Monday, March 28, 2011

It happened again

It happened again...I lost a patient. I don't know why this still shocks me as most of the people I deal with are elderly & not in the best of health, but this was only my 3rd "unexpected" death in my 7 years of nursing. I shouldn't really say "unexpected"...but I mean it as I didn't expect it "that" night. She was in her late 80's, lethargic (which I was told in report was her norm) & looked like she was knocking on death's door. I couldn't get her to wake least not in the sense of opening her eyes & looking at me. She did have this habit though of somehow taking off her allergy bracelets over & over I figured she wasn't in a coma since she was voluntarily making certain movements that had a purpose. So I let her be....let her rest...thought maybe tomorrow will be a better day for her.

I usually take my last set of vitals around 3 am. Technically it should be at 4 am, but for some reason when I am at work....I am the opposite of a procrastinator (like I tend to be outside of work). I guess I just want everything completed by 6:30 am so I can give report & get home. I never want to stay late everrrrrrrrr. So I am very organized & anytime I can get something done...I do it as soon as possible. This night though...I thought I'd wait until 4. I even pulled out a book to pass the time, since I rarely take any breaks. Plus I'm hooked on The Hunger Games series & was on book 2.

I think I got to the third page & then my phone rings. It's the monitor tech saying "Ummmm, your patient is in V-fib." Uhhhh,,,WHAT????? So I run over to look at her & it's the most awake I'd seen her the entire shift. By awake, I mean her eyes were wide open....but most definitely dying. I told the monitor tech "Uhhh, we've got a situation going on here!" (a little too much Jersey Shore fan). I call my charge nurse into the room & she immediately begins the code. I was like "Uhhh, she's a limited DNR....meds ONLY." Stop with the compressions & the ambu bag. Meds only means meds only!!! Which is basically worthless without the compressions to circulate the meds. Regardless, we have to do it by the book & call the code. It finally hits me that I should call the attending MD. I call his number & I swear I got a 2 minute recording of his office hours, how to reorder medications, what his shoe size is & where he'll be vacationing....before it puts me through to an actual person to page him.

He calls back pretty quickly & of course I cannot understand a word he says because not only is he from another country with a thick accent, but he's half asleep also. No problem, I hand the phone off to the rapid response He gave me a look like "WTF?" Ummm...sorry dude, I can't understand what he's saying, maybe you can. I then turn & look for my bff work pal & ask her to call the family. She's good with that stuff. I am not.

It's weird how when it's your code, you can't think at all. Anyone's else code & I know exactly what to do, what to say & how to get things accomplished.

Ok, family is on there way in & the rest of us are standing there basically watching her die, because meds only means meds only & they are not going to save anyone without the other interventions. I was pretty calm, as usual. I don't let work stuff get to me emotionally. I have no idea how I'm able to separate the two, but luckily it's just a natural response for me. That's not to say I don't care about my patients....I connect with the majority of them on a good level. I don't get emotionally involved though.

The daughter and granddaughter show up & I had already alerted my charge that I have no idea what to say to them, so she gets to them before I do. We gave them some time alone, but before that...they tell me the reason they didn't want her to be a full code is because they didn't want trauma to be her last life experience. I truly appreciate & understand that. They told me she had been sick for months & were ready for her to go when it was her time. They should talk to other families who think the exact opposite.

Afterwards I had to ask the dreaded you have funeral arrangements and do you want an autopsy. Luckily they did not mind those questions. Funeral arrangements had been arranged 30 years people. And no, no autopsy was necessary.

This happened over a week ago & the whole thing is still on my mind. I am not sad, it actually makes me think of other people dying every day. It makes me think of OB nurses & PEDS do you handle the death of a baby or a child? I don't think I'd be able to keep the line of not getting emotionally involved when it comes to that. It makes me think of my own parents & how I have had the conversation of what their wishes are. It's a conversation all people should have with one another....because when the time need to know what they would want. It's too tough of a decision to make when you're in the middle of something happening.