The man that exploded!

So there is so much for me to catch up on blogging about, but I figure I need to write about my experience last weekend at work before I forget all the details.

So on Saturday I had to work which means I was 37.5 weeks along in my pregnancy. I was having a steady morning with a discharge order for one of patient right at the start of the shift. I usually am pretty fast about getting all the paperwork done and really did jump on it fast and let my patient know when a good time a right could come pick her up. I though everything was under control and so I sent the other nurse in the unit I work in to eat some breakfast since one of her patients was just taken to surgery. So I'd really not have many patients I needed to watch (3). Well that what I thought.

So shortly after I sent Cindy to eat breakfast, my other patient(who had his bladder removed due to bladder cancer and had a illeostomy) called complaining of not feeling well. (He was trying solid food for the first time that morning since surgery) So I thought, we just pushed this a little fast, it was scrambled eggs though. So usually a nice soft food to start out with is great, but I pulled back his table and saw some drainage on his gown. So I thought I better investigate....So I pulled back his gown to see a full JP (Jackson Pratt) drain. (Basically it's a depressed bulb hooked to a tube inside his stomach area to drain out blood and other stuff out of the surgery area). So I went and got the container to empty the drain and when I popped open the little tab to empty it..It started spouting out!! I was so surprised. I hadn't had that happen in all my years of nursing. I even told him, "I haven't had that happen to me in the 8.5 years I've been a nurse." I also noticed that his other dressings had more drainage on them than they had earlier. I figured I better go double check what I had for an order to either change the dressing or reinforce them. My patient then started telling me that his abdomen really was hurting!!! I could tell because he was getting up pacing the room because it hurt more to sit or lay down!! He has a history of asthma and had been having quite a strong cough, which is a good thing to do after surgery to move air throughout the lungs and avoid getting pneumonia, but I kept telling him it wouldn't hurt as bad if he'd take a pillow and squeeze it against his stomach as he coughed. Well I hadn't had very good luck getting him to do that all morning.

Well off I went to find this man some pain med... I knew he was horribly uncomfortable. So I got the rest of his morning meds with them, cause he was running a high blood pressure and should probably get his blood pressure meds, right. Well after giving him the Demerol he stood back up and was starting to pace a little as I was preparing and scanning the rest of his meds, when he told me he was going to be sick. (BTW, I never like any patient telling me that) So I jumped to the closet where we have basins and dumped whatever the rest of the contents were out and rushed to get this basin to him. As he turned around on the other side of the bed to grab the basin, I heard this POP POP SquiSH!! and simultaneously saw his gown ballooned up to rival the pregnant woman that I've become!!

At that point I realized a few things: 1. I had a pretty good idea what had just happened. 2. I didn't have anyone in the unit that I could yell for. 3. I hadn't put on my Vocera badge that I usual put on every morning that makes me connected to the rest of the employees in the hospital. 4. I had to get some help some how and take care of my patient!!

So I had the patient lay down on the bed, cause he was still talking and being coherent!! And I used his phone to call the Clinical Coordinator (House Supervisor). So she got there shortly after I pulled back my patients gown and saw intestines peeking out from under the dressing that used to be taped on all 4 sides!! Wow I really hadn't seen that one coming from the my first clues, and I sure didn't think that anything that drastic would happen before I could get his pain under control and take a look at the dressing myself.

I'm just amazed at the team work that comes from working in this little hospital as I had the hospitalist at the bedside and he never left, and two nurses(Cindy and Nikki) assisting me at the bedside while the Clinical Coordinator (Sandy M) contacted the surgeon on call and a 2nd OR crew to come do surgery. It ran very smoothly and patient did well and maintained that high blood pressure clear through. (I never thought I'd be so happy to see someone hypertensive.) Within about 40 minutes we had him intubated and sedated/paralyzed, while the surgeon came and placed his intestines back in in abdominal cavity for transport to the OR, where he under went a major antibiotic washing and they remade his illeal conduit too (the first one was looking a little dusky in color). I was amazed though to see the intestines and how they were filled with air and fluid and that I could see some of the fluid in the intestine as the surgeon placed them back in the abdomen. (Sorry if that grosses anyone out.)

Later I asked the hospitalist and the surgeon how many times they had seen this happen and each of them had said about 3-5 times in their careers. One is a retired gentleman that just does on call surgeries for us and was in the army (I think). The hospitalist had seen most of his in his residency.

So far the outcome is good and my friend is on the recovery. He was extubated on Monday and he took a few steps at the bedside yesterday!! We've come to be good friends and he told me that I needed to be his nurse everyday. "If I've got to be in here, so do you!" he says. Well he gave him self the name of the exploding man (and okayed me writing this blog) as I talked to him about the thoughts that he had as this happened to him. I felt bad, cause I can imagine that would be the worst nightmare to have to live through and then have to live through the increased pain that comes with another major surgery in such a short time frame.

Recently I've had some really sick patients come my way and people have started labeling me as a problem child or a poop magnet. But I'm so excited that with the last 3 ventilated patients that I've helped take care of...they all got better. Well the other 2 have gone home and this one is on the mend.

This was definitely not what I expected to have happen to me coming to work on Saturday, but what an interesting experience I won't be forgetting anytime soon!!! I hope I didn't gross anyone out. I just wanted to keep some of the details for my memory sake, cause hopefully I don't have to see that again.