END OF SHIFT


A race against time By Melanie M. Bartnick, BSN, RN, CCRN, PCRN


surgicalICU. Iwas assigned to one stable post-sur- gical patient and had one open bed for a future admission.The first fewhours ofmy12-hour shift went by calmly and uneventfully.However, close tomidnightmy second patient arrived. She was a pregnant, 28-year-old female with


A


preeclampsia and fetal demise at 33 weeks,who had arrived in the EDwith abdominal pain. In the ED, she suffered a grand mal seizure and became postictal with a systolic blood pressure rising above 200. The physician diagnosed fetal demise, and the patient was admitted to the L&D unit for immediate delivery.Unfortunately, the patient’s blood pressure remained elevated and because of her critical medical status, she was transferred directly to the TSICU. When the patient arrived on our unit, shewas inHELLP(hemo-


s I walked into the hospital one Saturday evening, little did I know what was in store for me. My shift started off like any other in the trauma/


through contractions, and although I was able to give her morphine for pain, it seemed to only take the edge off. I contacted the Red Cross in an attempt to reach her brother,whowas serving in the Army in Afghanistan. Within an hour after the vaginal exam, the patient


was experiencing intense pain with contractions 30 seconds apart. Her cervix was dilated and she was ready to push.My adrenaline was flowing and my heartwasracing.Thepatientpushedonlytwice before the babywasdelivered.The roombecame deafeningly


Melanie M. Bartnick, RN


silent. Even though we all knew better, we wanted to hear the sound of the baby’s first cry, which never


came.Theonly cries came fromthebaby’s grandmother. After assisting the physician in cleaning the baby, I glanced over to the charge nurse andmouthed that I had to step out of the room, just as tears came pouring out. I’ve beena nurse for five years.This was the first time I had ever cried


lysis, elevated liver enzymes, low platelet count) syndrome. Itwas a race against time to deliver the baby and save the mother’s life. The patient’s condition had deteriorated quickly with a platelet count of 46and shewas in hepatorenal failure.The patient was oriented and aware, and fortunately, she had support fromher family. I am a TSICU nurse, not a labor and delivery nurse. I have


never had children, nor have I been pregnant. But I had recently received muchworthwhile information frommy colleagues in the L&Dunit. And throughout the night, theL&Dnurses shared their knowledge and experience withme, and they certainly played an integral role in the patient’s outcome. At02:00hours, aphysicianinducedlabor.Because thepatienthad


extremely low platelet counts, she was not able to have a cesarean section or an epidural and had to deliver the baby vaginally.Once herwater broke, intense contractions began, andwhenthe physician examinedher, shewas3centimeters dilated and80%effaced. I felt a brief senseof relief,because I thought sheprobablywould notdeliver onmy shift. I stayed by her side holding her hand and coaching her


42 Visit us at NURSE.com • 2016


about a patient.By the timeIwas able to collectmy composure and reenter the room, it was close tothe changeof shift. I gave the patient a hug andmustered a fewwords of sympathy, all thewhile knowing I could never fix the pain shewas experiencing. The patient named her son Daniel and kept himat the bedside for 11 hours before she allowed him to be taken to themorgue. After she delivered, the patient’s body started to correct itself.Her


creatinine andAST/ALTreturned tobaseline andher platelets started to rise.Her life was saved. I returned to work that night and was grateful to be assigned to


care for her again. Her brother was at her bedside 48 hours later. Two days after the delivery, she was transferred to a regular unit and then went home. I received a beautiful card fromher that I still have. Shewrote: “I


justwantedto say thank youfor everything you’vedone. You’ve helped me through a very difficult time by goingwell beyond your duties. I know this is a small token ofmy appreciation, but it represents how lucky I amto have such a kind, caring nurse inmy time of need.” •


Melanie M. Bartnick, BSN, RN, CCRN, PCRN, is a staff nurse in the trauma/surgical ICU at Tampa (Fla.) General Hospital.


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