waking up after four months in ICU

I'm still pretty new to the MICU, and others tend to steal the sicker patients. They're the 1:1 assignments, which people prefer because even though they are busy, there is one to worry about instead of two. Many times when you have a "pair", as we call 1:2 assignments, you run your butt off in similar fashion to a floor nurse. They can still be quite critically ill. Oftentimes I don't care for a particular human until he or she is through the worst period of instability. Suddenly that same patient is always up for grabs.

Why is this? Well, I think it is because their needs often grow at this point. By this time, they have tracheostomies, long term feeding tubes and central venous access devices, and are so horribly deconditioned that they can't even begin to reposition themselves on their own. However, if they are lucky and their brain has not been significantly damaged by hypoxia (lack of oxygen to tissues), hypotension (low blood pressure resulting in insufficient delivery to the brain), bleeding within the brain, or drug effects, they are now awake and aware of themselves and their surroundings. If their lungs are functioning well enough, they may be off the ventilator and begin to use a speaking valve on their tracheostomy. At this point they can finally start asking the questions that have been brewing since we first began to lighten the sedation.

They have no idea what they look like, why they are so weak, why they can't speak (either at all, or in their normal fashion), how they are getting fed, and what all those weird bags and tubes are. Yesterday a woman pointed in the direction of her tracheostomy and said through her speaking valve, "What happened to my breathing?" This was a long answer.

For these patients, the needs that grow are often not meetable by working with equipment, medications, pharmacists, or physicians. They are needs that can only be addressed by spending time with the patient, looking him or her in the eye, listening, and telling the truth about what has happened and what may be to come. This is not an easy job and it can be exhausting, but it is essential to humane and complete care. Sometimes I wish critical care nurses (and critical care physicians) took it as seriously as they did the physiologically teetering patient. I hope I always do.