The Big One and The Big Buddy

My goodness he looks awful. Where’s the doctor. 

“Hey please pull doc from room 4, we need a 12 lead in here.” 

“Sir how are you feeling?” 

“Something isn’t right.” 

Cycle blood pressure. Heart rate 49. Skin pale diaphoretic. When I say diaphoretic he’s already soaked his pillow case 

“Can you rate your pain right now on a -“ 

“10” 

He looks uncomfortable. Uncomfortable is an understatement. He looks like crap. His telemetry strip looks even crappier. What I saw as mild elevation is now tomb stones. 

By now five other people are here. EKG is getting hooked up. 

“I’ll need a second line. Can someone pull the crash cart in here?” Thank God for paramedics.

Wife is hysterical. 

“Is he having a heart attack?” 

“Well something seems to have changed. Right now we are doing the EKG to see if we can see any changes.” 

There will be a change. This guy is having the big one. 

EKG reads acute STEMI. Doctor at bedside. 

Doctor is studying the EKG. “It appears he is now having a heart attack according to what I’m seeing on the EKG. We are going to get some medications started here. Which hospital would you like him to go to? He will need to fly there in the helicopter.” 

Doctor continues to talk with wife. 

In the meantime we have a second line. Crash cart is here. He looks crappy enough I want the pads on him, if nothing else just to ward off evil spirits. 

“I don’t feel so good.” He holds the emesis bag closer to his mouth. 

“Can I get an order for Zofran too?” 

Doctor is consoling wife. Doctor has other things to do right now. Need social services. 

“Can you call a social worker to be with the wife? Also we will need a helicopter. Patient is 111 kilos – flying for STEMI.” Thank God for reg reps. 

I take over consolation with the wife. Second nurse is pulling meds right now. Social worker isn’t too far behind. Thank God for social workers. 

Heparin bolus 

Heparin drip 

Nitro drip 

Plavix 

Has he had his aspirin yet? His weight puts him past the max dose of the heparin bolus so that will be 4000 units. 

I’ll spike the nitro. She’ll spike the heparin. We converse about the bolus. Label our tubing. Still no order for zofran. I’ll override that. 

Back in the room he has sweat off his Telemetry patches. If at all possible he looks even greyer. 

“ETA on helicopter is 15 minutes. I put EMTALAs on your desk.” Thank God for reg reps. 

“Let’s get someone to secure the helipad. Turn the lights on please. Can you turn off the QRS alarm on the Zoll monitor please? Sir I have lots of medications for you here. Things are going to move kind of fast now since it does look like you are having a heart attack.” 

Scan wristband 

Scan nitro 

“This first medication is that nitroglycerin like I put under your tongue earlier but now it will go in your IV. What is your pain level right now on scale of-“ 

“10” 

“Okay well let’s see if we can get you feeling better, this nitro will help and we can increase it based on your pain level” 

BP 110/72 – okay he can start at 5mcg/min but I’m going to set that to recycle every 3 minutes. Started at 1544 so I’ll recheck at 1549 

“Hey can you have her come in here to sign off on heparin? This next medication is called heparin. Some people call it a blood thinner but it’s going to help break up that clot in your heart vessels causing your heart attack.” 

He’s not listening. I know he isnt. His eyes are closed. Right now he’s digging deep down as far as he can to stay alive. I’ve seen that look before. I’ll explain anyway.. 

Scan bolus 

Confirm bolus dose. 4,000 units 

Scan bag. 

Ugh. Damn Heparin drips. These orders are never right anyway. 

Other nurse walks in. 

“I’m going to have to override the pump to 1,000 units an hour so 20 mLs an hour. That order is never right in there. I’ll get it programmed – can you sign off on the bolus though? I have 0.8 mls for the 4,000 unit bolus.” 

“Yup looks good.” 

He’s sweat off his telemetry patches again. His IV dressing is next. I’ll wrap it on coban. Thank God for coban. 

“Can you get a cold washcloth for his forehead?” 

20mls/hr

1,000 units per hour 

Downstream occlusion 

UGH 

I hate these pumps 

Nope just forgot the roller clamp. 

“Did we get an order for plavix yet? I was going to wait and see what they said when he calls.” 

“Yup it’s in here – 600 mg” 

“Can you go pull that? And does he want a second troponin drawn before he leaves?” 

“I’ll ask” 

BP 107/58 

“How’s your pain? Did it change at all?” 

“No – it’s a 10” 

“Okay let’s bump up your nitro drip here – this should start making you feel better here soon.” 

Key word: should as in it SHOULD be helping some. 

Bump up the nitro drip 

10 mcg/hour 

Plavix is here 

Scan the plavix

“I know that looks like a lot of pills, there are 8 in there to make a complete dose. This makes your platelets extra sticky so they slide right past each other. Here’s a tiny sip of water to wash it down.” 

I can hear the helicopter landing. That was fast. 

My EMTALAs need to be filled out. 

Last set of vitals. 

36.0, 45, 24, 99/67 95% RA 

#6077 to reach admission and transfer center 

They don’t need much of a report. They were in on the call with the doctor. 

Cath lab is wondering what the patient has had so far. 

Wait on hold for cath lab. 

and some more… 

and some more…. 

Finally a friendly voice on the end of the line. 

I give last set of vitals. 

“He’s had 2 sublingual nitro and his pain increased dramatically after that. EKG is reading STEMI. Patient became pale diaphoretic, nauseated, pain is 10/10 – I’ll be increasing his nitro drip to 15 mcg/min. He’s had the 600 mg of plavix, 4,000 units of heparin, heparin drip running at 1,000 U/hr 4 baby aspirin he’s on 2 lpm oxygen nasal canula. 2 18 gauge IVs. Helicopter just got here. I need to go give them report. Should be to you guys in about 25 minutes.” 

I scribbled all of the meds, doses, and times on a pice of paper for the flight crew. 

Hang up. 

Flight crew is here. 

“Hello – you can come on into room 7. This is Gerald. Gerald stayed home from work today, he wasn’t feeling well. Was feeling really tired and run down and decided to come in to see us this afternoon….”

I continue on with report while I bump his nitro drip up like I told the cath lab I would. 

I hand the flight nurse my chicken scratch of the times and doses of the meds. 

The flight crew begins their assessment. 

I step back out in the hallway. The wife is watching. The social worker’s arm around her shoulders. 

I put my hand on her shoulder. 

“He’s in good hands. These are the best of the best. It sounds like he’s going to go straight to the cath lab. I have him on several medications to help minimize the damage to his heart. Is there someone I can call for you?” 

“I don’t know.” 

“Do you have any children? A sister?” 

“I…I’m not sure.” 

Her eyes don’t leave her husband. 

“Uhm…my son.” 

“Does your son live in town?” 

“He’s on his way.” 

“That’s good. He’s exactly where he needs to be. I’m glad you made him come to the emergency department. You did exactly what you were supposed to do.” 

“Is he going to be okay?” 

“He is exactly where he needs to be. He is in good hands. This flight crew is the best of the best. They are giving him several medications to help his heart.” 

I walk back to my desk. I’ve hardly documented anything. Only 30 minutes have gone by but it seems – 

A call light goes off. 

Room 5. 

I knock on the door. 

“Where is the doctor? We’ve been waiting for 45 minutes now. I’ve got to go pick up my kids from school. No one has come to check on me at all.” 

“I’m so sorry, I know that’s frustrating -” 

“I haven’t had anything for pain, I haven’t even seen a single medical person.” 

“I’ll make sure to get the doctor in here as soon as-” 

“You’d better!” 

She goes back to playing angry birds on her phone. 

I step out of the room. 

I take a deep breath. 

Heart attack guy is being wheeled past me by the flight crew on his way out. I’m so bad with names. 

I go back to my charting. 

The chaos has resolved as quickly as it came on.

I look up from my computer just as angry birds lady leaves AMA because we are taking too long. 

She swears under her breath on the way out and slams her Big Buddy in the garbage next to me on her way out. 

Somedays nursing is a thankless job.

Creative writing pieces published by The Pink Shoelaces are based on years of nursing experience and not always about one particular experience. While some of the stories published could be based on real life scenarios, names and details have been changed to protect the patient privacy and maintain anonymity.