Two nights ago the charge nurse approached Stephan about training to take a few shifts as charge nurse. She actually said, "You were Charge Nurse in Montana, right?"
Him: Uh, yeah. I was in charge of myself.
His training is going to be somewhat abbreviated. His first shift as charge nurse will be November 27th. To punctuate the difference between a 12-hour shift in Montana and a 12-hour shift at Loyola Stephan had a crazy half-night this week. I asked him about it this morning at the kitchen table. He was a little reluctant to let me post it, but I'm doing it anyway.
Me: Tell me about the other night.
Him: Tell you about it..? I don't know. It started off slow. We had a couple of psych patients in three rooms waiting for transport. We wandered around helping other nurses with their assignments, but as a whole the ER was slow.
Me: When did it change?
Him: What time did he come in? We got an ambulance call... an ambulance came in about 1:00am for an elderly patient who had been feeling sick for the last 2 days. The patient lived home alone so called an ambulance. Came in talking to us and said he just didn't feel good and thought he was bleeding. All he needed was a little oxygen and he felt better. We tried to put in an NG tube but his nose had been broken previously so it didn't work. So he was waiting to be admitted to the hospital. The admitting doctor came down from the floor and the man started getting confused and pale. His breathing became more congested. We increased his O2 and the doctor gave me a worried look.
Me: He was your only patient right now?
Him: Pretty much. When his condition started to deteriourate and we put the O2 mask on him I made sure the other nurse was with him all the time. He was a DNR so nothing heroic could be done. We started IV fluids, and he was still talking, just much slower. He was still ok. His breathing got even worse so we called his family. It became obvious he was going to pass really quickly. This was probably 4am already.
Me: Really fast. Wow.
Him: Yeah. Got him a little morphine to take away anxiety and pain so he could breath more comfortably. There was a trauma going on at that point so there was a ruckus. A few beds down there was an obvious heart attack, so I left a nurse with the man and helped get the heart attack sent up to the cardiac cath lab. With the extra commotion in the trauma I jumped in there to help put the four-point restraints on a combative drunk. The drunk needed to be sedated and intubated. I came outside to find our elderly gentleman had a doctor and nurse with him and was still deteriorating slowly. An ambulance showed up to transfer another patient so I took over in the trauma bay to let the nurse get the transfer patient out. The family got to the dying patient and we spent some time talking to the family. Another nurse helped us out by transferring a patient out who was waiting to leave so we could stay with the family.
The gentleman passed away then, and we left the family with him when another ambulance dropped off a drunk driver car wreck patient who was having trouble breathing. We were worried about a pneumothorax or something. He was arguably a trauma, but since the car didn't roll over he didn't count as a trauma. He didn't fit the critria technically. Calling something a "trauma" changes a lot of things.... anyway, then it was change of shift. So that was the end of my day.
As I was walking out the door a woman who was going through drug withdrawl needed to get to the bathroom, so I helped her there before she made a huge mess. She almost passed out there, but we got her back to her room safely.
Me: You seem to interchange "me" and "we" a lot when you talk about work. How often are you doing things alone versus with other nurses and techs to help you?
Him: When someone first gets to the ER, especially a more severe patient coming in on an ambulance, everyone who isn't busy gets together to help settle the patient in. We help each other transfer patients from an ambulance cart to an ER cart, start IV's, draw labs, do EKG's, and get basic information about the person into the computer... Everything that goes into getting the patient ready to be seen by the doctor. Once they're settled in, you're pretty much on your own unless they're critical, or something changes.
From the outside of this post, it seems like the big ER is very different than Baker. But sitting across the table from Stephan I really feel how similar it is to him to be present with a patient and their family as they pass on. He still takes the same moment, despite everything that is going on around him, to love the family, care for the patient, and be what he is: a truly great nurse.