Things Can Change in the Blink of an Eye

Last night at work, I was playing through my mind what I would be writing about in my journal this week.  I thought it would go something like this....I had 4 patients, didn't get a good report from the dayshift nurse, but had hopes that the night would get better.  I assessed all of my patients, passed meds & took care of their needs.  One of my patients was a rather large woman...over 500 lbs.  She was 40 yrs old & quite demanding & somewhat needy.  I was told she can be a bit of a drama queen & I was noticing between her actions & comments, that it seemed she was.  She was admitted last week with respiratory failure.  The doctors were wanting to do a CT scan to rule out a pulmonary embolism, but at her weight, it couldn't be done at our hospital or any hospital in the area.  We were trying to contact a hospital in South Florida that had the proper equipment for someone of that size.  One of the doctors came in to see her...a psych doctor.  He asked me why he was consulted & I truly did not know.  She was alert & oriented, actions were appropriate, nothing really out of character other than being needy & believing that the nursing staff should cater to her every desire.  He went in & spoke to her, I observed some of the interaction.  Then out of the blue I heard her say to him "Am I going to die?"  Both he & I were shocked by the question & he replied back something like "Why would you say that?"  She didn't really have an answer.  Little did I know at that point, that she was having a premonition of what would happen later in the shift. 

It was about 11:30 pm, all of my patients were stable...some were already sleeping, some were preparing for sleep.  My patient above wears a bipap machine at night (to help her breathe).  For some reason, she kept taking it off.  I'd put it back on her & she'd take it off.  She then said to me "Stay with me, hold my hand."  I thought she was being a little dramatic.  She grabbed my hand & begged me not to leave.  

This patient was having very poor urine output....like less than 150 for the entire day.  I thought maybe it was the foley catheter, so we took the old one out & put a new one in...still nothing...not a drop.  Meanwhile her heart rate was between 120 & 130.  I don't like heart rates above 110 so I was keeping an eye on it.  My clinical leader was in the room to help with the foley & she also could sense something in the room.  She asked if there was an ambu bag nearby.  We looked around & there wasn't.  She went & got one, put it near bedside while saying "Just in case...". 

My patient was continuing to refuse to wear her bipap, so I put the nasal cannula back on & called respiratory to come do an 02 sat.  She was looking a little dusky, but still responding appropriately.  At this time, I called the doctor...I was concerned about her lack of urine output & her heart rate.  He gave me orders to start some IV fluids & told me not to worry about the heart rate, she was ok with that heart rate.  At the same time, I am told we are unable to get an 02 sat, see if the doctor will order ABG's while the respiratory therapist is in the room.  He says ok.  I get the fluids from the supply room, go into the room at about the same time the resp therapist is drawing ABG's & now the patient is not responding.  Eyes are open, chest is moving, normal sinus rhythm on the monitor...but no verbal response.  Try a sternal rub...nothing.  We're debating...do we call a code?  She has respirations & a heart rhythm...but not responding.  The decision is made...."Jen, call a code."  My first code blue.  I run to the nurses station, pull the "code blue" switch & watch as my staff begins running to the room.  I grab the code cart & get it to the room...still in shock that this is really happening.  I didn't know what to do - so much for ACLS, huh?  Luckily we have a great code team who were all there in less than 60 seconds.  I get on the phone with the doctors while watching them work the code.  I put a call out to the family...not sure of what to say.  I've never done any of this before.  They worked the code for 40 minutes, but she didn't make it. 

My focus turned from what to do during a code to what to do afterwards.  Again, I was clueless because I've never been in a situation such as this.  I knew the parents & family were on their way - what do I say to them?  What paperwork needs to be done?  Who do I need to call?  I love the staff I work with....they helped me so much.  I know I probably would have fallen apart if I didn't have their support & guidance.  They were telling me what to say to the family & who to call...what to say.  How to fill out the paperwork properly. 

The hardest part in all of this for me was telling her mother the bad news.  She came walking down the hallway & I looked at her.  She walked right up to me & wanted to know what was going on...what happened?  I did not know the words to say.  She was looking into my eyes...wanting a response & I was speechless.  I looked towards a more experienced nurse for guidance - in hopes that she would take over or assist in the situation...but at this point I was on my own.  I looked back at the mother who was looking in my eyes & she could tell from my expression that it was bad news.  I think she then said "No, she's ok, isn't she?"  I shook my head & told her I was sorry.  She began to break down.  I can't even begin to imagine what she was feeling at that moment.  The news traveled quickly through the family & I watched as each family member reacted in their own way. 

I'm going to leave it at that for right now.  I don't have much more to say at the moment.