Monday, May 14, 2007

Evie's Exciting Weekend, Part 1. (An Opera in Three Acts)

Like I figured, I was offline for awhile. Here's a rundown of what the last three days have looked like:

Friday I went to my job knowing I'd be working a 12 hour shift-and-a-half, and pretty much psychologically prepared to deal with it. What I wasn't prepared for was that my replacement wouldn't show up at 2am as scheduled, and that shortly after that I would be forced to think. Quickly and intelligently...which was asking a bit much, from my standpoint.

I got a call from the Nursing Supervisor at 3am, telling me we would be getting a transfer patient with an abdominal aortic aneurysm (AAA, or Triple A in the lingo) from Herrin Hospital. An aortic aneurysm is a bad thing; it's a bubble in the wall of a big fat artery from the heart. Once the aneurysm bursts, pretty much all your blood pours out that hole in a few minutes.

Herrin called ahead to say the patient was being loaded onto the chopper. I was working in the blood bank, and the blood bank tech at Herrin, a small regional hospital that doesn't get a lot of critical patients, told me that he was sending two units of blood with the triple A. I told him, "Don't send them unless they're hanging (being transfused), or I'll have to crossmatch them again." There was a brief delay while the Air Nurse hooked up his two units, and they took off.

So the guy and his two hanging units (which now sounds vaguely sexual) were en route. I looked him up in the computer: he had a prior history of being an O neg...of which we had eight units on the shelf. I set up four of them for emergency release and a surgical nurse came down to pick them up. While I processed the units, she mentioned that she'd been working since 5am...22 hours straight. Suddenly I felt like a baby for being tired after 13.

The hand-off went smoothly; the chopper landed, the patient was whisked off to surgery, and surgery sent me a tube of blood to crossmatch six more units with. I only had 4 units of O neg left and since the guy was 66 and unlikely to ever give birth, I type-switched him to O pos.

Type-switching is kind of a cowboy move. You can't go there very often, but in certain cases, usually involving elderly people who have some kind of acute reason to need blood, you can give an Rh negative person Rh positive blood. That patient is then sensitized to Rh positive; you can never go to that well again. So essentially, it's a gamble that this is a one-time event.

So...I did it. I type-switched him, packed up another six units in a cooler with two units of plasma as a chaser, and sent them to surgery.

By then, it was 4:30am, and everything else in the lab had gone to hell from neglect. The phone was ringing off the hook, I had undone stats piled up to my armpits, and I was pretty much dead on my feet. I finally called Lisa and she came in early to help me catch up.

At 6am, the guy who was supposed to replace me rolled in, and said, "Was I supposed to come in at 2? I didn't know that." I rolled my eyes, gathered up my ironically named "For us, it's all about you!" employee appreciation swag, and staggered out the door with my head spinning from a combination of exhaustion and post-adrenaline letdown.

To be continued...

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