Friday, February 19, 2010

My Heart Aches

Ugh....not even sure how to start this, but I know in the long run it will help me to vent how I'm feeling. I rarely feel this way because I don't allow myself to become connected to my patients. I can get their whole life stories out of them...how they met the love of their life, how many kids/grandkids they have, what type of pets, etc & yet keep a safe distance emotionally as to not feel bad if their condition worsens or if I never see them again. Sounds cold-hearted but if you're a nurse, you have to do this to a certain degree or you wouldn't last very long as a bedside nurse.

I came into work Wednesday evening expecting a good night. Or more like hoping....like I hope for every night. I had my orientee writing down report while I listened...because at this point, she has one week left on orientation before she is completely on her own. So she is supposed to be taking care of my entire assignment with very minimal help from me. So I let her write down the report while I just listen & memorize important things in my head.

The nurse was giving us report on a new admission. He had just gotten to the floor at 3 pm after having spent like 10 hours in the ER. The day nurse said to me "Something just isn't right with him. He's slow to respond, although he responds appropriately, but something is just off. It's not right." She had called the primary doc three times to tell him this...her concern caused the primary to come in just to see this patient. He, too, became concerned. He told me he didn't know if the patient was septic or in diabetic ketoacidosis, but something wasn't right. I had yet to even see the patient as we were just finishing up report at this point. I soooo wish I had asked for an ICU transfer at that time, since everyone was so concerned...but I don't think it would have made a difference. And I had yet to assess the patient myself.

So we go to check this patient out & hang a bolus as his admitting diagnosis was dehydration, nausea & vomiting. His wife & son were at bedside. Very pleasant people. I asked the patient a couple of questions & could immediately see why the nurse & doctor were so concerned. Something definitely wasn't right. The doctor had ordered a CT scan of the brain...to rule out a bleed. Amazingly the CT department came for him immediately & took him down to do the test.

At this point I wasn't alarmed. I figured he was dehydrated & had a low sodium (125) & was a little disoriented because of that. Low sodium levels can cause people to behave a bit differently than normal. I thought we'll rehydrate him, start the antibiotics & hopefully he'll become better through the night.

When he came back from CT, he complained that he was short of breath. Checked his 02 sat & it was 100%. Took his blood pressure & it was in the low 80's systolically. My charge nurse turned up his IV fluids to 500 ml/hr. We called a rapid response because that basically is an ICU trained nurse that is great at assessing people that seem to be having problems. I was talking to the patient and although he seemed very out of it, he was able to answer my questions correctly. I changed his gown as he was all sweaty (he had a fever earlier of 103 that broke) and I got a cool washcloth & wiped his forehead with it as he appeared to be sweaty. He whispered that felt nice.

The rapid response nurse started a Neosynephrine drip on him in hopes of increasing the blood pressure. I had a call out to the primary doctor. We were already making plans to transfer him to ICU, regardless of whether the doctor called back or not. Our rapid response nurse has the authority to do that. They checked his blood pressure after about 15 min of running the Neo. Now it was in the low 70's. They rushed him over to ICU.

I stayed behind because I had another patient we were transferring to another hospital & EMS had just arrived to take him. I figured if ICU had any questions, they could call me or my orientee. She had already called report over to them before the transfer. The doctor had called & didn't order much at all. Guess he figured he'd just place the orders with the ICU staff.

I felt confident that ICU would be able to increase his blood pressure. As a PCU nurse, I like knowing that when a patient goes bad, we have a higher level of care we can take them to & that once I get them there....the problem is out of my hands. The stress stops there. I've done what I could do. It's half the reason I haven't ventured into ICU to become a nurse. There is nowhere else to take your patient when they go bad....it's all in your hands. I'm not ready for that level of stress.

About 2 hours later, I hear overhead....Code Blue ICU & they announce the room number. I wasn't sure what room my patient went to, but I knew instantly that was my patient. I silently hoped it wasn't, but my orientee confirmed the room number & all we could do is wait. I looked at his most recent labs...they showed liver & kidney failure. The CT scan was negative though. I was trying to figure out in my mind what could be causing his blood pressure to remain so low. Why wasn't he responding to the fluids and the medications???

Still though, I was praying ICU would be able to save him. He's too young. He has a wife & kids. He's a good person. We need to save him. Please, please, please.

About an hour later I was informed he didn't make it. Even with all of our interventions and three more doctors/specialists had come in to assess him when he was transferred to ICU, we couldn't save him.

Since my orientee was taking care of my patients for the most part, I spent the next couple of hours looking online for what could have happened. What did we miss? Why did he die? Why was he not responding to the medications?

All I could come up with is septic shock. As I read on, I learned that 1400 people a day die from that. What? I've been a nurse for over 5 years now & this is the first time I've seen it with my own eyes. I mean, I've gotten plenty of older people that were in the hospital being treated for septic shock, but I never saw anyone die from it.

It was so quick, so fast. I cannot stop thinking about it. It makes me so sad. I barely spent any time with this patient, but I feel this loss. My heart aches for him, for his family. I cannot logically figure this out. I am searching for someone to blame...but this time everyone did everything right. There was no delay of care. It was no one's fault. Still hurts quite a bit though.

He was only my patient for less than 3 hours, but the memory of him will last the rest of my life. May he rest in peace and his family be able to feel the many prayers being said for them.

4 comments:

Liz said...

Wow. It's amazing what happens sometimes when you never expect it. We were just talking about strange disasters like this today. It's good that you care - even though it hurts.

Amanda said...

So sad. He is lucky that you were his nurse that night and you were able to see something was wrong and act accordingly. I am sure you calmed him Jen--take comfort in the fact that you made his last few hours pleasant ones.

Julie said...

Those type of patients do haunt you for a long time. Especially the not being able to do anything to slow it down. It's sad. But sometimes it is just that person's time. I have lost a couple of patients to septic shock, its a bad thing.

Grumpy, M.D. said...

I have some like that I will never forget. We learn a lot from them. A few will haunt me forever, even though there was nothing more I could have done.