I thought I would share with you some of the reflections I wrote during my time as a student nurse, at the time I really hated having to write reflections, however, I can now fully appreciate the value of written reflections. Being able to read them back, only shows me how far I have come and how much I have developed over time.
(I have changed the names, locations and dates in line with confidentially)
My first CPR experience as a student nurse
It was Friday **th April 20**, I remember it vividly as if it were five minutes ago, I had just started my first late shift in the department of critical care. This was my 4th day on the unit, and so far, my experience had been fantastic, I felt welcomed and supported by the hardworking and dedicated team there, and for the first time in my training I felt like a real student nurse, the staff in this department made a point of reassuring my position as a supernumerary was respected and that I would be there to learn.
I had just sat through handover, they were always so informative and interesting, with a combination of both good and bad news about patient’s outcomes. On this occasion, however, it was a particularly sad one. A young man had been brought in a few days previous, I will call him Sam for confidentiality reasons. His admission was due to an attempted suicide through hanging, Sam had argued with his mother earlier that day and then ran off and attempted to hang himself. His mother found him, attempted to cut him free and resuscitated him, he came to the hospital by ambulance and was brought to DCC to be managed on a ventilator. After a few days of various attempts to manage Sam’s airways and cardiovascular system, it was sadly recognised by the medical team that treatment for Sam was of no beneficial outcome and that he would need to be withdrawn from his treatment. This was absolutely devastating to hear on my handover, I could sense an ache of pain in the room, nurses that had worked for decades and heard this scenario more than once I’m sure, showed nothing but complete empathy and devastation at this news. Although I didn’t know Sam personally or even his family I had this deep sickening feeling inside like I wish I could do more to help save his life and save his family this tragic loss! Even though I knew that all options had already been exhausted by the team to try a preserve his life. Unfortunately, this is only how my shift had started that day, I then went on to work with the mentor and our allocated patient that day. It couldn’t have been long after receiving our bedside handover that I noticed a couple of beds down the curtains were drawn and a fair amount of staff were going back and forth with various pieces of equipment. I asked the nurse in charge if I could go and have a look at a procedure they might be doing behind the curtains, she, of course, encouraged me to go and see what was happening as you should grab every learning opportunity as a student nurse.
The man behind the curtain, I will call Jerry, was a 46-year-old man who had initially come in having had a MI in the A&E car park, following this he had a PCI, angiogram and stent fitted. His past medical history was normally fit and well and he was an active man with a very stressful high-end job. I had been allocated him on my 2nd day, at that time he was intubated and was awaiting a tracheostomy. During that shift I got to speak to his family, his wife talked to me about how they met and how many years they had been married, the many adventures they had been on and had planned, he had young children some currently undertaking exams, she told me how worried he had been for his children wishes them nothing but great success of course! It was lovely to hear their story, I felt like I had known them for a long time. A few days had passed and now Terry had his tracheostomy and was sat up smiling and waving. I was happy to see him awake for the first time on this shift, anyway Terry was the patient behind those curtains that day. When I went in behind the curtains there were quite a few members of staff who all said they were happy for me to stay a watch the procedure. It had been handed over that Terry’s Trachy was bleeding earlier that morning but it had been resolved, though they were not sure of the cause. When I came in Terry had already been sedated as he had begun to bleed again and this obviously was very distressing for him and the doctors wanted to try a bronchoscopy, to investigate the trachea and surrounding areas to try and source what the problem was, by now there were a fair amount of staff about including doctors, consultants, nurses, a sister, anaesthetist and the surgical ENT specialist. They were all debating about what the cause of this bleeding could be when they noticed a small lump in the trachea, while all of this was going on the patient was being bagged as so the scope could go down the tracheostomy. Everything was calm and everyone was working hard to try a solve this problem, Terry had blood running out of his nose and mouth by this stage as well, then it became apparent that his SP02 was gradually deteriorating and there were even some manual manoeuvres to attempted to support his breathing by pushing down and applying appropriate pressure on to his chest while bagging him, this was the first time I had seen this done and though it appeared to work at first, he was then continuing to deteriorate. Then suddenly that was it, there was a call out to start CPR, his pulse had completely gone! I stood right back as to not be in the way. For some reason in my mind at the time this was just a minor disruption, I thought it would all come back around quite quickly, after all you’re in complete control of the situation in ICU, aren’t you? I was so terribly wrong to make this assumption, maybe I was just being overly hopeful, no one ever has complete control of a human’s unpredictable body. The team continued to give CPR and adrenaline, it all happened so fast. The sister came toward me gave me some saline and needles and said draw these up, at first I panicked! This simple task seemed so huge at the time! I didn’t want to do it wrong, I didn’t want to be the reason things went wrong! I quickly pulled myself together and got on with what I need to do! Things changed then, even though it was a minor involvement, I could recognise the importance of every single person in that small bed space, we all had vital roles to play to collectively deliver the necessary care. The consultant took the lead at the bed end giving people tasks, jobs and instructions. I quickly grabbed some PPE and decided I need to be there for the staff and more importantly I need to be there for Terry. At 8 minutes the doctor stated, we have not had a shockable rhythm yet? Should we continue? Without hesitation staff commented back ‘he is a young man and we need to try our very best’. The consultant went to call for help to see if they would take Terry to Cath Lab for an emergency operation. The rotation of people doing CPR was very well managed never allowing a moment of bad compression through tiredness, they asked for someone to take over, so I stepped forward and said I was ready, I knew that I had a part to play and that I wanted to help. CPR was 10 minutes at this stage I started off too fast, I heard a calming voice say to me ‘Just slow that down a little bit’ so I did, ‘that’s excellent you are doing great, keep that up’. This moment is the bit I keep replaying repeatedly in my head, it was probably only a minute or even less, but it felt like 10 minutes. Every single push down on to the chest I could feel as if it were in slow motion, I could see in the corner of my eye Terry’s face covered in blood, so much blood. His eye opens and staring at me with nothing in them, a real emptiness, it was truly upsetting to see. This sight took me back a bit and I don’t know if I physically was slowing down or if it just felt like I was, I couldn’t tell at the time, I was worried I was losing my CPR rhythm so I started singing the suggested CPR rhythm from the Bee Gee’s song ‘staying alive’ that id seen on TV, it is truly strange what thoughts come into your head in times of panic, when your filled with adrenaline, it felt surreal to think of this at the time but it was working! I thought briefly how ashamed I should feel for singing this song while a fellow humans life was in my hands, but on reflection, it’s what kept me going. I remember everything, tiny details, it feels like all your senses go into overdrive, noise-wise everything became fuzzy by this point I could only hear muffles, I heard them saying ‘Cath lab was not an option and should we end CPR’, I felt like I wouldn’t be able to stop even if I had too, then they called it. 12 minutes. Terry was pronounced dead.
I felt so sick, I could stop my hands from shaking, there was a sudden overwhelming moment where I would not let myself shed that one tear because I knew if I did I would probably break down. I could not help but think of how I had seen him only a few hours before smiling with his family and this feeling of knowing the agonising pain they were about to go through by losing their dad, husband or friend would be heart-breaking. I’ve spent the last 4 days grieving for a man I barely know, I don’t know if it was because I had insight into his story and his life, but it affected me in ways I can’t even describe. I’ve struggled with this over the last few days and therefore I have decided to write this reflection to help me come to terms with what has happened. The staff were more than excellent, they did everything they could, there was not a dry eye in the department after this loss of life, it was so refreshing to see that no matter how long or what these medical professionals had seen in their years of practice, every patient still mattered and every patient’s death hurt. We had a debrief which helped to put all the pieces together. I am sad that I had to witness such a tragic death, yet I am thankful that I got to give support, care and comfort to Terry and his family during his time as a patient and that I was privileged enough to have been able to try and save his life.