Vitals Stable, Nurse Not: ICU Diaries Vol IV

Millennial nurse diaries from the blurry edge of professionalism, burnout, and full moon charting chaos.

Jul 12, 2025

📎 Before You Proceed, Read This:

Disclaimer: These entries are fictionalized, satirical reflections inspired by real-life nursing experiences. All identifying details have been changed or merged beyond recognition in full compliance with Swiss law and nursing ethics. This is not clinical documentation. This is storytelling, survival, and spiritual processing in written form.

ICU DIARIES, VOLUME IV — “The Potassium, the Purple Leg, and the Pills That Tried to Kill a Kidney”

Unit: Internal Medicine ICU — Sector: Collapse & Creatinine
Date/Time: from “slightly worried” to “crying in the med room while holding a potassium ampule like a rosary”
Filed by: CRN Solena — charting through carnage with an electrolyte-laced espresso in hand

Incident Report No. 1: “Potassium? I Don’t Even Know Her”

Unit: Internal Medicine ICU — Cardiac Arrest Vibes Only Zone

Description of the Incident:
female in her 50s, admitted after three days of vomiting everything except her life force. Rolled into ICU looking pale, dry, and confused. Initial potassium: 2.1 mmol/L.
EKG? You remember that time the printer jammed, played a funeral dirge, and then caught fire? That, but on a monitor.

Her: “I just need some magnesium.”
Her telemetry: “I need Jesus, four amps of potassium, and a defibrillator on standby.”
Me: “Ma’am, your heart is literally writing its own resignation letter and your ventricles are playing a death remix.”

Initial Problem:

Severe hypokalemia with ventricular irritability
Frequent PVCs, a little VT for flavor
Clinically on the edge, spiritually already out-of-office
Confused but still polite enough to apologize every time the monitor beeps like a banshee

Efforts Included / Tactical Actions by Yours Truly:

Central line placed in record time while praying in medical Latin
Potassium replacement via central + oral (because why not both when you're desperate)
Switched her bed to “code-ready” just to manifest stability
Made eye contact with the crash cart more times than I’ve made eye contact with my husband this month
Sat at her bedside manually confirming each beat like I was training for a bomb squad
Had defib pads prepped and pre-trauma flashbacks fully loaded
Whispered to the EKG, “Don’t you dare”
Tried not to faint when she said “I feel much better now, can I go home?”

Root Cause Analysis:

Electrolytes gone rogue
Vomiting in a heatwave + no replacement = cardiac Russian roulette
Possibly possessed by an electrolyte-hating deity
Capitalism
Probably also men, just in general

Outcome:

Still alive. Heart rate now resembles a heartbeat, not a techno remix.
Potassium slowly climbing
Cardiac rhythm less angry
Patient asked if I could dim the lights so she could “relax a little” and I whispered “must be nice”
Solena: severely dehydrated from stress sweat

Recommendations for Future Prevention:

Ban heatwaves
Mandatory potassium IV at first sign of summer
Prescribe electrolyte packs with every vacation
Develop ICU nurse-specific CPR support group: Cardiac Pacing & Repression

Incident Report No. 2: “Purple Is Not Your Color, Sir”

Unit: Internal Medicine ICU — Anticoagulation Regret Zone

Description of the Incident:
male in his 70s admitted with NSTEMI, started on heparin + aspirin + classic cardiovascular guilt complex. Vitals borderline stable until he casually mentioned the most dangerous sentence in ICU:

“My leg feels kinda weird, kinda tight… sort of warm and kind of… balloon-ish?”

Lifted the blanket and almost screamed. His entire leg was dark violet and puffier than my emotional state.
Color: Cabernet. Texture: terror.

Initial Problem:

Femoral pseudoaneurysm after arterial puncture
Rapid hematoma expansion, possible active bleed
Surgeon “on their way” (lies), and leg pressure worsening by the second
No palpable distal pulse

Efforts Included / Tactical Actions by Yours Truly:

Held pressure like I was guarding the gates of hell
Elevated leg, wrapped dressing, called everyone including my ancestors, monitored O₂ sat, and prayed to Saint Vasopressin
Called surgery, got voicemail
Called again, got “they’re on their way”
Called again, got “can you hold pressure a bit longer?”
Called again, got blocked (emotionally)
Surgeon arrived 52 minutes later sipping coffee and said, “Yeah, looks nasty.”

Root Cause Analysis:

Arterial wall: not amused by anticoagulation
Surgeon believed time is a suggestion, not a linear concept
Possibly karma from that time he said he’d be “just visiting”

Outcome:

Hematoma contained, patient monitored
CT angio pending
Solena now permanently allergic to "tightness in the leg" complaints

Recommendations for Future Prevention:

Make surgeons sign blood oaths for ETA accuracy
Introduce “Rapid Leg Response” teams
ICU nurses receive yoga training to sustain pressure for 57 minutes straight
Heparin patients get GPS ankle monitors on femoral arteries

SIDEQUEST 1: “I Think My Catheter is Haunted”

While compressing the leg of doom, I get called to Room 4 — walky patient with neuro pain says his urinary catheter is “making a humming noise.”
It’s his IV pump.
He then tries to convince me it’s whispering at night.
I unplug the pump and the room goes silent. He whispers:

“See? You angered it.”

Incident Report No. 3: “I Just Took Some Pills” – The Renal Apocalypse

Unit: Internal Medicine ICU — Dark Potions Division

Description of the Incident:
female in her 60s presented with weakness, cola-colored urine, and very chill vibes. Creatinine rising faster than her excuses.
CK: 52,000
You read that right. FIFTY. TWO. THOUSAND.
She casually mentioned taking “a few pills from a friend.”
Turns out “a few” meant statins + antibiotics + probably something banned in three countries. A toxic cocktail with a side of rhabdomyolysis and renal fury.

Initial Problem:

Rhabdo-induced AKI
Oliguria + hyperkalemia + CK rising like a cursed tide
Fluids running at biblical levels. No output. Labs still climbing. Dialysis team says “not yet.” I say “y’all love to wait, don’t you?”

Efforts Included / Tactical Actions by Yours Truly:

Bolused fluids like she was a dying succulent
Monitored cardiac rhythm like it owed me money
Documented the medication list, which included “something round, kind of yellow, might’ve been from Italy”
Called nephro who said “Let’s just see where it goes.”
I know exactly where it’s going, actually: straight to hell.

Root Cause Analysis:

Statin + macrolide = disaster duet
Self-medication from the dark web
Patient thought “natural” meant “won’t destroy kidneys”

Outcome:

Patient now on dialysis. Asked if she can still go on vacation this weekend.
I had to sit down.
CK now dropping slowly
Solena seen pacing the ICU whispering “pharmacology is witchcraft”

Recommendations for Future Prevention:

Amazon checkout to require pharmacist intervention
Patient education including “What Not to Mix If You Enjoy Having Organs”
ICU protocol: If CK > 50k, nurse gets wine

ICU nurses get hazard pay for every medication that ends in “-mycin”

SIDEQUEST 2: “The Dignity Brief Code Blue”

Room 2's monitor flatlined. Sprint in, code team charging — turns out…
it was just the telemetry battery.
Patient was brushing their teeth.
I nearly coded myself.

Final Shift Summary:

K⁺: missing, then resurrected
🦵Leg: turning colors not approved by God
🩸 CK: demonic
💊 Pharmacy: DIY edition
🫀 Me: dodging arrhythmias and arterial drama like I’m auditioning for Nurse Hunger Games

At this point, I don’t run on caffeine — I run on second-hand adrenaline and sarcasm-laced trauma bonding.

Filed by:
CRN Solena — potassium repleter, hematoma whisperer, unofficial FDA regulator for pills found in random kitchen drawers.

🩺 Footnotes from the ICU (Vol IV)

Creatinine

Kidney function marker. Higher = kidneys are mad. Really high = kidneys are gone fishing. ICU nurses measure this like priests read omens.

Cardiac Arrest

When the heart flatlines. No pulse, no breathing, no time. CPR, defibrillation, and 17 nurses yelling at once usually follow.

Potassium: 2.1 mmol/L

Way too low. Normal range: 3.5–5.0. At 2.1, your heart’s electrical system is composing its farewell album. Needs replacing ASAP — or enjoy the arrhythmia mixtape.

Magnesium

Underrated electrolyte. Supports muscle and nerve function, including cardiac rhythm. Without enough Mg, potassium therapy doesn’t work — they’re in a toxic co-dependent relationship.

Severe Hypokalemia with Ventricular Irritability

Translation: your heart is glitching because there’s no potassium to stabilize its rhythm. The ventricle starts free-styling, and it’s not a bop.

PVCs / VT

Premature Ventricular Contractions = extra, weird beats. VT (Ventricular Tachycardia) = the rhythm before death if untreated. ICU monitors scream. Nurses sprint.

Central Line

A large IV placed in a deep vein (neck, chest, groin). Used for delivering strong meds or potassium at doses that would absolutely destroy normal veins.

Crash Cart

Emergency trolley with meds, defibrillator, airway tools — basically, a portable survival station. Every ICU nurse flirts with it in a trauma-bond kind of way.

Defib Pads

Sticky paddles placed on chest. Connect to defibrillator. Used to shock heart back to rhythm if it decides to go jazz improv (aka VF or VT).

Dehydrated

Low fluid volume. Common in patients who’ve been vomiting, sweating, or just ignoring water like it's optional. Leads to hypotension, electrolyte losses, and kidney rage.

Anticoagulation

Medications that prevent blood clots. Great for heart protection, awful if you start bleeding. Often includes drugs like heparin and aspirin.

NSTEMI

Non-ST Elevation Myocardial Infarction. A heart attack that doesn't look dramatic on ECG but is still killing off heart tissue. Silent but deadly.

Heparin + Aspirin

Blood thinners. Prevent clots but make any bleed a major event. ICU staff develop trauma around patients casually saying, “my leg feels tight.”

Femoral Pseudoaneurysm

A bubble of blood from an arterial puncture that shouldn’t exist. If it bursts, you bleed internally. If it expands? Welcome to hematoma hell.

Hematoma Expansion

Bleeding under the skin that gets bigger. Rapid = urgent. Press it, scan it, pray. If it's purple and pulsating, it's already a nightmare.

Distal Pulse

The pulse beyond (distal to) an injury or clot. If there’s none? Blood isn’t getting through. Possible limb loss. We panic accordingly.

O₂ Sat (Oxygen Saturation)

How much oxygen your blood is carrying. Normal: 95–100%. Below 90% = bad. Below 80% = nurses panic. Below 70% = code blue.

Vasopressin

A vasoconstrictor. Used in shock to squeeze vessels and raise blood pressure. Side effect: turns nurses into stress zombies who triple-check perfusion.

CT Angio

A scan that shows blood flow in vessels using contrast. Used to find blockages, leaks, or active bleeding. Basically: vascular drama in HD.

CK: 52,000

Creatine Kinase. Normal: <200. 52K = rhabdomyolysis — massive muscle breakdown. Kidneys hate this number. Dialysis is coming.

Statins

Cholesterol-lowering meds. Rarely, they cause rhabdo. When mixed with other meds (like macrolides)? That’s a toxic duet.

Rhabdomyolysis

Muscle tissue disintegrates → floods bloodstream → kidneys drown in waste. Causes dark urine, high CK, electrolyte chaos, and renal failure.

Rhabdo-Induced AKI

Acute Kidney Injury caused by rhabdo. Kidneys overwhelmed by muscle debris. Output drops. Creatinine spikes. ICU nurse? Screaming.

Oliguria

Low urine output. Early sign of kidney injury. Less pee = more problems.

Hyperkalemia

High potassium. Opposite of hypokalemia, but equally deadly. Heart gets irritable. Risk of cardiac arrest increases exponentially.

Nephro

Nephrologist. The kidney doctor. Can order dialysis, fluids, or say unhelpful things like “Let’s wait and see.” (Not recommended.)

Macrolide

Class of antibiotics. Includes azithromycin, clarithromycin, etc. Mixed with statins, they can wreck your kidneys. Known as the “-mycin” disaster crew.

Dialysis

Blood purification machine for failed kidneys. Removes waste, fluid, and excess electrolytes. Loved by nephro, tolerated by patients, feared by nurses on 1:1 shifts.

“-mycin”

Any drug ending in this = likely nephrotoxic, ototoxic, or just generally chaotic. Handle with fear and renal labs.

Code Blue

All-hands emergency response for cardiac or respiratory arrest. Everything stops. Everyone runs. Time slows down. We live here.

Arrhythmias

Irregular heart rhythms. Some are benign. Some are fatal. Nurses treat every flutter like it’s announcing the end of days — because sometimes it is.

Adrenaline

Catecholamine of the gods. Can be natural (panic), or injected during resus. Makes the heart beat faster and harder. Makes nurses sweat out memories.

`🛡️ Disclaimer: Read This Before You Report Me`

(a legally sound love letter to ethics, humor, and patient privacy)

The content of this newsletter is a fictionalized, satirical representation of nursing life, based on real emotional, spiritual, and clinical experiences from the trenches of healthcare.

All patients, colleagues, and scenarios are heavily anonymized, altered, merged, or completely fabricated for narrative and protective purposes. Any resemblance to real individuals is purely coincidental or unintentional.

No identifying details—such as names, initials, room numbers, hospital locations, birthdates, or medical case combinations—have been included that would allow identification under Swiss Federal Data Protection Act (DSG) or professional nursing ethics outlined by the SBK-ASI.

These entries are not clinical documentation. They are diary-style reflections meant to process trauma, celebrate absurdity, and survive this beautiful, broken system with just enough sarcasm and stardust.

I am a licensed nurse. I also have a soul. This space protects both.

Please do not interpret anything here as medical advice, gossip, or policy guidance. It is for storytelling, solidarity, and surviving another shift with our humanity intact.

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