Working in a trauma center's busy emergency department (ED), I thought I'd seen it all, from gang shootings to rodeo injuries. So it wasn't out of the ordinary when the helicopter crew brought in a woman in her 50s who'd suffered a gunshot wound to her chest at close range. She was hypotensive and tachycardic.
I was assigned to be her primary nurse. Another seasoned trauma nurse, Gary, was the procedure nurse. We hurried to get the room ready before the patient arrived.
Not 2 minutes later, the flight nurses swung around the corner with the patient on a stretcher--cardiopulmonary resuscitation (CPR) in progress.
"We lost her pulse on the helipad," one of the flight nurses explained. "We gave a milligram of epinephrine-no response."
A pause in CPR showed sinus bradycardia on the monitor, but we couldn't detect a carotid pulse, even with doppler. The trauma surgeon ordered a thoracotomy. Everyone in the room knew that the odds were stacked against this patient.
As I hung two units of blood on a pressure infuser, I watched the trauma surgeon open the chest cavity with rib spreaders and then make a small opening in the pericardium with a scalpel. Out popped a blood clot the size of my fist. And then the miracle-mechanical cardiac activity. Never before had I had such a dramatic experience, snatching life back from the jaws of death.
"Okay," the trauma surgeon said, "let's head to the operating room (OR)."
We quickly attached a portable monitor. I glanced at my watch as we raced toward the elevator doors. Only 5 minutes had passed since the flight crew rolled the patient into our ED. But then I started to wonder how much I'd had to do with this success. My contribution consisted of hanging two units of blood and documenting the heroic actions of others. I chastised myself for my brief episode of egomania.
When I returned to the ED, I talked with the flight nurses. They told me that the patient had been awake and coherent when the paramedics arrived. The paramedics had explained to the patient the severity of her injuries and the need for intubation, and had asked her permission to intubate. She had agreed, but added, "I think it's too late."
Three months later, I took a seat at the hospital's annual trauma conference. As people continued to straggle in, one of the trauma coordinators found me and said she wanted me to meet someone. Following her back up the aisle, I tried to think who it could possibly be. Then it came to me-the gunshot victim I'd cared for months before.
And indeed it was she, and most of her family as well. She was to be the first speaker that morning. After greeting her, I settled back to listen.
Her talk was about the importance of keeping up our skills. It was a miracle, she said, that she'd survived and was speaking to us today. But after she was shot, everything had gone so smoothly. The paramedics had arrived quickly on the scene because the 911 operator had properly prioritized the call. The paramedics, recognizing the need for speedy transport, had called immediately for helicopter evacuation. The helicopter had arrived and gotten her to the hospital in record time. In the ED, we'd worked efficiently to restore cardiac activity. Fewer than 30 minutes elapsed from the time she was shot to the time she arrived in the OR. If just one thing had gone wrong in that chain of events, she wouldn't have survived.
Every thing had gone right because we'd all practiced our skills until we could do them in our sleep. "You've done more than you'll ever know," she said, "and please don't ever stop doing it."
Now, when I've had a bad day and start to think that nursing isn't worth the trouble anymore, I recall those words and remember why I wouldn't want to be doing anything else.
Kathleen Whitney is a staff nurse in the ED at Harris Methodist Fort Worth Hospital in Fort Worth, Tex.