I love nursing in the cardiac ICU. But I worry the system itself will flatline
With the pandemic, it feels like the health-care system and my own coping mechanisms are collapsing
This First Person column is written by Heather Häberli who lives in Calgary. It was originally published in October 2022. For more information about CBC's First Person stories, please see the FAQ.
Ventricular fibrillation — it's a heart rhythm that is incompatible with life. One I'm all too familiar with.
I'm a nurse in a cardiac intensive care unit. Just minutes ago, I initiated cardiopulmonary resuscitation (CPR) for the man in front of me, and now my high-functioning team dances around our patient, a ballet of skill attempting to defy mother nature's plan.
Working alongside this team used to make me feel like I was part of something bigger than myself.
Until now, that was enough.
But in these last two years, I've felt like the system was collapsing around me. So were my normal stress coping mechanisms — so I'm sitting down to write about it instead.
That dance metaphor is an apt description for a day in critical care nursing. It's not always graceful.
Sweat burns in the space where my N95 mask pinches my face and my abs ache. I continue CPR, putting much of my body weight behind each compression. I feel the familiar sensation of ribs fracturing below my fingers. I cringe, but I need enough force to get the heart to compress.
Strange, the thoughts that drift through my mind as I work. Like that it's been a while since I had time or energy to exercise. This CPR will (morbidly?) count as my workout today.
I count out loud as I compress … 25, 26, 27 … a metronome to pace our ballerinas.
I hope someone else looks in on the patients for who I am the primary nurse. They're just as sick, but with staffing shortages, it seems life or death has become our triage system.
My mind drifts to the human beneath me during compressions.
I came into his room to replace his bag of norepinephrine and change the rates of his medication infusions. He was unresponsive because of the sedation, but I spoke to him anyway.
Then, as I organized the IV tubing (like every neurotic nurse does), his heart changed to ventricular fibrillation in a single, poorly timed beat.
I initiated CPR while calling for help. Time slowed down as I watched the team through the window in the isolation room, delayed by the donning of personal protective equipment.
I hoped someone was paging for respiratory therapy, but today there was a batch of new staff. They won't understand the non-verbal cues I normally use. I cursed multiple times under my mask as I waited.
If only his heart was beating the way I felt my own — pounding, flooded with adrenaline … 27, 28, 29, 30 ... My colleagues were now with me at the bedside. We looked at the monitor — asystole, or as pop culture TV would show, the flatline.
In a grisly game of tag, a colleague took over to ensure high quality compressions continue. He starts the count again.
As I caught my breath, I glanced at a family photo we hung on the wall. This man liked old cars and family gatherings. His daughter phones for updates regularly.
I wasn't this man's primary nurse. She was called away to escort another patient to MRI. If that hadn't happened, would she have noticed any sooner his clammy skin, his pale colour, decrease in urine output — those signs of an imminent decline?
… 27, 28, 29, 30
I started working in health care in 2007 as a nursing aide and studied to become a licensed practical nurse and later a registered nurse. Working with unstable cardiac patients and possessing this kind of unique knowledge feels like a privilege, and the reassuring lub-dub of a healthy heartbeat is comforting. Plus, I work alongside folks I still consider heroic.
But this man's heart rhythm wasn't improving. Our team lead reviewed his patient history out loud and asked for ideas — a strategy that enhances team dynamics and decreases mortality rates. Why does this only seem to happen in life-or-death situations?
A synth of electronic alarms surrounds us. It's a deadened noise in the back of my brain.
Thousands of dollars worth of supplies litter the room, flecks of blood and body fluid stain the snowflake print gown that lay torn to the side.
But this patient's alarms signal futility. On this day, we escorted another soul to the afterlife — in what might look like the least graceful attempt not to.
Deep down, I feel a sense of futility crushing my optimism and perseverance. During sleepless hours, I worry about the person this has made me into. Have I become passive as my patients suffer?
I am a tired mother and wife, who brings her frustrations home from work all too often. Now I pick up fewer shifts on this unit, because at times you can't pay me enough to feel so inadequate, to risk my license and compromise the standard of care I'm used to giving.
I lay awake thinking about solutions that go ignored and the "what ifs" at 2 a.m.
Some of those heroes I work alongside have disappeared — off on stress leave, a shifted career path, away to academics or cosmetics, while some left to other countries and provinces to nurse.
If I could rely on seeing enough familiar faces, walking into that alarming chaos of a patient in trouble wouldn't be so daunting. I've paused my work in critical care to preserve my own adrenaline. I'll hold on, working slightly removed from the ICU, and wait for the alarms in my head to subside.
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