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Some other things have happened to make me think. A good friend’s brother died in a freak accident, suffering a traumatic brain injury; he was an organ donor and was in good health, and I am told that as a last act, even though it was not a conscious one, he gave “right down to the marrow of his bones.” At almost exactly the same time, I heard from one of my dearest friends in the entire world (literally–he lives in Israel!) that he had been placed on the list for lung transplant and was told that the average waiting time there was 4-6 months. Not that one affected the other, but it seemed an odd coincidence that they happened so close together. Less than two weeks later he was called to the hospital and was actually prepped and waiting for surgery, lying on a gurney with arms outstretched.and when they opened up the putative donor, the lungs were in too bad a condition to use! I got a very funny e-mail from him after that, entitled “Dress Rehearsal Rag,” detailing what went on and what he thought. (With his trademark off-center humor, he described his position on the gurney thus: “They spread my arms out from my body, supported by the arm rests, and attached the IVs etc. to them. And i glanced at myself and thought: Hey fellas, just remember what happened the LAST time they stuck a Jew on a cross.”) Anyway, about 10 days ago he was called to the hospital again, and this time he actually HAD his transplant. He was supposed to be discharged on Thursday, but I have not heard yet from either him, his son (the designated communicator, who gives “taciturn” a whole new meaning) or his erstwhile girlfriend that he is indeed home.

So on to last night, which was busy but not horrendous for me.and was hideously so for my partner, who inherited not one but two from CCU, plus one that I’d had the night before.which was the one giving her fits. When I’d had her she was pretty confused at night and had some issues with her blood pressure, but not totally out of character for a 70-something with a sacral fracture and on some pretty heavy-duty pain meds. Last night, however, was an entirely different story. Apparently through the day she’d had increasing problems with her blood pressure, or as the day crew said “We kept thinking her head would blow off!” and they’d finally decided that since she was also trying to climb out of the bed, the problem was anxiety, and they’d gotten an order for Ativan which chilled her pretty much.until about 8:30, when she woke up and was utterly, totally, and completely bonkers. And then her blood pressure started to climb to unreal levels. At that point something started niggling at the b back of my mind. I’d seen this before.and history of multiple falls recently.do you suppose? So I wondered aloud if she’d been taking something before she came in that had somehow escaped her med list, something like Xanax, maybe.a favorite drug of little old ladies and one that has notoriously nasty withdrawal. Still, the more I looked at her, the more I thought of something else, and I said to my partner, “You know, she looks like the DTs.” My partner didn’t think so at all, and between dealing with that patient’s blood pressure and the correspondingly low pressures of the one in the next room, and the trauma survivor besides, she didn’t really have time to think about it. I didn’t say anything more, but the thought didn’t leave my mind. Meanwhile, the patient’s blood pressure kept climbing, her anxiety level kept rising, she had tremors, and her behavior became more and more bizarre. All meds to control the blood pressure were proving useless, and when the patient became sweaty and wheezy, she called the doctor. Of course it was the on-call, and she had to go into the history, but he asked one very pertinent question: could she be in withdrawal? While we waited for him to come up, we went into her room and she asked her a few pointed questions, like did she drink and how much and what. We got some confused answers, but enough to make us conclude that this might just be the problem. And when the doc came up, he took one look at her and said in his Chinese-accented English, “Yep, she is in DTs.” From then on it was pretty straightforward detox orders.ativan, banana bag (IV with multi-vitamins, so called because of the yellow color of the fluid), B vitamins, etc. She chilled out.and didn’t her blood pressure come down?

I guess people don’t think of little old ladies having drinking problems. Nobody probably thinks anything of granny’s nighttime glass of wine; hell, my own grandma had her *one* glass of Mogen David before bed every night of her life, though she would have been quite offended if anyone had offered her a second. But alcohol can be anyone’s problem. I lived with it for a long time, and worked at one time in a unit where, if we didn’t have two or three drunks or druggies detoxing, we just weren’t living right, so maybe I just picked up on it. Did I feel vindicated? Yes. Did I gloat? No, because I have missed things that should have been obvious, and I will again. Still, it feels good to know you’re right now and then.

Oh, and the patients? Well, surprise, there’s no decrease in acuity. We still have all the cardiac and vasoactive drips, our chronic vent, the recently extubated, complicated wound care, blood to give, and those who aren’t too terribly tightly tied and like to climb out of bed and do “face plants” on the floor, not to mention a few who think they have a private duty nurse who will cater to their every whim. This morning we got a call “Can you take a labetolol drip?” (this is a continuous infusion of a heavy-duty blood pressure drug which can take a nasty turn if you’re not careful) and the oncoming charge nurse said “No, not even if we had a bed, which we don’t.” Technically we *might* take such a thing, but it would be dangerous with the number and acuity of our current patient load. Oh, and the category I forgot.the gynormous, those weighing over 300 lbs., who are killing our backs and shoulders.

And how do they justify all this? It’s being done in the name of “productivity,” a model designed by the bean counters who have no clue about what really goes on out here in the world. Everything is measured by some formula which appears to be completely divorced from the reality of caring for the sick. “But we have to make money to keep going!” they wail. Right, and how many of YOU do we need? How much middle management is required to keep an outfit going, and why does the CEO need to make that much money? My dearest dream is that part of the curriculum for all programs in health care administration will include a year actually working as a tech, and at least 6 months closely shadowing nurses in a variety of units. In the best of all possible worlds.but it will never happen.

The result is burnout, despair, and a lot of bodies heading for the door. Our assistant manager left for one of the critical care units; one of our best day nurses took an assistant manager position at a smaller inner-city hospital; another went back to New Jersey; and almost everyone else has applications out or is looking either in the system or out. Of course there’s a hiring freeze on in the system, it being the end of the year and all.

I thought about posting an account of what happened last night, but just thinking about it makes me exhausted all over again, and considering what we might have overlooked is painful. Meanwhile our other 7 patients went unattended, and one nurse was there for nearly 20 hours. ame in for day shift, stayed over for 4, and it was her patient that tanked, so she was there past 1:30 charting. Please tell me how this can be safe?