“Get. Out. Of. My. Room.”
Truly. A patient hissed this at me. Lemme tell you all about it.
So, last year, I had a female medical-surgical (med-surg) patient in her mid-fifties. She was amicable enough and cooperated with performing self-care. She had been admitted to the hospital because of an exacerbation of COPD (Chronic obstructive pulmonary disorder. A person suffering from COPD cannot breathe worth a shit. Their lungs are shot, their alveoli, which are tiny little air-storing sacks at the “tree tips” of the bronchial chain, are popped and expanded. COPD patients, in a sense, are fucked). I can not remember the details exactly, but she was classic COPD and, (sorry, not sorry), classic white trash. Her personal belongings reeked of cigarette smoke and she gloated while I performed any care that she was not capable of doing herself (expelling her own turd from her anus, for example. She would get too short of breath while venturing to the commode, so the duty nurse and I had to help her, while she lay on her side, dig the turd from her butt. Yes. This is what the fuck nurses do).
In any case, her oxygen saturation (aka SpO2 – how much oxygen red blood cells are carrying to extremities, organs, etc., because (btw) THAT’S WHAT RED BLOOD CELLS DO) averaged around 91%. This was where she functioned, for the most part, and that is not uncommon for COPD patients. Normally, a person in optimal pulmonary health, maintain an SpO2 of between 96% and 100%, FYI. Anyway, at one point, while visiting with her son, my patient’s SpO2 reached 94%, of which I was very impressed, and I observed that she was content and conversing easily. I felt good for her.
Of course, nurses (and even nursing students) do not have JUST ONE patient. There are at least two or three more people relying on the expertise of one specific RN to ensure that their care and healing are accommodated to. While I was away from my COPD patient, respiratory therapy came into her room to perform nebulizers and assess her lung residuals and capacities, etc. That’s their job. They also know that O2 (via nasal cannula, usually) is mandatory, for comfort and perfusion. That being said, COPD patients cannot tolerate a high flow of O2 (it’s a whole pathophysiology thing) and their flow rates MUST BE MONITORED closely. They need O2 at all times, but NEVER too much (it has to do with the brain stem… too much O2 in the blood trumps CO2. The presence of CO2 triggers the brain stem to initiate breathing… not enough CO2 in a COPD patient, not enough breathing). In short: O2 is essential, even a low flow, for COPD patients. It is necessary. Respiratory therapy, of all groups, would know the importance of these O2 protocols.
Ok. About 15 minutes after respiratory therapy had left her room, I went in to check on her. Her son was gone and she was alone. She was not comfortable and was restless. She breathlessly explained to me, as we went through basic self-care routines (hand and face washing), that she did not feel well. I observed and assessed her closely. I put her on an SpO2 monitor and shockingly noted that she was maintaining only 88% – 89% blood oxygen saturation. I encouraged her to continue to breathe in deeply through her nose (that’s where the nasal cannula is, and I could hear the O2 connection running from the jet on the wall) and out through her mouth. Her O2 continued to drop and before my very eyes, her extremities (fingertips, lips) began to turn blue. I was desperate. I had pushed the call-button moments ago, to no avail; not a soul was coming to my aid, except for another nursing student and bless her soul (much love to you, Sarah!). I sent her out of the room to bring back help (as I could hear the damn call-bell dinging at the nurses’ station) but I decided I could not wait. I was eyeing the Code Blue button on the wall. My patient was moments away from the full-on respiratory distress of which I knew she would likely not make it back from. I needed help. So I left her side, stood in the hallway, complete in my dorky-ass nursing student uniform and yelled, “I need help! Now!” Help came. During the next split moments, I was told many things, like, “You must assess the patient, not just what the machine is telling you.” To this, I retorted, “Look at her lips and fingers.” The nurse began to look concerned, especially as the damn white-trash patient began to panic. The nurse noted the O2 jet, of which was set appropriately. She stood there, for a moment, at a loss. And then she did something I will never forget; she followed the nasal cannula line from the patient’s nose, fingering it all the was until she reached the end. The end lay on the floor. The end of my COPD patient’s nasal cannula was not even attached to oxygen. It lay, listless, behind her c-pap and bi-pap machines, completely useless. What WAS attached to the jet on the wall was a random cannula that ran to one of the machines. My patient was not getting any O2. This is bad news for a COPD patient.
Do you see what happened? Not to pass the buck but FOR REAL! After her respiratory therapy session, she was never reattached back to O2… the therapist FAILED to follow the cannula from her face to the jet. Almost costing this poor white trash woman her damn life. Thankfully, the patient recovered within moments of being reattached to O2. I remember feeling relief to see that she would avoid respiratory distress, intubation, and a coma. She would live another day to have shit dug out of her ass.
Ha. Oh, but that patient hated me. She had no idea that the only mistake I made was NOT FOLLOWING THE CANNULA LINE FROM HER DAMN FACE TO THE O2 JET (This is a huge thing for nurses to do, as menial as it sounds, I realized the validity of menial that clinical day). From her view, I fucked it all up. I did everything wrong. I scared the shit out of her and almost killed her. So she said after she caught enough breath to talk, “Get. Out. Of. Here.” Actually, she didn’t say it, she HISSED it.
I left. I cried. I wandered for a bit, reflecting. I found my clinical instructor in the med room and cried again. She informed me that the nurse had already reported that I was not at fault for anything more than NOT following the line. A report had already been filed against respiratory therapy. My clinical instructor asked that I gather my wits, continue caring for my other patients, and share my disaster at post-conference so that the other students could learn from my horror. NO problem. I don’t care how competitive and full of morons life is… I do not wish for another nurse to experience what I did. I do not wish for another patient to panic as mine did, either, because she could not breathe. Not cool.
I owned it, man. I am not big-headed, but I am smart and lemme tell you, I follow every mother-fucking line I come across now.