– The average age of the nurses in my block is 50. The oldest of us comes to save us in crisis situations. She is 70 years old. If seven of us did not come to the head on a day like this, when we have helicopters landing, accidents, ruptured aortic aneurysms, bleeding into our heads, it would mean the death of patients – says one of the nurses, who told MedTvoiLokony about their daily work hour after hour.
- Time: 9.56. A man my dad’s age on the floor. Someone is doing heart massage, someone is venting. He was going to the bathroom, he fell. I kneel on the floor. I give the anesthesiologist a laryngoscope, a tube. He cannot intubate, it is difficult to see. I compress the cricoid cartilage (next to the so-called Adam’s apple in red men), it prevents vomiting and facilitates ventilation.
- Time: 5.07. “It’s an iodine cut,” someone yells. “For iodine”, that is, cesarean for cito. Danger to life. There is no time to thoroughly wash your belly. A bottle of iodine is poured over it and cut.
- 21.07/XNUMX – There it is! – I open and close an endless number of cabinets, but I might as well look for water in the desert. Each door leads to some sort of drug and equipment storeroom. I open another locker and the alarm goes off
Ania, 8 years in the profession, works in the anesthesiology ward of a hospital in a town near Warsaw, author of the website www.matkawpigulce.pl A patient enters trepanation. The operating room looks like the great lecture hall from my university days, but there are cupboards and shelves instead of seats. Incredible.
(In the photo from the left: Justyna Pecherska, Monika Drobińska, Magda Kotala)
5.07, before dawn.
“Give me propofol quickly,” says the anesthesiologist. – Quick.
I reach for a well-known place on the column.
– There isn’t! – my heart freezes.
– How is it not?
– There isn’t! – I open and close an endless number of cupboards in the auditorium, but I might as well look for water in the desert. Each door that exits the auditorium leads to some sort of storehouse of medicines and equipment. I open another locker and the alarm goes off.
Frighteningly loud pi pi piiiii!
– What I’ve done?! – I say.
– Nothing, you’re awake – I hear from my husband who is sleeping next to him. – Just don’t snooze anymore, or you’ll sleep for work.
5.30 am
Gets up. I hate those dreams where I have to do something but can’t. The ones I fail, especially the ones where I make a mistake. I used to wonder where they come from. Maybe because working in anesthesia is like walking on thin ice? It can be deadly boring or deadly. It happens that during 12 hours of on-call time, we go to one extreme in one extreme.
5.52 am
I put coffee with milk on the bathtub. I’m starting to get overwhelmed. Light makeup, brushing my teeth, pulling my hair back into a ponytail. I don’t have time to sit down in the morning and enjoy my coffee. I choose an extra quarter of an hour to sleep, and the train won’t wait either.
– Mom, will we play when you get back? My daughter asks. – Will I come back from kindergarten with my grandmother?
– Honey, I’m going to work today. We’ll play tomorrow, I promise.
– So we won’t play? How will you come back?
– I’ll be back at 21.00:XNUMX PM. You will be asleep already.
– And if I don’t sleep? Mom, I’ll be waiting for you.
7.05 am
The way to the train is as long as it is always, but I am already used to this walking. I just have to be careful, because lately I almost got under the car at the traffic lights, when I was returning after the shift in the evening. Out of the corner of my eye I noticed that a green light was flashing at the crossing, so I stepped out onto the road. It was like that, but it was green for cars.
7.54 am
I am already at work. I change a friend who can barely see her eyes. I check the report.
– I see you’ve had a rough night.
I am taking over her “toys”. This is what I call everything that we emergency nurses always carry in our pockets: ampoules of drugs for quick induction of anesthesia and an access card to the cesarean section.
8.00 am
Routine: I check the oxygen cylinder in our transport cart. There must be enough of it to transport the patient who is connected to the ventilator, if necessary.
I am doing a defibrillator test to see if it is doing well and that it will work properly if I need to use it.
And the birthing route. We do not have a separate anesthetic team that would deal with anesthesia of women for caesarean sections and natural births. Our team is an anesthesiologist and me. It is very often a four-handed job. I check the cutting room. We go to anesthetize the planned and the quick ones.
I test the anesthesia machine – everything works.
I check the equipment, and above all the laryngoscope, whether it is lit.
I don’t even want to think what would happen if I pulled him out after administering our drugs and he wouldn’t work. General anesthesia is a point where anything can happen. It is important that we have everything at our fingertips, ready for use, because when a person after administering our drugs lies flaccid and does not breathe, there is no time to think.
I check to see if I have all my medications in the drawer. And the spinal anesthesia kit, the one in the spine that everyone is afraid of.
I fold the wrapping of disposable appliances to open them faster, if necessary. I break the foil in the box with Atropine. Like most nurses, I have very short nails. There are times when every 3 seconds is worth its weight in gold. I don’t want to fight the packaging then.
8.25 am
Phew, everything has been checked on the site. I am going back to my ward, i.e. ICU. There I will check if the equipment in the magazine is connected to electricity and is charging.
8.40 am
The anesthesiologist is called by phone. I can hear from the corridor. He comes out and says we’re about to go to a caesarean section. I grab a few sips of water and we go. Fortunately, this is a planned cut. We walk calmly, change our clothes and take the patient. The anesthesiologist conducts an interview, while I measure the pressure and plug in our cables. I am also preparing oxytocin, which I will give after cutting the umbilical cord, and I put an ampoule of the drug on the table, which we give at a high pressure drop. I prefer to have it on top for immediate serving. The patient signs the consent, we sit her down. I open the equipment sterile and hand it to the anesthesiologist who will stab the patient in a moment. Scheduled incision, there are no contraindications, so the anesthesia will be subarachnoid.
Our mother is very nervous. This is the first child and the first operation in her life. We try to calm her down and lift her spirits. After the injection, I measure the pressure immediately and set the measurement to automatic so that it is measured every 3 minutes.
9.00 am
Drip to the max. We stand at our head, we try to ask the mother.
9.05 am
Gynecologists take out the baby. This moment of taking the baby out is very unpleasant. While there is no pain, there is tugging and creasing.
9.07 am
– Is! Little Pola opens her astonished eyes and tries to look around the room. He cries a little and then tries to lie down in the air, still in the hands of the gynecologist, to sleep, placing the hands under his head.
I wish my mom could see it, so I try to tell her, but after two seconds she can give her daughter a kiss.
I am getting emotional. The same every time. Congratulations to mom. It’s so beautiful to witness the birth of a new life.
Mom’s vital signs have stabilized. It will be quiet now.
9.08 am
I can take photos of the gloves. Get down to the anesthesiology nurse’s documentation. After the operation, we say goodbye to the patient who thanks everyone. Now I will just clean and disinfect the anesthesia workstation and wait for the next call.
9.49 am
The gynecologists have finished sewing. They say we still have two planned cuts. One, because the child placed transversely, and the other as “post-sectional state” (if a woman has had one cesarean section, she has the right to choose whether she wants to give birth by force of nature or surgery).
9.50 am
I haven’t had half my sandwich yet and another phone rings. This time on the desk where I was typing in the report that I was on the cut. Interna, resuscitation. I pass it to the anesthesiologist, we take our big orange suitcase and go up the stairs. Fortunately, only one floor above. If you counted how many kilometers we cover each day with hospital corridors and stairs, there would probably be a few. If we go to do something planned, we take the elevator, and when we have to hurry, we choose the stairs, because what are the hospital elevators, everyone knows.
9.53 am
On the spot, we see a community of doctors and nurses. Everyone is trying to do something. One person performs heart massage, the other ventilates, and the third prepares something. There’s a guy my dad’s age on the floor. He was going to the bathroom, there was a cardiac arrest, he fell. We kneel on the floor. I give the anesthesiologist a laryngoscope, a tube. He cannot intubate because there is little visibility inside. I do Sellick’s maneuver – I press the patient’s Adam’s apple, it facilitates ventilation. I give the guide.
9.56 am
Goes. I seal the tube. While the anesthetist ventilates the patient, I fix the tube to keep it from coming out. I look at the man’s face slowly turning into color. We check the record – there is a sinus rhythm, heart rate. It’s good. This time it worked. After connecting to a ventilator, we transport the patient to the ICU. Fortunately, there were places. If he wasn’t there, he would have to stay on Interna until someone from the Intensive Care Unit is transferred to another unit or dies.
10.40 am
We manage to rest for 20 minutes.
11.10 am
I’m finishing my breakfast. We still have two cesarean sections and short intravenous anesthesia for gynecology for curettage of the uterine cavity. About 4 hours of intensive work.
11.12 am
We go back to the cutting room track and we have a repeat of what was done in the morning.
Time 12
Piotruś is born, he screams out loud. There must be a 30-minute break between cuts so that the cleaning ladies can clean and sanitize the room. At this time, taking advantage of the break, we go to the gynecology, make a short intravenous. We have five today. It is not so much, but also not little. We’ll do two of them and then come back to the next cut and then go over to the other 3.
13.15 am
In the treatment room, let’s joke a bit to lighten the busy morning. Besides, we spend a lot of time at work. Sometimes you just have to talk about something else. Even though we face illness and suffering every day, in all of this we need to create an appearance of normality. The first patient will have a curettage because she has had a miscarriage. She came in just as we were laughing at some new hospital joke. I feel guilty.
13.17 am
I plug in the cables, check the puncture, the anesthesiologist puts on an oxygen mask and tells me what dose of medication to give. Without further ado, I am giving you one by one, because I can see that the patient is teleplaying with nervousness, I do not want to prolong it. She is about to fall asleep and wake up in a few minutes when it is all over.
13.48 am
We numb one more procedure and return to the cutting room again. – You must like us very much! – the midwife laughs. – I’m going to get a patient ready. He says and walks towards the prep room.
Yes, this room is indeed a favorite because good things usually happen there. Although anaesthesiologists do not always like her, because one patient, a woman in labor, can suddenly turn into two, when it turns out that there is something wrong with the baby.
And we all like before – we change again.
14.57 am
Little Adaś has already gone to the ward. 20 minutes later his mother did too. We go back to gynecology and finish our short treatments. We surrendered the last patient.
15.00 am
– I wonder how they are doing in the block? – the anesthesiologist wonders.
Planned orthopedic, surgical and gynecological surgeries take place in the block. When it comes to anesthetics nurses, there are so-called girls who work there. rankings that come daily from 8.00am to 15.30pm. If a planned procedure is prolonged or if something suddenly pops up after 15.30, we take over. Well, unless it’s like today, when we leave gynecology and suddenly someone catches us and says:
– Look, the cut is quick, the umbilical cord fell out. It is 15.05. This is an iodine cut, so we talk about cuts that have very little time, because it is life-threatening. “For iodine”, because there is no time to thoroughly wash the pregnant belly, it is only doused with iodine. It’s something I hate. This slogan means that wherever I am and whatever I do, I have to leave it and run. We run into the cutting room, we only manage to put on masks and caps.
15.06 am
The anaesthesiologist turns on the monitor, and I scoop propofol and scoline. We take the patient to the table, everyone is running, packages fall to the ground. Nobody cares about it. The patient cooperates moderately, because it hurts her a lot. She was giving birth naturally, was nearing its end, and that unfortunate umbilical cord fell out. My speech is perfunctory and a little imperative. I don’t have time for pleasantries. My blouse sticks to my back. I try fast but everything goes like slow motion. I put a pulse oximeter on her finger, the anesthesiologist is already holding the mask over her face. Gynecologists are already preparing the operating field, green drapes are flying. The patient is still awake. I give propofol, skoline. Time: 15.07
He falls asleep. I did not manage to do the drip, now it has to wait, because I am giving the tube and the laryngoscope. The anesthetist intubates.
15.08 am
As I fasten the tube I can hear the baby crying, but I don’t have time to look at it. Now I can load up and give the rest of the medications my doctor ordered. Several dozen seconds during which you have to throw everything out of your head and focus on the action as much as possible. This is the iodine cut, to save a life.
15.25 am
I call my friend upstairs and say – sorry, we are on an urgent cut, I cannot change you.
Unfortunately, the nurse who works in the mornings has to stay overtime. Neither I can leave the patient during the operation, nor can she go home, leaving the patient in the operating room. Nobody will pay her for it, she will stay half an hour longer. These are the realities. He’s not gonna leave work. Anesthesiology is like that. Anesthesiology doesn’t care that you have to pick up your child from kindergarten, that you’ve made an appointment with the hairdresser, that someone is waiting for you, that the show is about to begin in the nursery you were supposed to be at. You can’t leave the patient. You can’t jump out of work for a while when school calls that your child has a fever. You can’t, because someone would have to come and replace you, and usually there’s no one.
16 pm, with minutes.
We end the scheduled surgery, which started at 14.40pm – it was predictable that it wouldn’t end at 15.30pm.
I have 4 hours of work left until 20.00. I miss fresh air. My head is splitting. A bit more.
17.30 am
I’m calling home because my daughter has just returned from kindergarten with her grandmother. He’s giving me a report.
– Mom, do you know that grandma cut her finger? And I brought her a plaster! – I acted like a real nurse, didn’t I, mommy? Waiting expectantly for my reply.
I laugh into the phone and promise to read her book when I get back if she’s awake. And I also listen to pre-school gossip.
We give the nurses from the ward a reasonably well-awake patient. An orthopedic surgeon calls and says he wants to do more gamma.
Such a time of the year. People fall, they break. Older people the most. These are large procedures with a high risk of blood loss. They make an appointment with the anesthesiologist at 19.00 p.m.
I have some time, just for the dinner I took from home. 19.00
A patient is coming. Very sore. We console her that just a moment longer and she will not feel any pain anymore.
20.00 am
I see a friend behind the glass pane, who changes me, puts on a bonnet and a mask, so I leave.
I like that moment when I close the last door of the hospital. I don’t mind that the air is cold. I put my headphones on, turn on my favorite songs and put my cold hands in my pockets. The way to the train is long. The ride itself is short.
21.00, actually just before.
I’m home already. My daughter is already sleeping with her favorite rabbit, which I once crocheted her for her birthday. I don’t want to wake her up, so they tiptoe out of the room. Tomorrow I have a free. I’ll pick her up from kindergarten. I don’t feel like sleeping at all. Besides, I tend to make up the coffee deficit throughout the day in the evenings, and then sit until 2 am, read, write, crochet. Sometimes I learn, because we medics must always be up to date.
Monika Drobińska, an anesthesiology nurse with almost 30 years of experience. He works in an operating theater in a large clinical hospital – 20 operating rooms in the central block, ten anesthesia stations outside the block.
7.30 am
I’m starting the day. On the way to the duty room, where I can leave my purse, I enter the wake-up room, where in special compartments there are patient premedication cards for today, from all clinics and lists. I check where I work today.
I have orthopedics. I take out premedication cards and check. Three treatments:
1. Arthroscopy of the knee
2. Shoulder fracture
3. Hip joint prosthesis. Surprise. Children’s survey. Fortunately, a fourteen-year-old. A big man, not a child.
I check the treatment plan posted on the blackboard in front of the operating room door to see if it matches my cards. I check the female instrumentalists and make sure there are no changes. They assure me that there will be a hip prosthesis first and I rush to leave my purse in the duty room.
7.35 am
I run into the operating room, fire up the anesthesia machine, assemble it earlier, and run the test. Fortunately, it goes without a problem. I dissolve drugs for general anesthesia: propofol, rocuronium, atropine.
I’m preparing a drip. I lay endotracheal tubes, a laryngoscope, guides, oropharyngeal tubes, plasters, pens and everything else on the table.
7.45 am
I’m on the airlock. On the way, I still cover the operating table.
7.50 am
I have a fourteen-year-old brought in by orthopedic nurses.
She asks him whether he has eaten anything, about allergies and diseases. I try to do everything to reduce fear. I introduce myself. I ask if I can call him by name. I am also checking the documents – consent to the procedure, consent to possible blood transfusion, test results.
The boy goes to the operating table and takes him to the room. If I’m lucky, someone will help me, when a heavy table with a 50-kg person left me, I push myself …
8.00 am
There is movement in the hall.
I monitor, EKG, pressure, pulse oximeter. I put on a cannula, connect a drip. An anesthesiologist comes.
8.15 am
There are already operators. One more moment of talking to the patient, everyone tries to say a few nice words, the operators go to “wash” and we start to anesthetize. Everything by standards.
All the time remembering to create as much a sense of security for the patient as possible.
8.30 am
The patient is asleep, the anesthesia machine breathes for him
I administer an antibiotic, prepare medications that I will need during anesthesia, and clean the table after intubation.
8.45 am
The operation begins. It takes over two hours. I am in the room all the time. I monitor all my life activities. I monitor the amount of blood in a mammal, it reacts to every accelerated heart rate, to an increase or decrease in pressure. Wherever there is pharmacology.
9.25 am
The procedure is still ongoing, but I have a moment to check the premedication card for the next patient. I already know that he has diabetes, I have to measure his sugar level before the procedure, and I am preparing everything for anesthesia .. He will be a subarachnoid. I’m preparing a set: lignocaine, syringes, needles, a cannula, a drip.
10.57 am
The operators complete the operation. We stay in the room, wake the patient up.
11.20 am
The patient, who is conscious and equipped against pain, is transported to the wake-up rooms.
Here I monitor again, at the same time handing over the sick to the team from the wake-up room, earlier we put the young man to bed together. I’m going back to the room.
11.30 am
I disinfect cables, table and all equipment.
11.30 am
I am picking up the next sick person from the nurses from the airlock.
11.45 am
We anesthetize
12.00 am
The procedure begins and, as before, during its duration, I prepare everything for the last operation.
12.50 am
The operators are done, our patient is conscious, anesthetized from the waist down, so we take him straight to the wake-up room, come back, sanitize everything again.
13.15 am
Third patient on the mucus. I ask questions, check documents. There is no EKG here. The nurses promise to send a tube to the block.
General anesthesia again.
13.40 am
Anesthetized patient, sitting on the table, after difficult intubation, I additionally cover all tube connections with a plaster, and protect the eyes.
Almost hours 15, I should leave soon. Unfortunately, the treatments take longer and I know that I will stay for a few minutes.
14.45 am
The operators finish the difficult procedure, we wake up.
Godz. 15.00
We enter the wake-up room.
15.11
I go back to the room and clean. I take the tubes off the apparatus, replace the lime. I complete the table. Everything must be ready in case there is an urgent procedure in the afternoon or overnight. I just run to the warehouse. I report the missing equipment, I write a report on three treatments. The average age of the nurses in my block is 50. The oldest of us comes to save us in crisis situations. She is 70 years old. Today was a quiet day. If seven of us hadn’t come along, with helicopters landing, accidents, ruptured aortic aneurysms bleeding into our heads, it would have been the death of our patients.
15.20 am
I’m taking my bag from the duty room. On the way to the changing room, I throw the empty XNUMX-liter water bottle that I kept in the vestibule of the operating room into the bucket. I’m coming back home. I’ll be back tomorrow.