MAE JULIAN
The Heart Implant Journal
30 Nov. ’84
Just woke up. It’s 3 P.M. After a 12-hour shift taking care of Schroeder, I needed 12 hours of sleep.
Dr. Heime from Germany arrived late yesterday evening and he and Rob Jarvik both came into the room to talk to Schroeder. They would have liked to have put him on the portable drive system today but, when I woke up, and flipped on the CNN News, I see they had not done it yet. I guess I’ll find out why tonight when I go in @ 7 PM for another 12-hour shift.
Last night I worked with an ICU nurse named Debbie. The ICU nurses and the CCU nurses do not usually work together, as we have our separate units. We also have our separate hierarchy. Now, we are mixed together and it is a bit uncomfortable for each. We get accustomed to working with our own people where we can almost read each other’s minds and we know each other’s skill level, which is important when working in critical situations. When we are thrown together, we may know each other, but not the working skills or habits of the other. This explains the problem that arose.
Debbie, from ICU, seemed really jumpy. We are staggering in new people from both units so that no one will ever be left alone with so much unfamiliar equipment. At one point in the night, looking at the Utah Drive, the wave pattern on diastole went wacko. We began getting a series of alarms reporting a very low cardiac output (This would be life threatening). I did not feel alarmed, as the patient responded to his name, his color was okay, and the pressure settings were fine on the Drive. One thing I learned at EMS is that no matter how dire the circumstances seem, LOOK at the PATIENT. You can’t just go by readings.
Debbie started to panic as she noted the readings. It’s understandable that you don’t want him to die, but he didn’t look like he was dying. Only the readouts looked like he was dying. We began getting a series of alarms from the Utah Drive, but still, the pressures were fine as I checked the settings and Schroeder still did not look any different. Deb was extremely agitated and began to panic. She called out for Larry Hastings who was sleeping in the next room. She kept saying, “Get the key! Get the key!” Now, there was no way I was going to put the key in and change the drive lines over to the redundant machine, because I didn’t think we had an emergency. I did turn on the redundant machine just to keep her panic down. But had no intentions of taking off his drive lines to switch them. Well, thank God, Larry walked in and I gave him a quick report including my opinion that we were okay. Larry looked everything over and said it was just a problem with the computer that was reading out the waveforms. I felt mildly annoyed at Debbie because I felt she overreacted, but I didn’t say anything because she momentarily broke down crying and left the room.
Larry fixed the problem with the machine and Debbie returned, having regained her composure. Then she started to freak out because she said I had all 3 stopcocks turned the wrong way with the pressure tubing from the intra-cardiac monitoring lines. I told her they were turned the right way. She got panicky again and dragged Larry into the room, again, saying that air was getting into the tubing going straight to his heart. All stopcocks are supposed to turn off to air—which they were. She thought they were all turned open to air and that we had air going into the patient’s heart. The only “problem” that existed was that I turn my stopcocks closed to air one way and she was used to doing it the other way. Actually, she is right, but can I help it if I’m dyslexic? It was no problem just like writing with the left hand is no problem; it just looks wrong to someone not accustomed to it.
She nervously told me that she gets pretty “hyper” in some situations, and I could sure see that. But, I did like her, and she is quite competent. I learned a lot about the computer from her and feel fairly well prepared to take on a new nurse in the room tonight.
Last night is the first I’ve been able to talk to Schroeder as he was intubated before, and he mouthed 2 or 3 word responses to things. It is still pretty much that way. He can’t really talk, but what he does do is cough. It’s enough to drive you nuts. His glucose is in the 400’s. He is a diabetic. Just one more problem to wrestle with. He awoke continuously during the night either coughing or the one word begging, “popsicle” All Night Long! Popsicle! He’d been put on fluid restrictions last night by Dr. Giradet.
When DeVries came in this morning he said not to have him on fluid restrictions. Deb apologized profusely–she isn’t supposed to take orders from anyone but DeVries. She had taken the order and I would have done the same. It’s hard to readjust your thinking that some bigwig doctor like Giradet can’t give orders…not on an artificial heart patient. We are so accustomed to taking orders from the heart surgeons.
The thing of it is, ALL of Lansing’s team knew that, but they come in and give orders anyway. When one of his team of foreigners comes in and tries to order something, I just act like I can’t understand them, and I usually can’t. I am always tempted to tell them to go back where they came from.
There was a serious flare-up yesterday between Regina and Margie. Margie is truly a pain in the a_ _ even by word of her fellow ICU nurses. Then, to try to merge a CCU nurse with an ICU nurse, both of whom think they have the first and last word will not work smoothly. There is such a sharp division between the ICU nurses and the CCU nurses. Both units feel they are the #1 unit in the hospital. We have hit a project where we have to work together for the first time. We don’t have enough nurses in either unit to do the job alone right now. So, the patient is in OUR unit and we have territorial rights. ICU nurses should show courtesy for being allowed to work with us (some of this I’m smiling about because I know how it sounds.) But anytime you are dealing with a lot of people who all feel like they are #1, you’ve got a lot of shepherds and no sheep. So problems were expected. All this is made 10 times worse by Polly. She is the bitch from hell. She makes everyone’s life miserable and there are no controls on her. Lansing…what is he thinking?
The tension is tremendous at times. More often than not. CCU nurses are very “huggy” and close—except for Cindy. The ICU nurses are not physical with each other. They are more like loners. Cindy really should work ICU because she is more like them. She has that standoffish reserve. The rest of the CCU nurses work with her with no particular like or dislike. They see her as a non-descript wallflower. DeVries knows all of our names but he didn’t know hers. He had to ask me who she was. It would kill her to know that.
I hate it that I got as angry as I did yesterday. Not like me. I let my ego get in the way. She was out of line and arrogant in that she released a press story. I would not have done that to her, but I can’t expect her to act any different. She is who she is…a very self-centered person.
I actually asked her for the $200 she owed me. She has owed me for 2 years and I suspect she was going to just let it slide. But not me. I made an issue out of it and I hate that it had to come to that. But I hate worse having her shoe prints on my back! I had also given her an air-conditioner and had Spike install it for her and her roommate. I felt sorry for her living in that god-awful heat in an upstairs apartment so I offered her a spare I had. I harbored some thoughts of going and ripping it right out of her window. I guess I’m still harboring ill thoughts!
But I noted that she bought a new car and went on two vacations whilst she couldn’t be bothered to pay back the money she owed me. So…I got it back. Perhaps she’d like to sail out the 6th floor window.
The disparity of what is reported on TV is so many times diametrically opposed to what actually happens. I heard on NBC nightly news that Bill Schroeder had a wonderful night last night, but I spent the whole night taking care of him, and he had a lousy night. He coughed all night and every time he woke up he wanted a popsicle. He got very little sleep and I am concerned about sleep deprivation. I’m afraid he will get batty on us with this problem of lack of sleep. He is interrupted with a lot for this and that. And the coughing—GEEZ! He also has body-wide edema.
He is taking more insulin to control his blood sugar. But with all the popsicles, it’s like feeding him sugar water which he doesn’t need. I feel sort of ragged out. I am not looking forward to another 12-hour shift.
To be continued…
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