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Jade is not just a gemstone

Just over a month ago, our unit had several H1N1 flu patients.  And they were sick.  Really really sick.  They were also fairly young – 30′s to 50′s.  I wondered at the time why the media hubbabaloo about the flu had died down when I was seeing more and more patients in my unit who had it.

Last time I worked there was only 1 flu patient and they weren’t too sick (yet?) to require a ventilator.  I was really glad to see the decrease in this particular patient population.  I won’t lie – it’s frightening to be a nurse caring for someone with a highly communicable disease.  Masks, gloves, gowns are all provided by the hospital, but I can’t ever shake the feeling that I’ve somehow come in contact with it despite these precautions.

And what of the times that we admit patients and don’t know they have a communicable disease?  At least one coworker I know of contracted H1N1 from taking care of a patient who had it before we knew they had it.

I’m sure she was quite shook up – every single patient who turned up positive for the flu in our unit in that time period ended up literally fighting for their lives on a ventilator.

The most harrowing patient we had was a woman in her 30′s who was pregnant.   Like the other patients, every time she coughed on the vent, her oxygen saturations would decrease to the 80′s and would take a long time to come back up.  Unlike the others, though, she was so fragile that sometimes merely coughing on the vent caused her to go into asystole.

I’m somewhat jaded about coding people at this stage in my career.  I remember, as a brand new ICU nurse, talking to a well-seasoned ICU nurse.  She said that hearing “code blue” being announced overhead didn’t give her any kind of adrenalin rush anymore.  At that time, I couldn’t imagine being in that frame of mind.  Being new, I was expected to go to every code blue that was called so as to get experience.  My heart started going into SVT at simply hearing the word “code.”  If the word “blue” came after I practically had to defib myself before running off to defibrillate the patient.

I eventually got to a place where I could fairly confidently go run a code without freaking out.  I’ve been an ICU RN for 11 years.  In those 11 years, there have been some awful codes.  Two stand out in my mind, and the absolute worst was on the pediatric floor.  When I heard “code blue, pediatrics” overhead, my first (naive) thought was, “little kids code???”  My second thought was to wonder if it was really an adult overflow patient.  Sometimes the gyne surgeries went to the pediatric floor if there was no more room on the surgical floors.  You know, maybe one of them got a little too much morphine and the nurse called a code.  A little Narcan, a few bagged breaths and everyone would sigh with relief and go on with their day.

No such luck.  After running full speed up 3 flights of stairs, I arrived at the room that had the most people spilling out of it only to find a bald, thin 5 year old in the bed.  I thought I was going to be sick.  PICU nurses – bless you all.  I could not do that for any length of time.

She didn’t make it.  Having been a nurse for a couple of years at that point, my naivety about the world already had a few chips and cracks in it.  But on that day a huge chunk fell out.

Since then I’ve come to be more like that seasoned ICU nurse that I spoke with so early in my career.  Along with the semi-jaded “oh crap, a code blue” comes a confidence in one’s abilities, so it’s not all bad.

However, watching that woman go into asystole, knowing that we would have to crash c-section her if she stayed in it?  That took me back to the days when I was new and inexperienced.  I’ve never seen anything like that happen.  Although I was perfectly comfortable with my (pre-arranged) personal role, the overall situation would be completely new to me.

Although HIPAA prevents me from saying much more, I will say that I did not have to experience that situation; not because I was off when it happened but simply because it never happened.

If it had, it surely would have made my top 3.

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Comments

Harrowing. We also had some of these H1N1 pts in the MICU a month ago (otherwise healthy, in their 20s-30s). Some made it, some didn’t. It’s really hard when we’re being told not blow the whole swineflu epidemic out of proportion while you are watching otherwise healthy young people actually die from H1N1 related ARDS.

Scared the crap out of me actually. I feel like my contract couldn’t have ended at at a better time.

Yep, pregnant patients are one of the highest risk populations to become critically ill with H1N1 or any flu (vaccinate please!)
My heart still races with neonatal codes. My heart comes out of my chest still (after 16 years)with pregnant mom/emergency C/S codes. Codes where you are doing CPR on the mom and the baby at the same time in the OR. No one ever gets used to that.

The Swine Flu is something to watch closely. I can’t imagine losing someone to something like a virus.

Thank you for this posting. In my position, I am asked to weigh in on vaccine policy as a part of pandemic response. I see the H1N1 vaccine as a critical piece of a prevention strategy (not the only piece, but still). Stories like yours help remind us that the perception of H1N1 as a mild illness and not something that should be of concern are naive.

we’ve had some h1n1 younguns on my unit, too..and by young i mean 30ish. i had the pleasure of coding one and i have to say it was one of the saddest codes i’ve ever witnessed. i’ve heard rumors that some people are getting so sick that they’re sustained on ecmo and awaiting workup for lung transplant…which honestly scares the living daylights out of me.

i’ve noticed that the media has gotten awfully closemouthed about the most recent h1n1 deaths. reports used to readily admit that victims were elderly and had serious underlying medical conditions that contributed to the death. now, all we hear is that details are not being released out of respect for the peoples’ families. it makes me wonder if this is turning into a particularly virulent epidemic under our noses.

Thank you for sharing your experience and helping raise awareness about H1N1. I would agree that H1N1 is not in the public consciousness as much as it was when it first broke and it was therefore ‘newsworthy.’ Nurses are incredibly brave for putting their own health on the line for their patients every day. Thank you so much.

Stories like the ones you share make me happy to be naive in my lack of experience.

Kids coding… I’ll never get used to that idea.

The media should kick back up soon enough. As the cooler seasons come, more and more people will be in closed spaces allowing h1n1 to spread more easily. Here we go!

I enjoyed reading this article. I found the uncertainty of every situation rather it in ICU nursing or another field to be very exciting. I could relate to the nurse when she reflect on her confidence and experince as a nurse helps her to cope with the stresses of not knowing whats going to happen next. I feel that you develop a coping mechanism in the nursing field.

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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