Thursday, September 03, 2009

Sometimes you cry.

77-yo WM, found down in bathroom at 1347. Last FTF thirty seconds before, RN assist to ambulate to bathroom. On discovery, pt had 0 pulse, 0 resps, 0 response. Code team called; multiple att. to revive pt failed. Called 1442. A.M., MD, pronounced.

This is what charting does not tell you:

A new nurse, only a few months on the job, helps his patient to the bathroom. The patient had undergone a simple, very minor surgery the day before and was ready for discharge. As the nurse walked him to the bathroom, he joked that he had a long drive ahead of him and didn't want his kids telling him that they'd asked him if he needed to go ten minutes before and that he'd just have to hold it.

The nurse heard him fall off the toilet. When he got into the bathroom, a matter of five steps (if that), the patient was unresponsive, not breathing, and did not have a pulse. The nurse ran the three steps to the door and shouted for a code cart and to call the code (which I did), then went back to start compressions.

Because he was literally seconds away from discharge, the patient had no IV. Three of us dug around in his arms before I was able to start two large-bore IVs in his ankles. We started fluids, continued compressions and artificial breaths with an Ambu-Bag, and pushed as many drugs as we could in a vain attempt to get his heart started again.

At some point in the proceedings, someone realized that his kids were downstairs with the car, waiting for him to be wheeled down to leave. That brave person went with the chaplain to tell the kids that something had happened, we didn't know what, but that the doctors were with Dad.

But he's not doing well. At all. You need to know that now.

We coded him for just short of an hour. At the end of it, we left the nasal trumpet and the tube in place, left the IVs where they were, turned off the useless fluids, and called for the coroner. The docs wanted an autopsy. It'll probably show either a massive pulmonary embolus, or a massive bleed, or a massive cascade of clots in the brain, but they want to know.

And I walked into the breakroom and found my colleague in tears.

I don't do well with tears. Especially not from people that I know and respect and care for. All I could do was hug him, and cuddle his head in my shoulder, and tell him that he did the right thing, that he acted fast enough, that sometimes there are things that nobody can predict, that sometimes shit just happens, without any warning from vital signs or behavior or a change in the level of consciousness.

All of those things are true. All of those things were true in this case. All of the residents, and the people on the code team, and the attending physician told him the same things I did. But true or not, real or not, sometimes those things make no difference at all to how you feel.

I should've been there faster. I shouldn't have turned my back to give him privacy. I should've left that IV in thirty seconds longer. These are the things that run through your head.

Three nice people lost their dad today. One very nice woman lost her husband of fifty-two years. My colleague lost...I don't know what. It's certainly not innocence, because that's gone within the first five minutes after you step on the floor. Something, though: maybe a certainty that we *can* win 'em all, that what you do can make a difference, that caring enough will pull people through.

He'll be thinking about his patient tonight. I hope to God that his partner rubs his feet and feeds him something strong and comforting for dinner. I'll be thinking about him, and wondering if he'll feel like I felt the first time I lost somebody.

We all do our jobs with the belief that we are invincible. That is not true, of course, but being shown our inability to save every life hits hard. Eventually the belief in invincibility comes back, because how on earth could you do this job without it?

But between now, when you pull the sheet up over your--*your*--patient's face, and the day that you forget what it's like when you can't bring one back, is a very long time.


Penny said...

I'm so sorry, for all of you. So sorry.

LivingDeadNurse said...

those are hard days...i have been there before. Did they find out what caused it?

Crabby McSlacker said...


I can't imagine it's ever easy for a new nurse to lose a patient, but this one sounds particularly tough.

You say you don't do well with tears but it sounds like you helped him a lot. I'd bet those words made a difference, even if they couldn't totally take the pain and sense of responsibility away.

So sad.

Bardiac said...

I'm sorry, too.

But, I have to say, you manage to communicate a whole lot here to someone who has absolutely no experience in nursing, and it's incredibly effective and well written. But, I wish you hadn't had cause to write it.

Sean said...

Try not to play the blame-game. We have all fallen into that trap, and the only thing it does is frustrate you. Nothing else.
Your words on this blog tell us enough about you to know that you did everything, you still will do everything, and continue to be one of the good ones.

Anonymous said...

I am sorry this happened to your patient and your colleague, sounds like he responded to the situation like a pro. As a new nurse myself this sounds like my worst nightmare as well.

woolywoman said...

Those are hard times. But, better to have heart for you patients than to wall off your soul.

Moose said...

What an awful thing to have happen. If it matters any, I'd rather know the medical team did what they could and cared, really cared.

From the patient's family POV a similar thing happened with my great aunt. Medical people aren't gods. You can't see the future. It's sad for everyone, even depressing, and the worst part is it will happen again. But when you stop caring about it, I believe, that's when you're lost.

shrimplate said...

I'll bet the empty bed was filled before the shift ended. With all the work and documentation which then ensues...

Deana said...

Oh my gosh.

Every time I discharge a patient, I think about this exact thing happening when I take the pt off tele and remove the IV.

I'm so new of a nurse that I get rattled when patients start circling the drain. I can't imagine how rattled I'd be if a pt. coded right when they are ready to walk out the door.

I feel for the pt., his family,and all the nurses involved in this. That's a tough one.

Anonymous said...

Although I cannot begin to relate to any of this, I must point out that I love you all simply for caring. I've seen too many go cold that it is wonderful to know you angels are still out there taking care of us idiots. Even in death, this is truly what matters.