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End of Shift: A race against time

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.

Melanie Bartnick, RN

Melanie Bartnick, RN

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.

By | 2015-11-10T15:27:20-05:00 November 10th, 2015|Categories: Nurses stories|3 Comments

About the Author:

Sallie Jimenez
Sallie Jimenez is content manager for healthcare for Nurse.com published by Relias. She develops and edits content for the Nurse.com blog, which covers industry news and trends in the nursing profession and healthcare. She also develops content for the Nurse.com Digital Editions. She has more than 24 years of healthcare journalism, content marketing and editing experience.

3 Comments

  1. Avatar
    Dena Williams Wright November 14, 2015 at 2:35 am - Reply

    Having been Blessed to be a L&D Nurse, I too was in on delivery with a Mom carrying her first baby. She presented to Labor and Delivery after her ObGyn sent her in for monitoring. Unfortunately at 39 weeks her beautiful baby boy was delivered still born. She was blaming herself, crying, her husband was by her side the whole time. I never left her room. When the Doctor told her the worst news possible, we all cried. I had no words to comfort her, so I just held her hand and cried with her and her husband. We sit there for what seemed to be hours. They held their beautiful little Angel and talked to him. Telling him their dreams for him. When they were ready, I cradled him in my arms down to the morgue. There I kissed him Goodbye and told him he had the greatest parents in the world. I asked him to be sure to watch over them, and gave him to the attendant. I have never forgotten that day, and I pray I never will. And there are people out there who say, ” Oh, your just a Nurse “. I disagree. God Bless You.

    • Avatar
      Melanie Bartnick November 19, 2015 at 11:26 pm - Reply

      Thank you so much for sharing your heartfelt story! I am always in awe to see how much support nurses have for eachother and we are truely a special profession! No instructor or textbook will ever teach us the compassion we share for others….. nurses have a special gift. I am so happy nurse.com gave me the opportunity to share my story and read countless other heartwarming stories. You response to my article meant a lot, thank you!

      • Avatar
        Christy March 23, 2016 at 8:57 pm - Reply

        Hey, Mel. I’m not sure if you remember me, but we cheer-leaded together in college. I know this is random and has nothing to do with the amazing article you wrote, but i really wanted to reach out to you and see how you were after all this time! If you are interested, please email me at the address above. If you’d rather not, I completely understand and please disregard this message.

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