. one hospital trauma room at a time. Make more money, no politics.”

I shoved Paula into the side hallway before she could reply.

“What?”

“That’s the mother-in-law lying in wait. And who decided to put the elevators across from the waiting room? We take the stairs.”

“Ten flights?!?”

“No, just to level four. Well take the connector to the garage.”

My phone rang as we settled at the table at I.H.O.P. I glanced at it, then Paula, “It’s David.” I snapped it shut.

She ignored hers when it rang.

“Double or nothing. Let it ride.”

I am intersected with SIMILIESSLIP find her wonderful entry HERE