The work of a nurse and a homesteader...

I was nearly two hours late coming home from work last night.  My day became a 13.5 hour one when the ambulance fellas brought in a very pale grey woman (about whom they knew nearly nothing as far as history goes) around six in the evening.  Within minutes, we were manually ventilating her with a bag valve mask.  We intubated her, tested her for blood in her stool (she was not bleeding from her bowels), drew lab work, and whisked her off to CAT scan within twenty minutes.  She was not bleeding in her brain.  Her hemoglobin was 3.8.  Her belly was getting larger and firmer as time went on.  She was bleeding into her abdominal cavity somewhere.  And then her heart rate slowed, and she lost her pulse, and we began the two-hour-long ordeal of trying to resuscitate her. 

We poured units of blood and plasma into her, using pressure-bags to squeeze the fluids in as quickly as possible.  We gave her every ACLS drug under the sun, multiple times.  We took turns working up a sweat doing chest compressions (which got a little bit easier after her ribs cracked on the first cycle), and as I pushed I saw the blood we were transfusing into her coming right back out around her femoral catheter in time with my compressions.  We defibrillated her. We cooled her core body temperature to 33 degrees Celcius to try to reduce the oxygen demands of her vital tissues. 

In between tasks, I ran out into the hall a few times to update her only family member, her brother, about what was happening. 

"She has stopped breathing on her own, we have her hooked up to a machine to breathe for her." 
"Her heart stopped beating, but we gave her CPR and medicines and it is beating on its own again." 
"She is losing a lot of blood, we are giving her donated blood now." 
"Her heart has stopped again, we are doing everything we can."

We tried very, very hard... several times we managed to get a pulse back, once or twice we even got a blood pressure.  But when the blood started coming out of her ears, and the heart monitor showed asystole, and no matter what we did no pulse returned... we had to stop.  She was gone.  It was time.

Her brother came out of the family waiting room, and in broken English asked me what was happening.  I was stunned, given that the physician had just spoken to him.  He didn't seem to have grasped the gravity of the situation.  "Her heart stopped beating, and we were unable to start it beating again.  She has died.  If you want to see her, now is the time.  We did everything we could, I am so sorry."

Throughout the code, as I pushed on her chest, pushed syringes, spiked bags of blood, started IV lines, wrote notes on paper towels.... my hands were steady.  My whole being was calm, collected, analyzing, thinking, working with my team, trying to save that woman's life.  After her brother left, and I sat down at my computer to begin charting everything that had happened over the past three hours, my hands started to shake violently.  Someone brought us all water to drink, and I became aware of the fact that my hair was disheveled and my face red and my scrubs soaked with sweat.  It took hours for the adrenaline to wear off. 

We do what we have to for those that we serve.

I came home and attempted to drain an abscess on the foot of Bambi, one of our Ameraucana hens.  She's a favorite of mine, always comes when I call her, lets me pick her up and cuddle her... a good-natured kind bird who never picks on the new chicks who are added to the flock.  I cleansed her foot, lanced it with a sterilized Xacto blade, then squeezed out as much pus as I could until only blood came out.  I applied an antibiotic ointment, dressed it, and she slept on a towel in the bathroom overnight. 

Today when I came home from work, the drainage coming from the wound was cloudy, and the foot was still very swollen.  It was time for a visit to the vet.  So, $100 later (exam, debridement, oral and topical antibiotics), I have hope that she'll be fine.  I don't know anyone who would pay $100 for a chicken, especially one that they have no intentions of eating.  But I love her.  She's one of the first four chickens we got, and she's a sweetheart.  It's not practical, and I certainly don't have money coming out of my ears to spend on birds, but I love her.  That's all there is to it. 

We do what we have to do for those that we love.

Tonight I'm going to take a shower, drink a glass of wine, maybe even eat some ice cream.  I'll smoke one of my favorite filtered cigars on the porch and talk with my fiance about our dreams.  Tomorrow I'll sleep in a little bit, before tackling the endless work of caring for animals and this beautiful place we call home.

We do what we have to for ourselves.