YON 2020 Day 335: Kathleen Hill, MSN, APRN, CCNS

A Clinical Nurse Specialist (CNS) since 1985, Kathleen Hill, MSN, APRN, CCNS, was the CNS for the Surgical ICU at Cleveland Clinic Main Campus at the time of her retirement in January 2020. She has practiced in medical, surgical, neurological, and cardiothoracic ICUs. Kathy shares two stories of experiences with patients—the first from early in her career, and the other many years later.

The Crazy Woman

I was working the 3-11 shift in a 4-bed ICU. The last admission was a 52-year-old truck driver who came in with chest pain. This was a community hospital in 1980, no Cath Lab, no routine PA catheters or arterial lines, just a bouncing ball ECG monitor, one RN and one LPN. It was dinnertime. I settled down to my sandwich and carrot sticks in front of the central monitor, preparing to chart (on paper). I saw the monitor change to ventricular fibrillation. I thought “I’m going to have to give mouth-to-mouth resuscitation with a mouth full of carrot! I spit the carrots out all over the front of the central monitor, pushed the code red button, and ran into the patient’s room. His eyes were rolling to the back of his head. I gave him a hearty precordial thump, and by this time the LPN had rolled the defibrillator into the room. I fired it up and defibrillated him. One shock did it. He returned to NSR.

Flash forward to the next day. I was very interested in a new phenomenon, Lazarus Syndrome, just being discussed in the literature. Today we know it as Near-Death Experience. I asked the patient what, if anything, he recalled from the events of the day before. He said, “I only remember seeing you spit on the desk screen and run into my room looking like a crazy woman, and then you hit me!” The strange thing was that there would have been no way for him to see me spit at the desk or run into his room until I was practically on top of him. The patient did well. I caught a lot of good-natured ribbing about the carrots spewed all over the monitor. To this day, I think of that event when I eat carrots, and am a firm believer in Near Death Experiences.

You never know when someone will need a nurse.

I was coming home from speaking at a nursing conference in Las Vegas on a 7am flight. We were about one hour into the trek when I saw a commotion among the attendants. A plea came for help from any doctors or nurses in the cabin.

As I made my way to the front of the cabin, the flight attendants directed me to an elderly man, mid-70s in the window seat. He was not responsive and no one traveled with him. I saw that he WAS breathing and he had a pulse (sigh of relief). He was sweating, mumbling but incoherent, and had lost control of his bladder. Oh, how I wished I had a Dinamap, an ECG, and a pulse oximeter! The attendants brought oxygen, an AED, and a B/P cuff. I put the oxygen on right away. He struggled when I tried to apply the AED so I went to the next possibility—hypoglycemia: an elderly person, a pre-dawn arrival at the airport, perhaps up all night at the casino, with no time for food. I asked the attendant for orange juice and a packet of sugar. I wasn’t confident that he would swallow, as he couldn’t follow commands. I made a slurry of the juice and sugar and placed “a bit between his cheek and his gum”. He became more alert quickly, giving his name, Frank, but nothing else. With the attendants as witness, I went through his pockets and found a huge roll of money, all large bills, and a bottle of nitroglycerin. Hurray, a clue. His blood pressure was low and with difficulty, I auscultated his heart. It’s striking how loud the cabin is when you are desperate to hear heart sounds. I heard the familiar irregularly irregular rhythm of atrial fibrillation. Now I was getting somewhere!

By this time the attendants had started to pass refreshments, leaving me responsible for this stranger. I analyzed what I knew and deduced I was barely monitoring a man with an unstable tachycardia, change in mental status, loss of bladder control, low B/P and tachycardia, with a presumed cardiac history (NTG). We still had 3 hours to go to Cleveland. I told the attendant that we needed to get this man more definitive medical attention. I was concerned he could have a stroke or MI in flight. They went to the cockpit. The airline’s medical control asked me to prove I was a nurse with a license. Of course, we all carry a copy of our license with us at all times (ha!). I had a business card with my credentials and my employer’s name and logo. I wrote a brief synopsis of Frank’s issues on the back of the card and it was delivered to the cockpit. About 5 minutes later the captain came on to say that, due to a medical emergency, the plane would land at Kansas City for a brief time. I was relieved. By this time, Frank had started to wake up. He was swinging at me and cursing up a storm, unable to accept that I was trying to help him. I saw on his driver’s license that he lived in the town next to mine and I tried to talk about local stores and landmarks, but he was having none of it. By the time we were making the landing, he had become quiet and less responsive again. I gave him some orange juice and continued to monitor his vitals. A policeman and two paramedics came to the seat to accept Frank. I handed the roll of money to the policeman in a very public way, asking that the paramedics mark on his sheet that there was $2300 on his person. Frank sailed off on a cart, cursing me in most colorful language.

Frank was no sooner off the plane, and they were closing the cabin door. The attendants invited me to sit in first class for the remainder of the flight. I had never flown first class, and relished the idea. I had a deluxe breakfast and a Bloody Mary. They gave me a bottle of champagne as I left the plane and indicated that several thousand frequent flyer miles would be added to my account.

At baggage claim, a paramedic and a physician came up to me to ask what had happened on the plane. I told them, but then asked why they didn’t come forward. They said it looked like I had things under control. I didn’t feel that way until Frank was wheeled away and I told them that I would have really appreciated another opinion. For a long time after this event, I wondered if I would run across Frank somewhere around town, but I never did. I also looked in the obituaries for a long time. He never appeared.

A few weeks later, I received a Proclamation from the State of Ohio naming me one of their finest citizens. Apparently, the airlines had contacted my state representative who arranged for this recognition. My family continues to tease me that I am one of Ohio’s finest!

Kathleen Hill, MSN, APRN, CCNS, has published and presented on topics related to critical care and advanced practice nursing. A member of the AACN since 1979, Kathy chaired the Scope and Standards for CNS Practice Task Force, was a member of the Evidence Based Practice Resources Work Group, and received the Circle of Excellence Award.

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