Never too old to learn, again. This week I'm spending two days taking the ACLS, or Advanced Cardiovascular Life Support, class at Capital Health. Of course I'm the oldest person in the class and have the oldest beat up vehicle in the parking lot. As I said the other day nursing is a young person's game, and spanning the classroom I see it's really true.
ACLS is the next step up from BLS, or Basic Life Support. In that class participants learn adult CPR and how to use an AED (Automatic External Defibrillator), which basically, shocks the heart back into a better rhythm. That class is offered for the layperson or a more enhanced version for healthcare providers. It's the basic standard which allows for early recognition and participation in cardiovascular events such as cardiac arrest. But there's more to responding to a Code Blue than doing CPR and hitting the shock button on an AED.
One of the things I have held onto in my hoarding disorder to prove to myself where I've been are my old yearly planners. I have them going back to the 1980's. Why? Just shut up. One thing about keeping records of where you've been and what you've accomplished is that you have a record of what is true, not what you remember to be true. So yesterday as we went around the room introducing ourselves and our ACLS experience I had to strain to remember. I answered, "I think I used to be an ACLS instructor?". That puzzled the instructor at the front of the class, and the young kids seated around me. They looked at me like, "How can't you remember if you taught this stuff?". I felt old. I felt like I couldn't remember. I felt like I might be lying, to them, and myself.
You see as time goes by so does the truth with some things. Even recently I was asked to prove when I was at the World Trade Center in and around 9/11. I know when I was there, who I was with, but I had to brain-strain to remember, and then they even had me doubting the days I was there.
So when I got home I had to take a quick peek at the planners from the 1990's. I knew I had taken ACLS and remember taking the instructor class and even teaching it, but it was a blur. I found the planner from 1996 and when I got to October I found it. Looking at the weeks events it brought me back to good times. In 1996 I was 28 years old, what I would consider my prime. On that Monday we took Ryan to his second doctor's visit, which followed his August 18th birth. Then on Tuesday I did two 14-hour nights in the firehouse at Rescue 1 on Mulberry Street in downtown Newark. I got paid on Thursday, which back then meant a paper check, and then ran to join a long list of citywide Newark employees at the bank to cash it. And then on Friday, Saturday and Sunday it was the ACLS instructors class. I was supposed to be in the firehouse for a 10 hour day shift on that Sunday and must have taken a personal day or did a mutual swap to attend. There you go. I'm no liar.
These planners are like a diary. Most all filled up, but some, not so much. I don't know if it was during those years of turmoil that I was too disconnected to go by what was on paper. It was probably all survival mode. I like a planner, it's structure, and even in a life of chaos, having it down on paper helps me focus and stay motivated, and puts me in the place or places I need to be.
I love a good code. Sounds sick I know. I also like a good trauma. And I liked going to fires, a lot of them. You never wish ill will on somebody but if something were going to happen you just hoped it went down on your shift. Codes are always chaotic and can be run well, or be a shit show depending on who shows up. That's either pre or in-hospital. Many people haven't seen a working cardiac arrest in person although these days all of the medical shows do provide a glimpse, and sometimes they're spot on.
Most of the actions you see during codes are based off of algorithms (above), which ensure providers are doing the right thing depending on what the patient is presenting with. CPR, defibrillation, cardio-version, pacing, airway management, and medication administration are all part of it. Sometimes it works, many times it does not, or half works, which to me is the worst. Getting a pulse back doesn't mean your patient is walking out of the door.
So throughout the day I paid attention and took notes. I raised my hand from time to time to answer the instructor's questions. Several times I was corrected, "They don't call that that anymore", or "The algorithm has changed since then", which made me feel old. But it did remind me that I had been here before way back when the dinosaurs roamed the earth.
While these days I let my students jump on the chest during codes I still enjoy the strategy and tactics of what goes into being part of a code team. Watching the team, especially the nurses, is a thing of beauty when all goes right and the patient responds. One thing I can tell you about all of this, one day we'll all need a nurse, and we'll all go into cardiac arrest. So hopefully, unless you're a DNR, the code team will be on point when your heart stops beating correctly.