Monday, April 26, 2010

Deadman, Chapter 2


Chapter 2

After graduation from nursing school, I returned to the hospital I had been working at as an orderly. I was now a new nurse in their coronary care unit. I had arrived; I was now one of the elite, a regular cock-robin.
Like most mid-sized hospitals of the era, the intensive care part of the hospital was divided into two sections – a coronary care unit and a surgical ICU. I was hired for the coronary care part. This was where they put the best and brightest – the cowboy nurses who could make a decision quickly, or not make one just as fast. The job required a combination of speed, restraint and judgment – the unusual mix of a beta mind in an alpha body – nervous, twitchy chain smokers who sat a lot and argued about the arrangement of bones.
 I spent most of my time with other nurses, all small ‘g' gods like myself. We sat in front of banks of heart monitors most of the day, just smoking our cigarettes and arguing with each other about the rhythms of our patients as they scrolled methodically in front of us. Our job was to watch... to patiently sit and anxiously watch until the time came when we leaped into action (mostly in the form of a reaction) as sudden, panicked alarms went off around us.
We learned to become passionate with inactivity. Like Calvin Coolidge’s theory of practical governmental inaction, we believed that the wheat would separate from the chaff if we allowed the movement of time to shake it loose. We pounced on grave concerns only, and set the bar as high as it could be set before we acted. We were the best; we were the people other people in the hospital came to with life and death problems. Most of all, we knew, in the core of our souls, that we were Gods chosen people (At least the people God chose to take care of really sick people.)
We were true believers in the religion of western medicine -- we believed that our individual actions made a difference, and that we were the ones on the front line with the job of making it happen.
We also believed that if you couldn’t beat death, you could at least explain it in scientific terms that were easy to understand.
We had a thing we called, “dead man talking”. Back in the old days, before TPA (Tissue Plasminogen activator- a “clot busting” drug) and other fancy treatments, we had nothing to stop a heart attack. We could treat the pain with morphine and nitroglycerin; we could rest the patient in bed, and give oxygen by a tube in the nose. None of those things would actually STOP a heart from dying, so we spent most of our time watching for signs of a damaged heart getting progressively worse -- irritability, irregularity’s, and other signs of a pump that no longer could pump.
We also tested for damage by running a lab test for the enzyme released when heart muscle was damaged (CPKmb) --- the higher the number, the more the damage. Back then, when you saw a number over 10,000, you knew trouble was coming. When you saw numbers over 20,000, you knew that they were dead.
          I remember seeing a borderline famous guy in a picture from a newspaper. He was sitting in a dirty swimming pool and looking stunned during one of those late summer Malibu fires. He looked alert and relatively untouched, but died later that day of massive burn injuries.
That’s the way dead men looked on arrival to our coronary care unit- kind of dazed, but otherwise normal. There was a real strangeness when you looked at a normal person and knew that he would be dead in three days- it took more than getting used to it, it took practice.
          It was like a drill that had become a process. These soon-to-be dead people would come up from the ER, with their pain mostly relieved. They looked thankful and almost happy that the worst was over. Once they arrived to the unit, we would make them safe with the structures of industrial caring – forms filled out, procedures explained from pre-prepared sheets of paper, and orientations made to new equipment. We established our bonifides through these displays of confident competence – even if we had to fake it. (Nursing is really one of those jobs where it’s much more important to look good than to be good. Fair warning.)
To the person involved in the death of their heart, it comes out of nowhere. It happens at a routine part of a routine day, usually a day like every other day--- nothing special. A big attack usually slams a man down with sudden acute chest pain, usually radiating down an arm or up the chest to the throat. They have an acute feeling of impending doom and their anxiety escalates big time -- worse than when they were a child and left waiting alone in a room for hours, waiting  “for their father to come home.” Sometimes they can’t breath, sometimes they can’t lay flat- but they ALL know that they are involved in a major life event, a thing that will change them forever.
 What they are is dead, with three days of grace. The real working part of the drill was to be with them as they figured it out.

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