Secrets Ch. 01byBird_Man_RN©
This is my first attempt at writing something other than medical articles or my Thesis. I have always wanted to write a good story. Hopefully this accomplishes that. When I decided to write, a friend of mine who teaches High School English told me to just write what I know.
So, here goes. I hope you enjoy. Unfortunately, there is no sex in Chapter 1. This is a true story, although, the names have been changed to protect the innocent and not so innocent... ;-)
Alex Young RN, MSN, CNS, CCRN trudged up the back stairs to the ICU physician break room. As a CNS (Clinical Nurse Specialist), Alex covered the night shift four days a week and another CNS covered the other three, so that the surgeons didn't have to take night call, except for surgeries and that left them available for office hours and unit rounds during the day. Having CNS's cover the unit at night was a new program at the hospital and was starting to catch on. Other services within the hospital were looking into similar programs.
As a staff nurse, Alex worked in the Transplant ICU at Rush Medical Center for years and made friends with the director of Transplant Surgery, Gregory Tanner MD. When Alex finished his Master's Degree in Nursing as a Critical Care CNS, it was only natural for him to seek out employment with the Transplant surgery group. Dr Tanner hired him right away and then spearheaded the night shift call program with CNS's, which ensured that someone from their group would be on the Transplant ICU twenty-four hours a day.
Alex was tired. This was his fourth twelve hour night shift in a row. On top of that, he hadn't been sleeping. He missed Mark terribly and found it hard to sleep when he wasn't there. Mark Schmidt is his partner and had been since they graduated college five years earlier. Mark was the director of Marketing at the hospital. As far as he was concerned, Alex felt as if he had found his soul mate and intended to stay with Mark for the rest of his life.
Mark took a four day weekend and went home to Gurnee for his younger sister's wedding. He also planned to come out to his parents. The Schmidt's had been after him to find a nice girl and settle down ever since he graduated from college. They also wanted him to move closer to home and couldn't understand why he wanted to live in Chicago. He told Alex the evening before he left that he was tired of hiding and that he felt he owed it to his parents to finally come out of the closet. Although Alex agreed, since he came out in high school, he didn't agree with the timing of this revelation. Everyone was going to be stressed as it was with the wedding, and he told Mark that he shouldn't distract from his sister's big day.
Alex hoped everything was going well with Mark. He hadn't heard from him in two days, which was strange. They usually called or texted each other multiple times a day or night, depending on which one was working. "Oh well," Alex thought. Mark was probably just busy with family. He was due back tomorrow evening and Alex had several days off after tonight, so they could catch up properly.
A sudden alarm brought Alex from his thoughts of Mark.
"Code Blue...Code Blue...Code Blue. Transplant ICU room 225," was announced overhead.
Alex shoved his jacket and back pack into his locker and was just about to lock it, when the intercom in the break room came on.
"Alex, are you in there?" asked Jennifer, the Unit Secretary.
"Yeah, I'm here," Alex responded. "What do you need?"
"We need you STAT in 225!" Jennifer exclaimed. "All of the docs are gone already!"
"Well, shit," thought Alex. Kip Preston, one of the residents, was supposed to stay until Alex came in to relieve him. This was not the first time the resident had done this. "I am going to bring this up to Dr. Tanner in the morning during rounds. This is unacceptable and unprofessional," he thought.
Alex grabbed his stethoscope and lab jacket, and then headed in the direction of room 225. As he entered the room, the nurses were well under way with the Code. CPR was already in progress and a Respiratory Therapist was providing respirations with an Ambu bag. He could see that this was the Kidney transplant patient from yesterday. When he went home this morning, the patient was sitting up in a chair and looking pretty good.
"What happened?" he asked.
Wendy, the day shift Charge Nurse responded, "We had just gotten him back to bed when his heart rate began to elevate. He has urinated a lot today, and I dipped his urine for Specific Gravity, which was normal so it wasn't DI. He just seemed a little dehydrated, so I gave him a fluid bolus. About half way through the bolus, his QRS started to widen and then he became unresponsive"
"Ok," said Alex. "When did he lose his pulse?"
"Right before we called the Code," Wendy said as she checked her watch. "That was six minutes ago."
"Has he had any drugs?" asked Alex.
"Yes," replied Wendy. "He had an amp of Epinephrine three minutes ago."
"Ok, stop CPR and let's check his rhythm," said Alex.
Kelly, the nurse currently doing CPR stopped and everyone looked at the monitor.
"We have Ventricular Tachycardia. Kelly, can you feel a pulse?" asked Alex.
"No, Alex, there is no pulse," said Kelly.
"Alright, we need to shock and Wendy, draw up 40 units of Vasopressin," directed Alex. "Everyone clear the patient! Shocking!"
After making sure that everyone was clear, Alex shocked the patient with 120 joules. "Resume CPR and give him the Vasopressin," said Alex. "RT, are you getting good ventilations with the Ambu?" he asked Tammy the Respiratory Therapist.
"He is a little tough to ventilate," replied Tammy. "Would you like to intubate?"
"Yeah, we might as well," responded
Alex. "Someone go call the Respiratory Therapy department and have a ventilator brought to the room. Tammy, open the E-box and give me a #8 endotracheal tube and a curved tongue blade. When I am ready to intubate, I want you to stop CPR. Ready? Stop CPR."
Alex quickly inserted the endotracheal tube and checked capnography to ensure that he was in the proper place. "The monitor still shows V Tach," he said. "We need to shock again. This time Wendy, give him 300mg of Amiodarone. Everyone stand clear. Shocking!"
"Ok, resume CPR. Tammy, I will bag while you set up the ventilator. I want PRVC mode with a rate of 24, Tidal volume 500mL, 5 of Peep and 100% oxygen," said Alex.
After the ventilator was ready and the patient was breathing with the machine, they did another rhythm check which showed Sinus Tachycardia and also had a pulse. An Amiodarone drip was started at 1mg per minute, and Alex left to go find the family and give them an update.
Later that evening, after Alex finished rounding on all of the other patients on the unit and spoke with the nurses to see if they needed anything, he sat down with a cup of coffee to write some progress notes. Everything seemed to be running smoothly as the unit fell into its overnight routine of assessments, treatments and medications.
Kathy Simpson, the night shift Charge Nurse sat down next to Alex with her own cup of coffee and let out a big sigh. "You did a great job with that Code earlier Alex," she said. "I just knew I trained you well."
"Thanks Kathy," grinned Alex. Kathy had been his preceptor when he first came to the unit five years ago. He was always envious of her knowledge and it was her suggestion that he get his Graduate Degree.
"So, when does Mark come home?" Kathy asked.
"Tomorrow evening. He is coming back on the North Shore. I have to pick him up at the station at 8:15," he said.
"Anything special planned?" Kathy asked raising her eyebrows.
"Oh, I thought I would make Lasagna. That's his favorite, and then move on to something that involves a lot of kissing and...," he said, deliberately leaving the end of the sentence open and wagging his eyebrows.
"I can only imagine," Kathy laughed.
Suddenly, Jennifer poked her head around the corner. "Alex, the hospital operator has a doctor from another hospital on the line for you."
"Thanks Jennifer," he said and picked up the phone receiver. "Hello, this is Alex Young. How may I help you?"
"Hey Doc, this is Mike Connor. I am a Hospitalist at Northwestern Lake Forrest Hospital," was the reply from the other end of the line.
"Sorry Mike, I am not a doctor. I am a Clinical Nurse Specialist," said Alex. "I am on call this evening. How can I help you?"
"Oh, I thought I would be speaking to a Resident," said Dr. Connor.
"Well, the Transplant group here has CNS's that cover the unit at night. I assure you that aside from doing surgery, I can handle anything here. What's up?" he said.
"Ok then," said Dr. Connor. "We have a guy here in our ICU in liver failure from a suicide attempt. It seems he took two full bottles of extra strength Acetaminophen, and then locked himself in a hotel room for 18 hours. The family had to have hotel management open the door when he wouldn't respond to calls or knocks at the door. They found him there drunk with the two empty bottles. This guy knew what he was doing. We would like to send him to you to be worked up for a liver transplant that is, if one can be found before he dies."
"Ok. I can accept him as a patient. We have an open room here," said Alex. "I am not familiar with your hospital. Where are you located?"
"Oh, right," said Dr. Connor. "We are located up in Gurnee. The patient's name is Mark Schmidt. He is 28 years old. His liver enzyme levels are..."
Alex didn't hear any more. He had dropped the receiver with a gasp and Kathy looked over at him in shock.
"Alex, are you alright sweetie?" asked Kathy.
End of Chapter 1