The people who die--that is, the patients you can't save--generally leave little holes, the sort that punctuate a baby Swiss cheese. If you gave them any more space than that, you wouldn't have a soul left.
But one time in a hundred, you get a really big hole.
The patient had a big hole in her. She was split from breastbone to pubis, and from one side of her ribcage to the other. They'd had to take out both of her kidneys and most of her large intestine, and a few bits and bobs in her mesentery, as well. What had been gut was now Gore-Tex. What had worked--however marginally--was now gone, and she was going to be on dialysis for the rest of her very short life.
"I think I'm going to die", she said, and I checked her color. It was good--her cheeks were pink and her eyes were bright. "I'm okay with that," she said, "I'm just scared of pain."
So I hit the button on the Dilaudid pump and prepared to listen.
The one thing nursing at night teaches you is listening. For some reason, patients are more prepared to talk about their fears and hopes at two a.m. than they are at any other time.
We talked about dying. She talked about her family, about her husband, with whom she'd shared forty-one years. It hadn't always been easy; she had secrets she'd kept from all of them that she told me that morning, in the quiet space between lab draws and rounds. Sometimes you're the nurse. Sometimes you're the confessor.
She died. She ended up dying. She passed. She coded, and we couldn't bring her back.
She left a big hole in my chest. As bad as things are, I wanted to tell her, they are still better than they could be; you have somebody at the side of the bed who loves you. You have your faith--with that, you ought to go to Heaven. You have children to remember you, and grandkids who will remember you, too, without the static of discipline and daily life to complicate their affection.
Put bluntly, without sentimentality or the rosy glow of blogging, something cut loose in her belly. She bled to death internally, probably experiencing a fifteen- or twenty-minute period of intense pain. We tried to bring her back with artificial respirations and chest compressions, but that only made the bleeding worse and hastened her death.
A fifteen- or twenty-minute period of intense pain would be welcome right now, as I contemplate the hole in my belly that matches hers. You can't always catch everything. You can't prevent every complication. You can't be enough.
She was mine, and she's dead, and I wonder what I missed, what I lacked.
Sometimes, you are not enough. It's an interesting process, to learn how to live with that.