Technology: Only As Good As the Attitude Behind It!

One of the draws of cardiac electrophysiology, for me, was the technology. While working in the Cardiac Care Unit, I cared one day for a patient who had a pacemaker. When I walked into his room to administer some medications, I noticed that he had something funky going on with his heart rate and rhythm. In one lead, it looked pretty normal, just slightly tachycardic. But in another lead, it definitely looked like ventricular tachycardia. And, indeed, that’s what it was. His vitals signs were normal and he was asymptomatic so I called his doctor, who promptly arrived with a programmer and taught me to overdrive pace the ventricular tachycardia as needed until he could be taken to the lab for an EP study. I must say, I enjoyed playing with the programmer quite a lot! I happily paced the day away and was just a little disappointed when they took my patient and my new toy away to the lab. Fast forward a few months to my first day in the EP lab. Imagine my delight when I saw the Bloom stimulator. All of those buttons and toggles and switches, oh my! I was overcome with sweat with just the thought of getting my hands on that machine. It seemed my techno-geek needs were just constantly being met when I began scrubbing into cardiac device implants as well as being sent to several programmer classes. I learned about R waves, impedance, slew rates, and thresholds. In the lab, I learned about H-V intervals, effective refractory periods, programmed ventricular stimulation and clockwise versus counter-clockwise flutter. Such delightfully high-tech gadgets! Such highly technical jargon! (I need a moment to compose myself.) I was twitterpated, my friends. I really was. But if I thought the geeky, technical stuff was going to be the best part of the job, I was wrong. Oh boy, was I wrong. Back in the day of my beginnings as an EP nurse, there were only two of us to work every case. My colleague and mentor, Brenda Neckels, RN, and I had our routine down pat. Admittedly, a well-oiled team was a necessity because, face it, if we didn’t bust our humps to get those cases done, there was no one waiting to relieve us so we could go home. We were the EP team. Period. We had a certain way we did things. We switched up who would sedate and who would run the stimulator and who would scrub with every other case. However, when I speak of a routine, I really mean we had more of a comedic routine going on with our patients. A typical case started with Brenda picking up the patient and, as she pushed the stretcher down the hall, she might say, I hope you don’t mind, but the elevator’s broken so we have to take the stairs. It might be a little bumpy. The patient stammered, eyebrows raised in alarm, Um...well... until he saw the twinkle in Brenda’s eye. A relieved sigh was exhaled, a chuckle was shared, and the ice was broken. In the lab, as we slid the patient onto the table, just before launching the assault that precedes an EP study (12-lead ECG? Check. BP Cuff? Check. Pulse ox? Check. ETCO2 monitor? Check. You get the idea.), I’d introduce myself and ask the patient if I could call him by his first name. As I simultaneously lifted his hospital gown and covered him with the standard, little blue towel, I’d quip, I just thought we should be on a first-name basis before I saw you without your clothes on. Believe me when I tell you that our patients drifted away on their own personal Versed and Fentanyl cloud with a smile on their faces. We made sure of it. Upon waking, our patients often thanked Brenda and me for our kindness and for a job well done (meaning they really appreciated that warm blanket we gave them at the end). Brenda nonchalantly asked if they might be willing to put it in writing so she could take it to her parole officer. If it happened to be me who received a compliment while she was in the room, she’d usually tell them, Yeah? You should see how good she is when she’s sober! Silly, I know. But the patients we care for are often chronically ill and are always terribly frightened. They feel horrible and they are cranky, and all they really want is to go home. Our little jokes brought a smile to their face and made them forget how frightened they were, if only for a little while. The joking and laughing together also helped form an emotional bond so that, when we had to talk seriously about recommended treatment, there was an added element of trust. The patients appreciated it, that much I know for sure. I know it because of the tins of cookies and chocolates Brenda and I received every Christmas for years. I know it because the thirty-something year old photographer who came in for syncope and left with a pacemaker offered to photograph my children for free. I know it because little blue-haired ladies still sometimes walk up to me in the grocery store and tell me how grateful they are that I cared for their spouses. So yes, technology is great. Knowing what all of the squiggles on the intracardiac electrograms mean is impressive. Scrubbing into surgery and showing off my slightly obnoxious vocabulary is...well, it’s pretentious, but still pretty awesome. You and I know that I may have saved an EP patient’s life with a timely defibrillation. You and I know that knowing which switch to toggle at what time is not as easy as it looks. You and I know that sedating a patient so that they are comfortable yet suffer no respiratory depression is an art form. But do you know what the patient knows? He knows that we made him smile and feel at ease. He knows that we brought him a warm blanket at the end of his procedure. He knows that we communicated with his family and held his wife’s hand when she was frightened for him. He knows that he felt safe and well cared for during his hospitalization. And people, all of the technology in the world can’t achieve those results. For more information about Heather, please visit her blog at www.nurseblogger.net