Free Opening My Heart by Tilda Shalof Page B

Simone might be one who is. What she lacks in experience, she more than makes up for in book smarts and an eagerness to learn. At first glance it would seem unwise, even unsafe, to pair an inexperienced nurse with a complex and unstable lung transplant patient, but new nurses will never come into their own if they aren’t given challenges, especially under the watchful eye of a well-seasoned (sounds like a roast turkey) veteran. That’s where I come in. It’s how I learned.
    I’d been hoping to coast tonight, but I’ll need to keep my radar out to help Simone if she needs it. So far, she doesn’t seem worried, not the least bit daunted, but I have a feeling she should be.
    It’s less than an hour into the shift and Simone is in over her head. I go over to help, staying mere steps from my own patient and well within earshot of him and his monitor alarms. At first Simone balks at what she sees as my interference, saying she can manage on her own, but quickly softens when she realizes that I’m here to help, not to criticize. She’s clearly overwhelmed, glancing from the monitor, to her patient, to the countertop cluttered with meds due to be administered, not sure where to start first. Her patient’s ventilator alarm keeps going off and she silences it withoutchecking the reason. The family has been calling in repeatedly from the waiting room, asking to come in, and she is flustered, snapping at them over the phone,
Not now
. I go over and suction her patient’s lungs and give him an extra boost of oxygen. I change the chest tube drainage system that has filled up with bloody drainage and then start sorting out the “spaghetti,” the tangled-up, intertwined IV lines. Her patient has a fever and a high white count and needs blood cultures, so I do that. Together, we check and doublecheck, then co-sign for two units of blood, and I prime blood tubing, then prepare extra drips of IV Levophed and epinephrine. These powerful meds are running in each of the IV ports and cannot be put on hold while the blood runs in.
    “After the antibiotic runs in, a port will be freed up to hang the blood,” she reasons.
    “But you have other meds due and your hemoglobin is only sixty. Your patient needs the blood now. It can’t wait. You’ll have to start a peripheral IV and let the doctor know we need a new central line. This one may be a source of infection.”
    “I’m not good at them,” she admits, eyeballing her patient’s arm.
    Veins are one of my specialties. The plump ones look juicy, but I don’t fall for that easy temptation. I prefer the ones you can feel rather than see. First, I send her on a scavenger hunt to collect what’s needed. It’s like a
mis en place
before preparing a complicated French recipe: if you assemble the angiocath, tourniquet, alcohol wipes, and prime the IV tubing before starting to “cook,” you won’t be scrambling and will calmly nab that vein. It doesn’t seem that long ago that I was bumbling around, coming into a patient’s room, forgetting to bring something, going out to get it, coming back in again, running around in circles. “Have you started many IVS before?” I ask Simone when everything is ready.
    “Yeah, but only on the simulator models at university.”
    Ahh, this is the new nursing education, a more
in vitro
process than
in vivo
. What Simone means is that she learned to take a pulse, auscultate lungs, and perform other skills on high-fidelity dummies made of plastic, rubber, silicone, and computer chips. They even mimic human responses like crying out in pain or expressing distress. What they don’t mimic is the disruptions, distractions, interruptions, fatigue, and simultaneous multitasking of real-life nursing.
    Way back in the day when I was a nursing student, we practised our skills on one another before working with patients under the close supervision of an experienced nurse. It was the old-fashioned training or apprentice system. We took blood pressures,