hard-core even for nurses. When it suddenly dawns on you what you’re taking on, it’s daunting – or should be. I’ll never forget the look of utter amazement and discombobulation on one newbie’s face as she looked around and pronounced the place“phantasmagorical.” She was a Trekkie and nailed it: “They say space is the final frontier, but I think it’s here.” She was trembling with excitement and fear at the prospect of working here. Laura, the eponymous leader of “Laura’s Line,” and a buddy of mine, came over to help bring down her stress level a notch or two.
“Relax. It’s only machines.” Laura gave the ventilator a little kick. “Just keep in mind that that’s a person in the bed and it’s all about hands-on care, you’ll be okay.” At that moment, a high-pitched alarm went off. Laura glanced at the monitor and smoothed the patient’s covers. “See, it’s just an artifact. When an alarm goes off it doesn’t necessarily mean something is wrong, only that something
could
be wrong. Your job is to know the difference.”
Laura herself could detect a problem long before any machine. To her, the truth was with the patient.
In the ICU , “vital signs” has a different meaning. On the floor, they are taken once a shift; here, they are noted moment by moment. You have to have a solid grasp of normal before you can recognize abnormal. Further, you have to know what normal is for your patient, like a “personal best.” Take blood pressure, for example. Before I came to the ICU , I thought of BP as a routine task or something measured once a year at an annual checkup (for those who had them). Very quickly you realize that in the ICU , blood pressure is a big deal. Your patient’s blood pressure is always on your mind. We monitor it continuously by a line in the patient’s artery and are concerned not only about the systolic and diastolic pressures but a calculated ratio of the two, called the mean arterial pressure (MAP) . It reflects the perfusion of the vital organs, but I tend to think of MAP as the force that propels life forward. To me, MAP is that poetic.
Heartbeats are given equally close attention as we examine them in second intervals, measure parts of them in milliseconds. We are constantly sizing up whether the hearth rhythm is regularly regular,regularly irregular, irregularly regular. The same close attention is given to breathing. Second by second, breath by breath, each is counted and measured, as well as the intervals in between breaths.
Then there’s urine! We note the colour, if there is sediment, and the amount, millilitre by millilitre, we tally it hourly, not just allow it to accumulate to the end of the shift. In the ICU , all the elements of life – cells, enzymes, minerals, electrolytes, and microbes – are under scrutiny. Moment by moment, bodies are in the balance – beating, dripping, dropping, ticking, pulsing, and pumping.
Another thing I love about the ICU is that everything about my patient is my business: heartbeats my responsibility to safeguard, each drop of urine my concern. I’ll never forget the first time I heard an ICU nurse say, “My pressure’s low,” and realized she meant her
patient’s
blood pressure. “It’s like when your child coughs, it’s your cough, too,” she explained.
A nurse has to earn the privilege to work here – and stay. You have to study hard and keep on top of your game, proving yourself over and over again. The learning curve is steep, especially at first. For me, the technical skills came slowly and acquiring the mandatory knowledge and critical thinking took even longer. As for the emotional fortitude – well, I’m still working on that.
“Why are you still there?” friends often ask. “Isn’t it time to move on to bigger and better things?”
Like what? I wonder. What could top this? I’ve found my place. To me, what happens at the bedside is the most interesting and important thing – and in the
“Relax. It’s only machines.” Laura gave the ventilator a little kick. “Just keep in mind that that’s a person in the bed and it’s all about hands-on care, you’ll be okay.” At that moment, a high-pitched alarm went off. Laura glanced at the monitor and smoothed the patient’s covers. “See, it’s just an artifact. When an alarm goes off it doesn’t necessarily mean something is wrong, only that something
could
be wrong. Your job is to know the difference.”
Laura herself could detect a problem long before any machine. To her, the truth was with the patient.
In the ICU , “vital signs” has a different meaning. On the floor, they are taken once a shift; here, they are noted moment by moment. You have to have a solid grasp of normal before you can recognize abnormal. Further, you have to know what normal is for your patient, like a “personal best.” Take blood pressure, for example. Before I came to the ICU , I thought of BP as a routine task or something measured once a year at an annual checkup (for those who had them). Very quickly you realize that in the ICU , blood pressure is a big deal. Your patient’s blood pressure is always on your mind. We monitor it continuously by a line in the patient’s artery and are concerned not only about the systolic and diastolic pressures but a calculated ratio of the two, called the mean arterial pressure (MAP) . It reflects the perfusion of the vital organs, but I tend to think of MAP as the force that propels life forward. To me, MAP is that poetic.
Heartbeats are given equally close attention as we examine them in second intervals, measure parts of them in milliseconds. We are constantly sizing up whether the hearth rhythm is regularly regular,regularly irregular, irregularly regular. The same close attention is given to breathing. Second by second, breath by breath, each is counted and measured, as well as the intervals in between breaths.
Then there’s urine! We note the colour, if there is sediment, and the amount, millilitre by millilitre, we tally it hourly, not just allow it to accumulate to the end of the shift. In the ICU , all the elements of life – cells, enzymes, minerals, electrolytes, and microbes – are under scrutiny. Moment by moment, bodies are in the balance – beating, dripping, dropping, ticking, pulsing, and pumping.
Another thing I love about the ICU is that everything about my patient is my business: heartbeats my responsibility to safeguard, each drop of urine my concern. I’ll never forget the first time I heard an ICU nurse say, “My pressure’s low,” and realized she meant her
patient’s
blood pressure. “It’s like when your child coughs, it’s your cough, too,” she explained.
A nurse has to earn the privilege to work here – and stay. You have to study hard and keep on top of your game, proving yourself over and over again. The learning curve is steep, especially at first. For me, the technical skills came slowly and acquiring the mandatory knowledge and critical thinking took even longer. As for the emotional fortitude – well, I’m still working on that.
“Why are you still there?” friends often ask. “Isn’t it time to move on to bigger and better things?”
Like what? I wonder. What could top this? I’ve found my place. To me, what happens at the bedside is the most interesting and important thing – and in the
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