Monday, April 4, 2011

Days Like Last Friday

They don't tell you when you become a nurse that there will be days like last Friday.  They don't tell you when you become a nurse there will be days that are 11 hours and 45 minutes of normal and 15 minutes of the surreal.  They don't tell you when you become a nurse that somedays there is nothing you can do but be the sentinel that watches the end come.  They don't tell you when you become a nurse that there will be days like last Friday or you would never have become a nurse.

I have not had a patient die in four years.  I have not had a patient die in four years but I can remember every last one.

The first death I was ever present for was when I worked in the ER. It was a woman who had an aneurysm while driving.  She was 50ish; an average looking woman. After her car met the highway barrier, the paramedics were able to restart her heart once, but when she came in, she was fading fast. After she coded for us, we lost her.  Her very large hispanic family began the ritualistic weeping and wailing in the hallway, that I could hear through the curtain where I had been left to clean the body.

Alone in the room with her, I finished cutting off the rest of her clothes, removed all the IVs and equipment attached to her, washed and prepped her for viewing. What I remember that most was that she had these ridiculous Halloween earrings on; tiny hinged skeletons that danced when moved. Removal of jewelry is not part of the checklist, due to the jewelry usually being quite expensive, so we leave them on the person. Had they been any regular, expensive earrings, I would not have given them a second thought. All I kept thinking was she got up this morning in her own house, she put those earrings on, jolly and having no idea she would never see another Halloween. She was not a failing body shipped to us from the nursing home, awaiting the sweet release of death. This morning she was a person, and now she is nothing more than a chunk of flesh that had to be dealt with.

The first death of my own patient was an elderly black gentleman, exactly the nursing home patient most of my deaths are.  He had been my patient the previous two days, and no family came to see him, no friends crowded his room wishing him well.  The third day, I had some extra time, so I pulled out a razor gave him a shave he was in very bad need of.  While I shaved him, we had pleasant chat.  Near the end of my shift his heart failed, and upon his request, we did not attempt to save his life.  Instead I watched from the doorway while the death he knew was coming claimed him.  His was the only death I have cried at.

I remember the toddler we could not save after she choked on a toy, I remember the post-op bleed that left literally pints of blood in the bed, I remember the AAA who died on the toilet, I remember the cancer ridden patient who's family was finally ready for the morphine that would release him, I remember them all, and Mr. S from Friday will be no exception.

Mr. S was not even my patient.  He came up to the floor around 04:00 with a GI bleed of unknown origin.  As I helped the other nurse get him settled in, he chatted with us.  He told me about his dog, Precious, whom his daughter rescued from Mexico last time she was down there, and I showed him pictures of Tucker on my phone.  He chatted with me about how warm it was getting, and about how the doctors were making a big fuss over nothing.  We tucked him in and told him to call if he needed anything. I didn't go into the room till his call light went on at 0645.  His nurse was not around, so I got up and went to see what he needed.  When I got there, he asked to see his nurse because he needed to urinate.  I left the room, had another room ask me for a warm blanket, told his nurse he wanted to see her, and went to get the blanket.

I could not have been gone for more than 30 seconds.  When I returned, his nurse yelled at me to get the charge nurse.  I went and got her, and by the time I turned around, she yelled at me to call a code.  I called the code and when I entered the room, he looked nothing like the man who asked me less than two minuets ago to get his nurse because he had to pee.  He was ashen, and limp, and the monitor told all of us, heading for death.

His heart stopped, and we intubated.  After we intubate, the doctor told us that his lungs were full of blood.  Turns out he was bleeding from more than his rectum.  We pulled out 1,000 cc of bright red blood from his lungs. We brought him back once, but he never had a chance.  One moment he was holding my phone, talking to me about my dog, and the next he was just like the 50ish Hispanic lady with the skeleton earrings.  Covered in blood, naked, surrounded by a room of frustrated people who want nothing more than for him to open his eyes.

By the time we were done, he was cold, he was pale, and he and half the room were covered in blood.  For most people, death is an abstract concept.  People are in their lives one day, and the next they are not.  They might as well have moved away.  For the unfortunate few, death is life shattering because the one on the bed is their whole world.  But for the even more select few, death is something we work against everyday.  We struggle and we fight, and even when we do everything right, and we do all that we can, we still have no control over death.  We don't get to say that Mr. S gets to go home to his dog, or toddlers get to live because they are young, or that someone should live because they are loved.  They don't tell you when you become a nurse that there will be days like last Friday, days where there is no control, that you don't get to be the hero, that your patient doesn't ever get to leave.  They don't tell you when you become a nurse that there will be days like last Friday or you would never have become a nurse at all.