Late one evening, in Open Heart Recovery, my seventy-five-year-old patient’s temperature shot up from 98 to 103. I gave her Tylenol suppositories, double-checked the blood she was getting and called her surgeon. Dr. Vance instructed me to repeat the Tylenol, add intravenous steroids, then quickly hung up the phone. He needed some sleep after performing cardiac bypass surgery all day and on-call.
Mrs. Smith’s elevated temperature both worried and puzzled me. She might be having an allergic reaction or malignant hyperthermia.
Still sedated from anesthesia, Mrs. Smith seemed tranquil. She had normal vital signs, and her breathing was controlled on a ventilator. Central venous catheters monitored her heart pressures, and wave forms displayed hundreds of data points. This information allowed me to detect minute-by-minute abnormal changes.
While waiting for the drugs to take effect, I gasped when Mrs. Smith’s temp went up to 106 degrees. My heart pounded, while hers beat steadily at eighty.
I called the doctor, who remained professional, unlike those who blamed nurses for patient problems. Dr. Vance ordered more Tylenol, steroids, and a cooling blanket. Then he offered, “I’ll stay on the phone with you,” the kindest thing he had ever done.
The only other RN in my unit tended to another patient, so I had to request help from the nursing supervisor. She covered the whole hospital, so by the time she retrieved the cooling system and helped me set it up, Mrs. Smith’s temp was now 108. I had never seen this before; I had only read about in textbooks. Her heart rate increased to 120, and she started to shiver. Even her teeth chattered. I was afraid my patient might have seizures or a cardiac arrest.
My shift ended at 11:30, and overtime wasn’t permitted, but I couldn’t leave Mrs. Smith. Fortunately, two hours later, her fever normalized with the drugs and equipment. I handed off to the night nurse and went home.
The following evening, I read in Mrs. Smith’s chart she’d suffered no ill effects from the high fever. Quite a relief.
While I never learned why her fever rose so high, I was thankful for the convergence of many variables: a calm physician, a supportive nursing supervisor, effective medicines, modern technology, and my experience as a cardiac nurse. Everything came together at the right time to assure a good outcome for Mrs. Smith, who had the physical resilience to withstand such a stress in the first place.
Marilyn Barton
Hampton, Virginia