Monday, January 19, 2009

To Obama

My Advice to Barak Obama

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“Evil isn’t driven out; it’s crowded out by the expulsive power of good.”
MLK
I was a coronary care nurse two years before they allowed me to train to take care of open heart patients. Part book learning, but mostly hands on with another nurse – the training itself took another six months before they allowed me to work on my own. The actual work involved getting to know the stages of post-op – the cold patient warming up and all the body’s dislocations that happened in the process. We had to learn the first sixteen hours without killing anyone, or waking the surgeon unnecessarily. But mostly, we had to learn to live with the terror of the transfer.

Anesthesiologists brought the patients back to ICU after surgery. It was the luck of the draw who you got and how well they were organized. The patients themselves made a difference – the sick ones went later in the day after the routine cases had finished. Difficulties in surgery – sewing veins on a fresh heart attack patient was ‘like sewing wet tissue paper together’  took longer; diabetics had fragile, small veins – even finding a good donor vein from the leg took extra time. And bad surgeons took longer – and the longer on bypass – the longer they dug around and pulled and pushed – the more bruised and battered the patients came back.

The anesthesiologist made the difference. A good one would gently roll the patient from the gurney to the bed with all lines labeled and everything neat and orderly. They also tended to stick around a bit and pass on some good info as to what happened – not in the glowish surgical manner of parts fitting – but time, nicks and tears, and problems.

Ah, but the bad could be very, very bad.

Patients return to the ICU  intubated, with arterial lines in either wrist or leg, IV’s in both arms, catheters than run from either the chest or groin to the heart that are used for measurements, chest tubes that need to be hooked up and functioning, NG tubes from their nose to stomach, heart leads that need to be plugged in, pacemaker wires tape to the check that need a machine hook up and calibration, and sometimes, on special days, an intra aortic balloon pump threaded up their left groin that needs immediate attention before it clots up.

Now imagine a patient coming back late in the day, with all the stuff listed above sliding over from the gurney in a hurried thump in two large brown grocery bags of tangles and ooze as the anesthesiologist says, “it’s all yours ladies” as he turns and walks out of the room for his next disaster in the OR.

Welcome aboard Barak, have fun. Here is what I suggest:

1.      Do something, anything, and eventually it all makes a sort of sense. Do what needs to be done first, and then keep doing something.
2.      Trust that your choice of a god will watch over until you figure it out.
3.      Ask for help. (See #4 )
4.      Have fun, make crude jokes and laugh -- you are doomed if you forget to laugh.
5.      Keep in touch.

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