Chapstick
In the early hours of an afternoon in September, I received a patient in my recovery bay: seventy-something Shirley, waking up from spinal surgery. The bed was brought into the bay by a nurse anesthetist, awkward as she juggled both paper chart and bedframe. An operating room nurse pushed in tandem.
Shirley had well-coiffed, slightly matted, grey-blonde hair. Tissue paper wrinkles spread across her face. Black mascara was smudged along her heavy closed lids, and the charcoal remnants of liner had settled into deep rivulets on the edge of each eye. Her thin, raspberry-tinged lips lay agape. Gentle rolling hills of female abdomen swelled beneath the cream blanket, and short, wide legs with cherry-red toenails splayed out on the gurney beyond. Shirley moaned, delirious still.
I repeated my usual reassurances as I placed her on my monitors: You’re in recovery, Shirley. Surgery is over. Everything is just fine. I’m your recovery nurse. Repetition is key here, short-term memory blunted. You are just fine. Surgery is over.
The operating room nurse spoke, describing an unremarkable surgery.
We rolled Shirley to one side and together ran our eyes the length of her pink-tinged, fresh-cut incision. I scanned Shirley’s back as an editor perusing a page—flagging irregularities, mentally cataloguing notes.
Shirley’s nurse anesthetist talked about the medications she had given for sedation, and then Shirley gave a loud, low growl of discomfort and a grimace. The anesthetist interrupted herself: I’ve got some more fentanyl here… She paused to consult my expression. Shirley was my charge now; transfer of care passed the moment she was in my space. I gave an approving nod.
As she continued with her report the anesthetist pushed the syringe of pain medication into Shirley’s venous line. The three of us held worship around the alter of Shirley, discussing, commenting and scanning, as the narcotics swooshed unceremoniously into her bloodstream. Heart. Lung. Brain. And then, as we stood there by her bedside—without fanfare or alarm—a fragile, invisible dam inside Shirley broke, and the drug sent Shirley across an ominous threshold. She stopped breathing.
We were, for the millisecond, unaware. And then Shirley went ashen the way only complete cessation of breath can procure.
Realization hit us before her monitors sounded. We dropped the bed flat and I pushed the code button on the back wall. Alarms went off all around us as I shook Shirley, hollered her name, and rubbed hard on her breast bone. No response. The anesthetist swore as she struggled to pull the large plastic breathing bag from the wall. My monitor bleeped expletives in chorus, as Shirley’s oxygen levels plummeted.
She freed the stubborn bag and cupped the mask over Shirley’s opened mouth, forcing intermittent breaths with the plastic barrel. I watched her chest rise, and pulled up on the sides of Shirley’s jaw until I was sure we had airflow to her lungs. We made a high-stakes deal with her heart in that moment: We’ll bring in the oxygen, you keep carrying it.
The crash cart arrived and I glanced at the black defibrillator paddles atop. Shirley’s heart seemed to pound faster now. Did her heart see the paddles, or was that just mine?
The medication Narcan would surge through her bloodstream towards the opioid receptors in her brain and quickly blunt the fentanyl’s effects. It would create intense and untreatable pain, but she would breathe again.
As a colleague took over the chin-lift, I stepped back, grabbed Narcan from the cart and pulled it into a syringe with a shaking hand. A white-coat appeared.
What did she get?
The nurse anesthetist rattled through the anesthetic agents and other drugs she had given. The white coat then looked to me.
How long has she been down?
Two minutes.
Get ready to give 0.2 of Narcan.
Ready with 0.2, I parroted back.
I triple-checked my syringe.
I looked back at the paddles perched atop the crash cart.
We continued to breathe for Shirley. Her heart kept beating. Time moved in slow-motion.
Breathe, Shirley!
I waited for the green light, syringe in hand.
Then seventy-something Shirley took a rattling breath of her own. And another. And a third.
And as a sudden passing of clouds might reveal the surprise of sun behind, the gray chased from her face. She began to turn pink again. Her oxygen levels rose on my monitor. Her eyes fluttered. We sighed.
Shirley I said, loudly, how are you feeling? My voice shook just slightly, but I smiled.
She rolled her eyes towards me with a dubious, obtunded expression. It was the look of hundreds of patients I’d witnessed wake from surgery—searching for context. You’re in the recovery room. Surgery is over. Again, my lines.
She cleared her throat, coughed, and lolled her whole head towards me now.
The crowd dissipated. White coat patted my shoulder goodbye.
Nurse? she barked.
I nodded to her; ownership of the tremendous fragility of life held my voice at bay. I took my own deep breath.
Nurse? she repeated again, now with more annoyance.
Yes, Shirley? I replied out loud, placing my hand on her arm, looking her in the eyes. She pulled away, uncomfortable with my touch and gaze. Her conscious mind knew nothing of our recent intimacy: the way I had placed my hands on her jaw and drawn emergency medications into my syringe; the way I had prayed for her to stay in her body and willed her to breathe.
She did not know me.
Her voice was rough, demanding:
Get me my chapstick.
*name changed to protect anonymity.
About Moya
Moya Anne Meckel received her Bachelor of Arts in Literature from the University of Minnesota- Twin Cities in 2003. She entered the GEPN program at YSN in 2005. There, under the watchful eyes of Linda Honan, she became a nurse, and then spent ten years as a critical care RN prior to a return to Yale in the fall of 2017. Her passion is collaboration to improve nursing education and nursing care in rural and underserved areas around the world, and representing nursing in executive leadership. She may be ‘nurse’ to the outside, but her proudest job is ‘mama’ to two little ones at home. Moya is the 2018-2019 Yale School of Nursing SGO President, and she will graduate in the spring of 2019 as an Acute Care Nurse Practitioner with a concentration in Global Health.