code blog: tales of a nurse

Submitted by My Own Woman:

It was one of those rare nights on midnight shift where the ER was eerily quiet. The quiet and calm doesn't happen often in the ER and the nurses try to take advantage of it when it occurs. After all the supplies were stocked in each room and the trauma carts and the Zoll monitors were checked to make sure all was functioning properly; the nurses sat down together for a rare moment of rest. It was 4 AM, the time on night shift where the wind starts to go from your sail before you catch your second wind about 5AM.

As we sat and talked about non-nursing related things in our lives the Ambulance phone went off. I got up to take the call. "This is A-1 Ambulance. We're bringing in a 20ish year old male with severe injuries to both of his legs. He was hit by a car while riding on the back of a garbage truck. His heart rate and respiratory rate are within normal limits. His blood pressure is slightly elevated and he rates his pain in both legs at a 10 out of 10. He has an IV established with Normal Saline at 100 and we have him on high flow oxygen. We'd like to give some Morphine. He has no allergies. ETA 5 minutes." I relayed the information to the ER doctor who authorized Morphine 2mg IV and we will re-evaluate upon arrival.

The patient arrives to the ER 5 minutes later without any relief from the previous Morphine. His legs are deeply cut and crushed at the level of the knees where the car clipped him while he was riding on the back of the truck to collect garbage. His vital signs were stable except his blood pressure was elevating probably in response to the increased pain. After an assessment by the nurse and the ER physician, Dilaudid 2 mg IV was ordered and given along with some IV fluids. X-ray came to the department for a series of xrays on his legs. The Patient Care Technician came into the room to draw blood and do an EKG. All the while the patient kept asking me if he was going to lose his legs. "Please, am I going to lose my legs? Please tell me." I couldn't answer him, I had no way of knowing at that time but the prospect of him losing his legs was a good probability. He had no pedal pulses and no sensation below his knees. I told him, "I don't know right now, we have to wait to see what the tests tell us." It was an honest answer. He turned to the Patient Care Technician and asked her the same question, she immediately responded, "No, you're not going to lose your legs, quit thinking like that. Everything is going to be fine." I wanted to scream at her but held my tongue and tended to his immediate care.

We cleansed his gaping wounds behind his knees and bandaged them with sterile water and gauze. We gave him repeated dosages of Dilaudid as we prepped him for surgery. It was horrible watching this young man with his whole life in front of him crying because of the pain and the uncertainty of his diagnosis that must surely have been going through his mind. After a short time we shipped him off to surgery and the Emergency Department was relatively quiet once again. We had added a few more patients in the time I spent in this man's room, but everything seemed to be under control.

I couldn't get the young man off of my mind and the scene and conversation I had witnessed between the Patient Care Technician and him. Finally, after wresting with my conscience, I took her aside and told her that telling him he was not going to lose his legs was not a very good thing to do. I told her that she could have very well given him false hope and that is the last thing you want to do to a patient. She apologized to me and told me "she just wasn't thinking."

The night ended without any more trauma and we all went home to our beds. I had the following day off and went about my normal routine. The following day I returned to work and my arm was grabbed by the Patient Care Tech that had helped me with the young man two days earlier. Her eyes were red and swelling with tears. "He lost both of his legs," and as she spoke the words the tears rolled down her face. "They cut off both of his legs, they couldn't save either one of them." At first her words were not registering in my mind until I realized what she was talking about. The young man who she told would be just fine had lost the very thing he was so concerned about and wanted reassurance about. The tears welled up in her eyes more. "How could I have done that, how could I have said everything was going to be ok?" My heart went out to her. In her attempts to ease his mind, she let him down and herself. "How can I ever make this up to him?"

I shook my head back and forth and said, "You can't do anything for him, but you can learn from him and never tell anyone things that you don't know for sure. You learned, and learning is a good thing." She replied, "Yeah, I learned, but I still have both of my legs."

This is a very good lesson. However, I can't help but wonder if despite her comments, the patient really knew deep down that he was going to lose his legs. Denial is a double-edged sword. It can keep one from seeing what's really going on, but it's also a highly effective coping mechanism meant to protect us from knowledge that we aren't ready to process. I doubt that the young man took the tech at her word. I'm not condoning what she did, but really? Truly? Deep down, I don't think he was surprised at the outcome. So tragic. -geena