there are certain milestones in a nursing career. i'm guessing they're different for each type of nursing. but for an oncology nurse some of them might include - first admit, first mistake, first death, first code. i've been a nurse for more than EIGHT years now; hence, i don't experience firsts very often anymore. but on september 26th, i had a first. i did CPR on a patient. now, i have had my patients transfer to the ICU (when they are VERY sick). and i've had patients die, more than once while i was in the room - sometimes with family present and a few times with just me in the room, witnessing the last breath. i've even had my own patient code - two different times. but each time, other people responded. the first time, i was still a brand new nurse and was in such shock, i'm not sure i could have stated my own name. and the second time, another nurse walked into the situation (a blue patient) and started the rapid response that led to CPR and intubation and eventually, days later, to death.
but this time, i did the CPR.
(WARNING: this is not for the faint of heart - which means, i probably shouldn't read it either)
it was such a strange day. i was precepting a new nurse (as i do frequently these days). she was on her last few weeks of orientation so she was mostly doing all of the work. she's a rockstar newbie (because i trained her as a nursing student!). but anyway, i left the unit that morning to complete my annual CPR training. in front of an evaluator, i had to demonstrate that i know how to do CPR. i did two minutes of compressions on a dummy and was given my gold star. i passed. and just a few hours later, at about 1PM, there was a code on my unit. a young patient flatlined. dozens of people filled the room. and i assumed my normal position - delivery supplies, finding chairs, kleenex, and water bottles for family and loved ones who are hysterical in the hall. but i did not do CPR. i wasn't needed at that time. there were plenty of nurses in the room. and to be honest, i'm scared of CPR. i don't even know if i think CPR is ethical... on my unit that is. even when our patients survive codes, the likelihood of them surviving long term is miniscule. and CPR breaks ribs. it's violent.
but in the afternoon, i sat with other nurses discussing codes and CPR. and i admitted out loud that i've been a nurse for a long time and have never done it. in my head, i started to regret not volunteering during the code. i thought that perhaps it's something i should be able to say i have done.
so, when we had another code in the evening, this time with a different patient (the previous patient survived the code and the day), i decided it was my time. perhaps it wasn't that conscious of a decision. i had been in the room, handing nurses syringes and priming tubing when someone started to round up a few folks to do 2 minute rounds of compressions. there weren't many volunteers. so, i jumped in. my anxiety was present - me and my little sidekick. i announced to the physician running the code and to the respiratory therapists that this was my first time. that if i was doing it wrong they should let me know. but in we went. and before i even knew what i was doing, i was thumping on a man's chest. his lifeless body jumped with each compression. and blood spewed from his orifices. all codes are different. but this one, it was particularly messy. he must have been bleeding internally so with every compression, a fountain of body fluids sprayed in the air. the respiratory therapists at the head of the bed tried to contain the fluids, as they were bagging the patient (breathing for them). but it was to no avail. there was HIV positive blood everywhere.
the code did not end well. the patient expired (i hate that word). and because i had chemo to hang and another patient needing things, i left in a rush, sweating profusely without time to think or process. it was about 6:30 PM at that time, and the day was coming to a close. i gave report and headed home. cole picked me up. and i'm guessing i was still a bit stunned. but i shared the news - and the scary fact that the patient had AIDS. and that there was blood everywhere. but we discussed it. and decided, i was not at RISK. i was wearing gloves while doing the CPR. i couldn't remember, but i think i was wearing a mask for all of the rounds of CPR i completed (isn't it crazy that i can't remember? adrenaline is a funny thing). nothing splashed on me that i know of. so when we got home, cole inspected my scrubs. there were no traces of blood on my clothed or naked body. i took a shower. headed to bed. and went back to work in the morning...
only to find that those involved in the code, many of them had gone to the ER that night due to risk of blood exposure during CPR. people involved to the very same extent as me had been treated and were now taking anti-retrovirals to prevent them from contracting HIV. i was flabbergasted. a bit frantic. and worried. i called cole. i called cassie. i even called my mom (the infamous worrier). and i discussed what to do with those involved the day prior. so, to appease my concern, i went to the ER to get blood drawn and to see what they had to say. it's interesting. medicine is so not standard; it varies from physician to physician, even for patients in the very same situation. the physician i saw had a completely different reaction than the physician my friends had seen the night before. she decided my risk was SO small that it wasn't worth being on anti-retrovirals for ONE MONTH! plus, anti-retrovirals make people feel like crap. and of course, i was headed out of the country.
turns out. i'm happy with my decision. i thought about my risk of contracting HIV - they say with a KNOWN needle stick exposure (which i did not have) the risk is less than 0.3%. and on my trip, i maybe had a few fleeting thoughts. but i was not distracted or scared. i wouldn't even say worried. my initial blood work came back negative - not surprisingly. and i'll follow up again soon.
so, i guess i had two firsts. my first experience with CPR. and my first potential HIV exposure.
phew. sorry this turned out to be SO long.
