It just never fails. On that rare shift when you just don't feel quite right, things will, like clockwork, go straight downhill. Rare combinations of events will create the perfect storm.
For inexplicable reasons, I had the attention span of a fruit fly. (Okay, so that isn't rare, but it was even more pronounced than usual.)
Early in the shift, I assumed care for a baby with a new onset of NEC. A 6 cm increase in abdominal girth within a few hours, frank blood in the diaper, that familiar and haunting look of generalized craptasticity. Multiple pH's less than 7. Portal venous gas.
Nasal cannula, nasal CPAP, conventional ventilator, oscillator. Blood, plasma, saline boluses, IV immune globulin, multiple antibiotics, starting and restarting peripheral IV's. The OR team came for an exploratory laparotomy and bowel resection.
This kid was acidotic as a can of Coke, had air in places that air was never intended to go, and had an abdomen so large that it impeded the movement of her chest. Those are big, big issues. But when things get bad, it's the little stuff that gets you. Apparently I got the defective box of fragile gloves. Mom wouldn't answer her phone. The leads would not stick. Once the patient was fully draped and anesthesia needed to access my IV, I couldn't remember right from left.
When I left in the morning, the patient remained quite critical, but she was alive with some chance of recovery. As for me, I am absolutely amazed at the beatdown I took -- all at the hands of a million tiny details.
For inexplicable reasons, I had the attention span of a fruit fly. (Okay, so that isn't rare, but it was even more pronounced than usual.)
Early in the shift, I assumed care for a baby with a new onset of NEC. A 6 cm increase in abdominal girth within a few hours, frank blood in the diaper, that familiar and haunting look of generalized craptasticity. Multiple pH's less than 7. Portal venous gas.
Nasal cannula, nasal CPAP, conventional ventilator, oscillator. Blood, plasma, saline boluses, IV immune globulin, multiple antibiotics, starting and restarting peripheral IV's. The OR team came for an exploratory laparotomy and bowel resection.
This kid was acidotic as a can of Coke, had air in places that air was never intended to go, and had an abdomen so large that it impeded the movement of her chest. Those are big, big issues. But when things get bad, it's the little stuff that gets you. Apparently I got the defective box of fragile gloves. Mom wouldn't answer her phone. The leads would not stick. Once the patient was fully draped and anesthesia needed to access my IV, I couldn't remember right from left.
When I left in the morning, the patient remained quite critical, but she was alive with some chance of recovery. As for me, I am absolutely amazed at the beatdown I took -- all at the hands of a million tiny details.