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The Little Blue Button

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A “code” is the term that medical professionals use to describe the orchestrated chaos that surrounds a patient that is on the brink of death.  Depending on the facility a code may be called a Code Blue, Code Red, Code CPR, or sometimes Code 99.  They all mean the same thing.  A person is about to die unless there are medical interventions made immediately.  Sometimes it means that death will come no matter how hard we try to stop it.

 

A few months past graduation I experienced my first code on my own patient.  The man had been verbally abusing me all day.  I had been running around trying to make him happy and also care for my other five patients.  He was bellowing from his bed that he was going to die.  A lot of patients speak in that way, but something about the way he said it terrified me a little.  All his vitals, physical assessment findings and that he was able to yell with so much energy all assured me that he was stable.  I called the physician anyway.  He agreed to assess the patient. I went to check on my suddenly quiet patient.  When I walked into the room I knew something was different.  I will never forget how grey he looked.  I froze in a moment that felt like eternity while I listened and looked for breathing.  It only took a few seconds to confirm.  I reached up above his head and pressed the small blue button.

 

I was the person yelling now.

 

I called above the alarm sound for help. Help came.  Almost before I could lay the patient flat in the bed, a nursing aid, with a football player build, began chest compressions.  Respiratory commanded the head of the bed, bagging and preparing for intubation. A metal crash cart clanked into existence, pushed by my charge nurse.  The emergency room physician and intensive care nurse rushed in together. The ICU nurse asked who the primary nurse was.  All I could think was ‘Oh Crap! That’s me.’  She told me to grab the chart (that’s back when patient’s records were big, clunky, 2-ringed, plastic folders stuffed with a ream of paper printouts and handwritten notes) and call the patient’s physician.

 

I ran to the desk and called the doctor again. He was just getting off the elevator. We met at the patient’s bedside. I calmly answered questions about history, vitals, and labs, all while the resuscitation dance continued.  I was calm only on the outside.  Inside my mind raced, searching for what I might have missed.  This man had been screaming at me all shift.  How could we be coding him now?  I couldn’t think of anything I could have or would have changed.  Even now looking back, with much more experience, I know gave him appropriate care.  I watched the code continue, clutching the hard plastic chart.  I optimistically observed that his color was pink again.  Surely that was a good sign, I told myself.

 

As if someone had flipped a switch, everything stopped.

 

The ER physician called time of death after nearly 40 minutes of trying to coax my patient back to life.  I watched as my patient lost his rosy color while the team waded through the open package wrappers that had been hastily discarded on the floor.  The CNA stayed and helped me to clear the debris and prepare my patient for the morgue.  The aftermath of the code was over quickly.  I think that is what stunned me the most.  The physicians and nurses went on caring for their patients.  Housekeeping came and cleaned the room for my next admission.  I did not have time to cry or sit in disbelief or process what had happened.

 

The shift went on and so did I.

 

I have since been to countless codes.  Sometimes I am doing the compressions.  Sometimes I am the nurse directing the chaos.  Occasionally I am the primary nurse questioning every action I did or didn’t make that shift. Luckily one aspect of patient codes has changed since I was a new nurse.  It is now an expectation in many hospitals that a debrief occurs after a code, regardless of the outcome.

 

A debrief is conducted as soon as possible after the event.  All available team members are expected to attend.  It is a confidential and non-discoverable group discussion of the event.  The purpose is to discuss the facts, problems, barriers, needed improvements and to acknowledge and share feelings.  This is not a time to place blame or try to find fault with one another. This opportunity to discuss the event and acknowledge how we feel about it is a valuable practice.  I never want to feel that losing a patient is business as usual.

 

Debriefing is the pause that we need to take to acknowledge, gain knowledge and make adjustments for the next time we press that little blue button.

 

 


Debriefing Steps 

1. Introduction: The facilitator establishes the group goals and rules and reinforces the need for confidentiality about anything that transpires within the group.

2. Fact gathering: Each staff person describes what happened and facts are gathered.

3. Reaction phase: Led by the facilitator, the group examines its feelings, thoughts, and responses to the event experienced. If the debriefing session happens soon after the event occurred, there might not be any symptoms.

4. Symptom phase: If some time has elapsed since the event, group members may be experiencing symptoms. The facilitator helps the group examine how these reactions have affected personal and work lives.

5. Stress response: The facilitator teaches group members about their stress response.

6. Suggestions: The facilitator offers guidance on how to cope with stress related to the incident.

7. Incident phase: Group members identify positive aspects of the event.

8. Referral phase: The facilitator concludes with this phase, whereby specific individuals who require additional support are referred for individual follow-up.     

Adapted from: Hanna, D., & Romana, M. (2007). Debriefing After A Crisis. Nursing Management (Springhouse), 38-42,44–45,47.


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*all accounts are fictional
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When there is No Rainbow after the Storm

I have a large family, by current standards.  I am the proud mother to five beautiful children.  I conceived all of them easily, had uneventful pregnancies and easy vaginal deliveries.  Sounds like a dream come true.  Not exactly.

My husband and I always planned to have six children.  We were happily pregnant, with our caboose baby, when all my good pregnancy mojo disappeared.  We lost our sixth baby at 12 weeks gestation.  I was devastated.  After a few months I became pregnant with my  Rainbow Baby.  I was a few weeks pregnant with baby number 7 when my former due date arrived.  I mourned the loss of my last baby again as that date passed, but I was comforted and reassured by the new baby growing inside me.  My seventh pregnancy only made it to 7 weeks.  A new storm overtook me.  I almost lost myself.  It seemed strange to many people that I was so sad.  It is hard to explain how it feels.  I felt selfish for being so sad, especially when I have friends that struggled to have even one child.  I know that my children are a blessing and I am grateful.  It was impossible to talk my heart into understanding that I should feel grateful and not miserable.

After two losses, we decided to not try for any more rainbows.

I have secondary infertility due to hormone imbalances.  Although it is possible for me to become pregnant, it is difficult to sustain the pregnancy.  When I learned my body was the reason my babies died it felt like my heart had been sucked from my chest.  I hated myself for ignoring every physical symptom that seemed so glaringly obvious in hindsight.  My mind replayed, on a loop, every possible time I could have been diagnosed prior to becoming pregnant.  “If only” became my nemesis.  I mourned my lost babies.  I also mourned my shattered body image.  I had trusted my body.  I owned a strange pride in my ability to conceive and birth perfect babies.  I rocked at baby making.  I gave birth like a boss.  I was a wizard at lactation.  That sounds bizarre perhaps, but I enjoyed my fertility and all the happiness that it brought to me and my husband.

I still have days when the “if onlys” sneak into my mind.  I sometimes think about what those babies would be doing now, if they had lived.  Those times are getting less frequent and I am grateful.  More of my minutes are spent in awe of my amazing five.  More kisses, more hugs, more cuddles are given to the ones that stayed.  

I did not get a rainbow after the storm.  

bookends

 

My rainbow started with my first son and ended with my sweet baby girl.

This rainbow was made bigger and brighter with each of my five children.

It is not what I imagined it would be, but it is the most beautiful thing in my life.

Perinatal Loss Resources:

https://www.nowilaymedowntosleep.org

http://www.bandbacktogether.com/miscarriage-resources/

http://www.mymiscarriagematters.com

http://www.ahearttohold.org/blog-2/

 

 

 

 

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Why October Sucks

A year ago today I was happily pregnant with my 6th baby and easing into my second trimester. Within 24 hours I knew that my baby was dead. I became pregnant again after 6 months of sorrow and grief. I was over the moon happy and put aside my fears of losing the new life growing within me. I lost my seventh baby by 8 weeks of pregnancy.

Since I work in labor and delivery, each day is a constant reminder of the two little holes in my heart. I’m beginning to see women come in with the due date I should still have. I literally bite my tongue to not cry sometimes when I place the fetal monitors on their growing bellies. When I teach childbirth class for new parents, I can’t watch the birth videos. I thought about leaving this area of nursing, but I couldn’t do it. It’s my life work and I’d be even more empty if I left it behind.

I just discovered that October is Pregnancy and Infant Loss month. I had no idea. My first reaction was a little incredulous. Parents don’t need a special month to remember their loss. All they need is for it to be any day of the week or to get a well wish from someone who still thinks you are pregnant or seeing a TimeHop from about your happy “I’m pregnant” Facebook announcement you couldn’t bring yourself to delete. I have been thinking about it over the last few days, as the one year anniversary of my first miscarriage is closing in on me. Maybe it’s a good idea to have an awareness month for perinatal and infant loss. Maybe it’s a blessing to have an excuse to talk about our wee ones that aren’t with us. Most people don’t want to be “that person” whom is constantly talking about their dead baby. It’s too depressing although incredibly common.

Part of coping is moving on with life and a lot of people are trying to do this every day. But this month is set aside for awareness and it’s not taboo to talk about perinatal loss apparently. So today I will cry while I’m blogging and share my feelings and remember my two little babies I won’t see grow up. Tomorrow I’ll paste on a smile and try not to relive all the horror from a year or six moths ago. Next month will be Thanksgiving and then Christmas and I’ll pretend that my heart isn’t broken, because there isn’t another stocking to be hung up for Santa. Eventually I won’t think about it every day or even every week. It will get easier, but it never goes away.

 

My Facebook pregnancy announcement 1 week before my miscarriage.
My Facebook pregnancy announcement 1 week before my miscarriage.

 

 

To remember and honor the little ones who left us too early, reach out to a parent this month and let them know you remember their baby and are thinking of them. Having someone acknowledge my baby’s existence, near my due date or the anniversary of the miscarriage, has been the most helpful thing anyone has done for me.

 

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When Yes Turns into a No

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I hate the word “miscarriage”. Miscarriage sounds like an accusation that the mother didn’t do something right. It may be true, in some cases, that a woman’s actions cause her baby to die in the womb or be born too early to live. This is not the case most of the time. Perinatal loss is a better term, but I’m not quite satisfied with that either. It should be called the-hardest-experience-a-woman-goes-through-that’s-unrecognized-by-society.

I spent 4 months crying by myself. I listened to well meaning people  discount the loss of my baby. To the outside world my baby was all theory. For my husband and me this new life was already a reality. I spent three months holding my baby, thinking about her, planning for her, and making sure I was being healthy for her. Three months is a long time. People fall in love in three months and get engaged or even married. Three months is plenty of time to fall in love with your own baby. A few people did understand my grief and I appreciated their empathy. I also felt incredible guilt to feel that sad when I had 5 beautiful and healthy children. I had so much more than so many women.  I felt selfish and miserable.

I don’t know if my baby really was a girl, but that’s how I think of her. I held her in the palm of my hand, grey and lifeless. She looked like a tiny baby. She had the faintest hint of fingernails, but not a bit of hair. In contrast to the grey of her skin her lidless eyes were dazzling blue. Those blue eyes are what stay with me. To my grieving soul they were an undeniable testament of personhood for my baby. My husband buried that tiny love, under a tree, in the yard. We struggled for awhile before we decided on that route. Our society and culture doesn’t have rules or customs to guide us in handling these tiniest of human remains.

The next time someone asked me how many kids I had, I stumbled. I wanted to say six, but that didn’t make sense. I only have five and the one that wasn’t anything to anyone, but me.

I started thinking of all the women I knew with losses. Surely I couldn’t be the only one who’s felt this severe grief. We seldom talk about it as women. In a world where nothing seems taboo anymore, a common and terrible life event is blatantly ignored.

As a labor nurse I’ve taken care of countless women who were actively losing and grieving their babies. I hope my words and actions helped. I thought I was sensitive, understanding and helpful to those women. That was before I knew for myself the real pain. The knowing is so much worse. Now I reflect on the past and see how futile my actions were to soothe those women.

I remember one very sad case. A woman was losing her baby in the second trimester. The baby had already died and the mother had to have her labor induced. The mother was of course distraught. When it came time to push she couldn’t, wouldn’t do it. No amount of gentle but firm coaxing could convince her to push out her dead baby. As long as she didn’t push she didn’t have to accept the truth. Her cervix eventually started to close and the induction process had to be started again. I felt appropriately sorry for her at the time. I helped her feel comfortable and eventually she was able to push. If I had that patient today, I wouldn’t feel appropriately sorry for her. I would be devastated. I would cry and whisper in her ear how much my heart hurt for her.  I would tell her how strong she was to push and how beautiful her baby was sure to be.  I would urge her to make just a couple more pushes and we would be able to meet her baby together.  I would wrap that precious one in a blanket and help her to look at every beautiful thing about her baby. It wouldn’t be enough to heal her hurt, but it would be a memory that she could hold in her heart.

I’ve been changed forever. Not many things or people in life can truly change a person. One tiny person changed me. It’s a shame that we don’t talk about how these babies affect us. I would love to hear all your stories. Share your sweet and sad memories. Together we can celebrate, mourn and remember our tiny ones.

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Dear God, It’s Me Again

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Dear God, it’s me again, Denise RN. I know that I just asked for a miracle last week, for that VBAC, but I could really use your help again. The mom in 407 is only 19 weeks pregnant and her water broke. She’s laying flat in bed, with her head a foot lower than her feet, trying to keep her baby inside. Give her strength Lord. This baby will never make it. Grant her the peace to accept that her baby will not go home with her. Heal her heart so it will be open to another baby someday.

Dear God, it’s me again. It has been a week and 407, I mean Candace, is still pregnant. She has finished her IV antibiotic course and is showing zero signs of infection. I saw her smiling and talking to her belly last night. She has done everything we instruct. I see her hope growing. Why are you allowing her this hope? That baby won’t make it 4 more weeks.

Dear God, it’s me again. I’m amazed at Candace’s strength. She is tired of lying in bed, but she never complains. She would sit on a pin if I told her it would help. 21 weeks, everyone is on the countdown now. Hope is spilling out onto the unit. Why are you letting this hope continue to spread? That baby won’t make it 3 more weeks.

Dear God, it’s me again. 22 weeks! Are you kidding me? Candace is so tired, but full of joy. Thank you for this miracle. We are almost there. The baby is growing and mom still has no signs of infection. This is really going to happen, isn’t it? Since you are in such a gracious mood, can I get a chance to pee before noon?

Dear God, yeah it’s me again. Help me to not fall asleep driving this car. Today was awful. Candace went into labor. I tried to stop it, but the baby came anyway. He was so small and fragile. I laid him on her chest and they cuddled together while he died. She cried when I told her that he was gone. Why, why, why? Why didn’t you take that baby last month? Why couldn’t she keep her baby? Why did you let her have hope for a month and then leave her childless in the end? Give her strength Lord, she is in pain.

Father in heaven, I became a mother today. Thank you for this gift. My little boy was only with me a short time. I wish he could’ve stayed with me. You must have needed him more. When my water broke so early I thought I would never meet him, but he was so strong. Every day I talked to him. I told him how much I loved him. I told him his name is William, just like my dad. I told him about all the things we would do when he was older, and the places we would go together. I prayed every minute for his safe birth. I cherished every little kick and movement this last month. Thank you for those moments. Oh and please bless my nurse, you know which one. The one that pretends she’s not too busy to massage my achy back. The one who smiled encouragingly, while she checked Will’s heart tones each day. The one who helped me hold him when he was born. The one who pointed out all his little miracles, from his tiny toes, to how his nose turns up just like mine. The one who told me how much she loved the name I picked out, while she pretended that she hadn’t been crying. Bless her with peace. Bless her with strength. Bless her with the wisdom to understand she can’t save every baby.

Thank you, God, for my nurse.

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