I hope you enjoy a small sample of what is in the book.

Code Blue (Chapter 4)

"At that moment, it was only me, so I did what I was taught to do. Taught from a book, this was not something we practiced in the nursing skills lab. Unlike giving each other shots, there were no nursing students who would volunteer to stop breathing so the classmates could practice bringing them back to life. I was taught to hyper-extend the head and lift the chin to open the airway. Look at the chest to see if it was rising—was air entering the chest? Position my ear just above the face to listen for any sounds—sounds that may indicate any signs of breathing. And, finally keep my face close to his, to feel for any air movement.

Nothing, nothing was happening, no movement of the chest, no air flowing in or out of the mouth or nose. For God sake, this man was not breathing. This was what I went to school for, to help sick people. But, I was the only one there now. I was his only hope. Practice or not, it was time to save my first life.

I placed my mouth over the cold, wet, limp lips of Mr. Murphy. My mouth sunk into his lifeless cheeks as I created an airtight seal around his mouth. I blew life into his cool, pale body. Not once, but twice, just as I was taught to do. Two deep breaths. As I held back the waves of nausea that had suddenly come over me, I slid my right hand down to his neck to check for a pulse. I held firm pressure on the carotid artery located on the front of his neck, hoping that there would be some sign of life. I was hoping—please let me feel some weak pulsation under my fingertips. No, nothing there either, so I climbed onto the bed with Mr. Murphy. I held back the waves of nausea caused by his cold, wet, sullen lips. I needed to position myself above him in order to lean over his body and start chest compressions. The bed was too high. I didn’t have a stool to raise myself up so I climbed onto the bed. I knelt with my knees against his ribs, positioned my hands on the lower end of his sternum, the breastbone, and pushed as hard as I could. Now that I had breathed what little air I had into his lungs, I needed to circulate it to his vital organs. Without oxygen, this man would never be smiling at anyone again. One, two, three, compressions. It was now my job to squeeze his heart between the breastbone and the backbone to push the blood through the blood vessels so it could travel out to the entire body. Four, five … Oh, thank God, the team finally arrived. The 240-pound orderly took over the job of chest compressions. His strong arms would surely be more effective in circulating the blood than mine. The respiratory therapist entered with mask and ambu bag in hand. He slipped the mask onto Mr. Murphy’s face, attached the ambu bag to the oxygen and squeezed air into those empty oxygen-starved lungs.

I backed off, away from the bed, watching the team function like a finely tuned orchestra."


The Open Heart (Chapter 17)

"What I was expecting to see, as we took the large drape off the chest, was exactly what I had seen a few days earlier when helping with this same procedure. We would see a clean incision. The sternum, which the surgeon had cut in half, would be separated and resting on each side of the open space. As we removed the packing, we would see the pink heart, positioned deep within the open cavity, galloping on and on as if it didn’t even care that human eyes were gazing down on it. I remember the first time I helped the surgeon with this dressing change; I was in awe of what I was witnessing. I was amazed that I was actually standing over this person, still alive, and watching her heart beat in her chest.

This was just one more example of the excitement that ICU nurses experience—the excitement of watching a beating heart, laying in that gaping space, while we went about our duties. I was actually looking forward to seeing that amazing event, once again.

On this day, my excitement was replaced by terror. As Rhonda and I removed the last gauze from Pat’s chest cavity, we watched the heart beat. But this time, as we reached for the first replacement gauze, we watched the heart stop. That heart muscle that had provided entertainment while we watched it dance in her chest previously, was not dancing for us today. Pat’s heart didn’t want to oblige us, it just wanted to lay there, still and quiet.

Rhonda and I both saw that last heart beat. Our first instinct was to look at each other, then look back into the chest cavity just to make sure we were seeing the same thing. After looking, first at each other, then back into the chest, we simultaneously looked up at the cardiac monitor. The flat line of the monitor confirmed what we didn’t want to admit, that we had just seen this dancing heart stop.

A million thoughts were running through my head. My first thought was, Oh no, what did we do? Then all of the doubts came at once. Did we pull the packing too forcefully? Did we do something wrong? Did we forget something? Should we have done something different? Too many thoughts and doubts were flooding my mind, but I couldn’t focus on that right now. We needed to interrupt what Pat’s body was trying to do. Pat was not going to die; I was not ready for that.

We called a “code blue” and started going through the steps to save this life. Rhonda and I had done this many times. We were both experienced nurses; we knew just what to do.

“You bag her, I’ll start CPR.” Those words came out of my mouth just like they had hundreds of times. But his time, as soon as the words left my lips, I realized that I didn’t know how I was going to do CPR.

CPR—cardio-pulmonary recessitation—something we do in ICU all the time. Place your hands on the sternum, compress the chest, and squeeze the heart between the sternum and the backbone. That is what we did time and again when the patient had no heart beat. But with wide eyes, I looked down into Pat’s open chest cavity. There was no sternum where I could place my hands. There was no chest to compress. All I saw was a gaping hole with a lifeless organ lying absolutely still at the bottom of the hollow space. As Rhonda began squeezing the ambu-bag that was delivering oxygen to Pat’s lungs, she looked up at me with eyes wider than mine as if to say, “It’s right there, you have to do it.”


Who calls the Shots? (Chapter 18)

"That was not good enough for me. I could not stand by and watch this cute little lady deteriorate if I could prevent it. Since the doctor was not able to come and assess the situation for himself, I had no choice but to take control and make sure that my patient got what I knew she needed.

I consulted with the charge nurse. Situations like this require alerting those higher in the chain of command. When something is not right, the charge nurse needs to know. Often the charge nurse can enlist the support of others, the nurse manager, the medical director, or whoever needs to be involved. Hopefully this would not get to that point, hopefully the doctor would be strolling in soon and we could resolve this issue. After consulting the charge nurse, she agreed with my plan of action. I was going to make one last phone call to the department where the doctor was in the middle of a procedure. I emphatically requested that the secretary relay my request for the orders that I knew Mary needed: arterial blood gasses (ABG’s), chest x-ray, a catheter, and oxygen in any form that would maintain an adequate oxygen level. I couldn’t wait for the doctor to come to my unit and see for himself; he was too busy. I needed to act now, and I needed to do what I knew this patient required. When I heard his approval in the background, I wasted no time implementing the stat orders that were not coming fast enough. I quickly got the ABG’s that would allow me to evaluate Mary’s oxygen level. While the portable x-ray was being taken, the ABG results were being processed. I inserted a catheter into her bladder in order to monitor her urine output from the diuretics. I requested all of these orders over the phone, because my gut was telling me, something was not right.

It didn’t take long to obtain the stat results for the requested test. The ABG results showed that Mary had an extremely low oxygen level. The chest x-ray showed pulmonary edema was causing the shortness of breath, the drop in oxygen, and her frequent moist cough. Her lungs were filling up with fluids, extra fluids that she had received during her procedure. Her heart was old and weak and the extra fluids she had received during her procedure were just enough to tip her into this fragile respiratory state.

I once again increased the oxygen level; this time I placed Mary on a mask that would provide one hundred percent oxygen. This was the most I could do on my own. I did, however, command the respiratory therapist to get the bi-pap ready so we could quickly secure to Mary’s face if she continued to deteriorate. Once again, I tried to interrupt Dr. Burns in his procedure. Minutes seemed to pass like hours while I waited for his response. Once I finally was allowed to talk to him, I reiterated all of the facts, Mary’s condition, and the results of the tests. This time he heard the distress in my voice. He was finally convinced that Mary was in trouble. This time, on the other end of the phone, I heard an almost frantic voice saying, “I’ll be right there.”

By the time he arrived in the ICU, I had the respiratory therapist nearby to assist with intubation. Mary had quickly moved beyond the bi-pap option and now was in need of imminent intubation. The tray was ready, the team was ready, and I was waiting impatiently for the overdue medical treatment. Mary had deteriorated significantly and it seemed like I was the only one who was helping her. She was going to need to have a breathing tube placed into her lungs. The support from a mechanical ventilator would help maintain life until we, her trusted medical team, could treat her through this episode of pulmonary edema.

Within minutes of arrival, the doctor had intubated Mary—she was breathing easier with the support of the ventilator. I was also breathing easier knowing that Mary was safe. After all the activities had settled, Dr. Burns asked me to again explain the sequence of events. After listening, this time attentively, to all of my assessments and all of my interventions, he apologized for not doing what he now knew was necessary before Mary deteriorated. He thanked me for taking control of the situation, doing what needed to be done, and rescuing both Mary and him."