By Melanie M. Bartnick, BSN, RN, CCRN, PCRN
As 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/surgical ICU. I was assigned to one stable post-surgical patient and had one open bed for a future admission. The first few hours of my 12-hour shift went by calmly and uneventfully. However, close to midnight my second patient arrived.
She was a pregnant, 28-year-old female with preeclampsia and fetal demise at 33 weeks, who had arrived in the ED with 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, she was in HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. It was 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 46 and she was in hepatorenal failure. The patient was oriented and aware, and fortunately, she had support from her 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 much worthwhile information from my colleagues in the L&D unit. And throughout the night, the L&D nurses shared their knowledge and experience with me, and they certainly played an integral role in the patient’s outcome.
At 02:00 hours, a physician induced labor. Because the patient had extremely low platelet counts, she was not able to have a cesarean section or an epidural and had to deliver the baby vaginally. Once her water broke, intense contractions began, and when the physician examined her, she was 3 centimeters dilated and 80% effaced. I felt a brief sense of relief, because I thought she probably would not deliver on my shift. I stayed by her side holding her hand and coaching her 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, who was 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 heart was racing. The patient pushed only twice before the baby was delivered. The room became deafeningly silent. Even though we all knew better, we wanted to hear the sound of the baby’s first cry, which never came. The only cries came from the baby’s grandmother.
After assisting the physician in cleaning the baby, I glanced over to the charge nurse and mouthed that I had to step out of the room, just as tears came pouring out. I’ve been a nurse for five years. This was the first time I had ever cried about a patient. By the time I was able to collect my composure and reenter the room, it was close to the change of shift. I gave the patient a hug and mustered a few words of sympathy, all the while knowing I could never fix the pain she was experiencing. The patient named her son Daniel and kept him at the bedside for 11 hours before she allowed him to be taken to the morgue.
After she delivered, the patient’s body started to correct itself. Her creatinine and AST/ALT returned to baseline and her 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 from her that I still have. She wrote: “I just wanted to say thank you for everything you’ve done. You’ve helped me through a very difficult time by going well beyond your duties. I know this is a small token of my appreciation, but it represents how lucky I am to have such a kind, caring nurse in my time of need.”
Melanie M. Bartnick, BSN, RN, CCRN, PCRN, is a staff nurse in the trauma/surgical ICU at Tampa (Fla.) General Hospital.