Road Trip!

Traveling with the critically ill is an art. I am a master at few things; but I will say that parallel parking, and moving the sick and intubated patient are amongst my top skills. Some of this is from instinct and most of it is from practice. I also am a perfectionist, and I try to be prepared for any situation. As I write this, I am acutely aware that the art of preparation is an exercise in both instinct and practice. Whichever came first is unimportant, as they all are intimately intertwined.

Patients need to move through the hospital for different types of procedures and scans, and the patient's nurse is usually solely responsible for their care as they are pushed through the halls.

Road trips are an exercise in preparation, focus, assertiveness, bravery, and well...exercise. These trips can take forever, and that bed is flipping heavy. You struggle to keep the IV poles together and kick visitors out of the elevator, and by the end, you are sweaty and disheveled. When you take a patient out of the ICU you are leaving the safety of staff support, an alternate oxygen supply, and unlimited resources. You are a lone wolf wandering the halls with with a sick patient, a lumbering hospital bed, a portable monitor, and your instinct to guide you. Traveling can be either a quick uneventful trip, or it can be a harrowing experience that makes you wonder if you are in the right profession.

Moving through the hospital with a sick patient is, I believe, the best way to gain confidence and experience as a new nurse. You learn how to be on your game; preparing for the worst to happen, being able to adapt to difficult circumstances, and learning who to call when all hell breaks loose. All orientees should go on as many traveling procedures that they can. This is the most basic ICU nursing, because all you have is you and the tools you bring to the table. You strip your patient to the basics, since you want to travel light. I put a few vials of emergency meds in my pocket, make sure I have an IV start, put an ambu bag on the bed, and get ready to roll. Some nurses tie themselves down with a crapload of equipment and IV poles; they are the wost kind of traveler. They are unable to adapt, freakout at every inconvenience, and they end up turning a stressful situation into a traumatic event for all involved parties. Road trips with the frantic are not fun. They are loose cannons with no focus or discipline, and if you are a patient, you are lucky to make it back unscathed.

I have learned many lessons through these patient expeditions. Always confirm IV access and patency. Nothing is worse than losing your access when your intubated patient is thrashing during a CT scan. Always bring an additional oxygen tank when your patient is on a non-rebreather mask, least the tank runs out while you are waiting for the elevator and your patient starts to turn blue. Be prepared to be a guinea pig in IR, where you are requested to disconnect your unstable patient from the vent over and over, while hiding behind a radiation blocking barrier. Know how to call anesthesia stat when your patient won't respond to sedation and is bucking while a hole is being punched and stented through his liver during a TIPS procedure(I have has to do this twice). These trips are in the extreme, but they do happen frequently. I have learned to not be optimistic, and always assume that when the shit hits the fan, it will be with me, on this particular road trip.

These experiences can be frightening, but you learn to take in your surroundings, know who your allies are, and know when you are in over your head. You also learn how to get the job done when it counts. An example is when I was traveling through the hospital with a very sick patient and making stops to CT, MRI, and to Nuclear Med for a VQ Scan to rule out a pulmonary embolism (PE). This poor man was tortured all day by me. Transferred back and forth from his bed to testing areas. He is old, in pain, and going to die any day. Who fucking cares if he had a PE? It doesn't make a difference in his treatment, seriously, I know. But, in order to provide the most thorough care we must turn over every stone, despite the discomfort of our elderly dying patients. The VQ scan looks at ventilation vs perfusion in the lungs. One has to breath in a radioactive gas, and then get transferred into a horizontal tube where they continue to breath in this toxic gas and sit until it permeates all of the lung spaces. This scan can take an hour and it sucks. It is uncomfortable, confining, and you have to keep wrapping your lips around this tube and breathing in this gas like it is the Devil's houka. I can understand how this would be unbearable. My poor old guy started to cry. Tears rolling down his cheeks. He started to scream "No more, No more!". My heart moved in my chest, I almost went to call it off, but then I thought of how I was working for three more days, and how I would have this guy again tomorrow. I didn't want this trip again. "Mr. So and So, you will finish this test. I am sweaty and tired, I look like hell, and I will not do this again. Put your mouth around this tube and breath. Breath deep and breath hard, and we will be done. I am not screwing around, and I will not take you back until we finish!" He looked at me first with fear, and then with understanding. He wrapped his lips around the tube and finished the test. We both got a resolution to get this bullshit test out of the way and be free from traveling to this hellhole again. I felt kinda bad, but I knew what needed to be done. I think he forgave me.

I like road trips for a few reasons. You are autonomous, intuitive, MacGyverish, and fluid. I get to be a better nurse for these experiences. Meeting and depending on new people, discovering my own strengths, and hopefully being able to make a difference in someones life. It is a fun break-away from the unit, and we need that sometimes. By taking ourselves out of our comfort zone, we are able to grow in ways that we could never imagine. I found that I was able to rely on gut more than monitors, and experience more than security. Most important though, I have learned to trust myself and my patients more. I was once so scared to go out of the unit by myself with my patient. I did the same thing with my daughter when she was first born. We tried to go for a walk in her jogger stroller when she was five days old. I got about fifty feet from the house, and immediately turned around and ran her home. I felt like a fool to be so scared of something so easy. It took me a while and I was finally able to move through this fear. I began to take my kid to the zoo, not unlike taking my patient to CT really. So, all and all, traveling is a necessary evil, though while uncomfortable, will ultimately be a benefit to you, and possibly to your patient.

(Plus, I haven't been to the gym in a while, and I can use the workout)