My day went to hell in a hand basket at about 3 pm today. In a total of 6 hours we got 3 calls for emergent pheresis (never mind that one of them didn't have access!). My attending and I got the 1st 2 taken care of, and then I went to round in the ICUs and write my CVVHDF notes (waaaay to many of them right now!). My attending and I were trying to get out so that we could go and pay a shiva call, but it was not to be. 4pm-a phonecall from an intern in the MICU. They have a 37 yo pt who they think has TTP. We all went over a lot of possibilities (DIC? Something to do with her scleroderma?) but the final decision was to do the pheresis. One of our 2nd year fellows came up to put the line in. He's really good, and he had a hell of a time-the 1st 2 clotted before he could even get the guide wire in. Finally it was in. The FFP was being defrosted, all 12 units of it (and let me just tell you, if you've never had to do it-blood banks are NOT happy when you ask them for that much FFP. However asking for 12 units is better than asking for 20!), the nurse was getting ready to go, and the patient was relatively stable. I started leaving, but I was caught by one of the nurses and asked to come look at a dialysis pt on CVVHDF who had just returned from having a pericardial window and was having SOB. Turned out in the OR he had had 1 unit of packed cells and 1 L of fluid. BP was 190/100. After turning up the UF, getting a nebulizer and some Morphine he was better. I spent some time with his wife-they;re both really nice people, and it really sucks b/c he has a crappy prognosis.
OK, so anyway, I left. At 7 pm. Drained. Went home, vegged, combed my daughter's hair, put her to bed. And vegged some more.
At 10 pm my beeper goes off.
The TTP pt had arrested 2/3 into the tx. Asystole. They got her back, but only for 20 minutes. And that was it.
And all I could think about was her father. When we were getting the consent he asked when the blood bank was open so that he could go donate. My attending said that it probably wouldn't be used for his daughter. His response? "Some one else gave the blood that they're going to give to my daughter. I can help some one else the same way." I felt very...humbled, I guess.
And now he's going to be planning a funeral. It. Just. Breaks. My. Heart.
Someday I'll write about other stuff-my family, the wreck that is my apartment as it's being painted and replastered, the fact that the green that I had chosen for the bedroom looks more blue, our trips, my experiences with postpartum depression. But right now all I can think about is that woman's father, asking where he could go to donate blood.
Location: NYC metropolitian area, New York, United States
38 years old, mother of a 7 year old daughter. Married for 16+ years to the guy that I started dating in high school. I've been working in health care since I was 14. Got my BSN 16 years ago and my NSN, FNP 10 years ago. Speciality-dialysis and pheresis. Pratice site-large teaching hospital.