The Making of an Adrenaline Junkie
My journey through critical care nursing
When I first heard the term "adrenaline junkie," I was in my mid-twenties, close to the beginning of my nursing career. At some generic nursing function, over a glass of red wine and a fruit platter, I was asked by an obviously seasoned RN, "So what area do you work in, dear?" I replied shyly that after recently completing my recommended year of med-surg as a new graduate RN, I had begun a training program in the intensive care unit at a large community hospital. "Oh, you’re one of those adrenaline junkies," she sneered at me as she raised her eyebrows, chuckled, and was on her way.
At the time, I had no idea whether to be offended or complimented. I clearly had no concept of what that meant or that I would ever become one of that "breed" of nurse. You know, the ones who are all too eager to jump on the bed and pound on a chest, or who rate the quality of the "rush" on the degree of stress and disaster involved in a patient’s care.
Now, if you had told me during my brief ICU rotation in nursing school, as I stood terrified in front of all the multicolored invasive lines, tubes, tangled IVs, and loud, agitated monitors and machinery that continuously sing and scold and spew out rolls of paper for one issue or another—if you had told me that I would one day be completely at home and comfortable in this environment, I would have insisted that you had the wrong nurse!
I got into critical care because soon after I started mastering the world of med-surg, it occurred to me that inevitably one day one of my patients who was not a DNR would arrest and I would be stuck there freaking out and looking totally incompetent without any idea of what to do. The fear of this made my stomach hurt on a daily basis. As soon as I could, I enrolled in an ACLS class, where amidst a pool of ICU, recovery room and ER nurses, I was lovingly introduced to the culture of critical care.
After observing the wicked sense of humor, and the calm, "not easily impressed by just any old chaos" vibe of these girls, and being dragged around in "the unit" by one of the hardcore, old grumbly ICU nurses during lunch that day, my interest was curiously and irreversibly sparked. Perhaps impulsively, that night I came home and declared to my husband that I had decided that the ICU was where I belonged, and that I must transfer there as soon as possible.
How Did She Know He Would Code?
A month and a half later I found myself on the first day of orientation in a high acuity, mixed (surgical, medical and coronary care) intensive care unit, sitting next to my preceptor, an older, cynical-yet-sweet nurse, as she gazed at the cardiac monitor perched over the patient. With a serene, straight face she matter-of-factly stated, "yeah, this guy’s gonna code, you watch…I give him about an hour…"
I was dumbfounded. I stood up and looked desperately through the little desk window at the patient, searching for what I was clearly not seeing. How did she KNOW??
There he was, one minute sitting up in bed, chatting with his wife, reading his paper and sipping his decaf, and sure enough, a subtle forty-five minutes later, all hell acutely started breaking loose. And in the midst of a plummeting blood pressure, increasing arrhythmias, the patient’s loss of consciousness and concurrent intubation, my preceptor just floated gracefully through the scene. Sharp, collected, and surprisingly content, she effortlessly maintained complete control of the situation, joked with the doctors, and flawlessly predicted every intervention and patient response as she and the rest of the team saved this guy’s life without breaking a sweat.
At the end of it all, I was exhausted, even though I had done nothing but watch, and keep my jaw from hitting the floor. But at the same time, I also noticed a kind of speedy, strange yet definite endorphin bump, like you get the first time you kiss somebody or "borrow" dad’s car without permission after he’s asleep when you’re newly 16. It confirmed that I was definitely in the right place and all I knew was that I wanted more, more, more!
"Who Hasn't Done CPR Yet?"
The first few months on my own that followed were challenging and at times very nerve wracking, as I felt like a brand new nurse all over again. However, I learned quickly that the best way to master fear is to jump in and immerse oneself in the causative agent. The exhilaration and subsequent tachycardia that comes along with doing that, as well as the development of the ability to predict things and become more competent, is what kept me going.
Those first few months I wouldn’t leave the bedside, even during my breaks, my eyes glued to the monitor and the peacefully sleeping patient fearing that I would miss something, and as my patient would have an extra PVC or two, so would I. Yet gradually, as my comfort level increased, my PVCs started to subside, until at the end of the sixth month or so, during an especially long code, one of the educators rounded up all of us "newbies" and hollered out, "okay, who hasn’t done CPR yet?" There were only a couple of us left, and when I raised my hand gingerly the respiratory therapist on top of the patient at the time exclaimed, "well get on up here, Kiddo!"
So, as I had been shown how to do, I interlaced my fingers over this frail little woman’s tiny ribcage, inhaled and swallowed my stomach, and proceeded to take over chest compressions for a good five minutes. I had never worked out so hard in my life, the sweat rolling into my eyes, my heart pounding loudly in my ears, and when I came out of my daze for long enough to hear the next nurse asked me if I wanted a break, I was like, "no way, this is great!!"
"Train Wreck, Crashing"
Eight years have passed since that summer on night shift. While I still consider myself a young nurse, I definitely crossed an invisible line some time ago where most of the typical challenging situations in the ICU setting no longer make me too nervous.
For just like a real "junkie," one builds a tolerance to the substance that induces the "high" (in this case stress), and it takes more and more of it to induce that "rush" like the one you got the first time you did CPR. Nowadays, after getting a complicated, gnarly report from a shaken floor nurse, I will admittedly look forward to the arrival of the "train wreck, crashing" patient from the floor, to have a chance to take my skills and training to the maximum.
This may be mistaken by other, non-critical care nurses as arrogance, or lack of compassion or empathy for the patient. I assure you, it absolutely is not. In fact, I hope I never become so arrogant as to think that there is no more room in my mind or my heart to learn something new on a daily basis, or so desensitized that I no longer feel the pain of that patient and their family every single time a life threatening crisis ensues.
I know my purpose is to genuinely try to make a positive difference in the outcome of the patient there in the bed, and to try to be an example of grace and control to those standing on the outskirts of the scene in horror, as I once had been.
Amy Stokes is a staff RN at Brotman Medical Center in Los Angeles, California, in the Surgical Intensive Care Unit.
This article is from workingnurse.com.