As I have said before, most of my shifts are done three in a row. Two Mondays ago was no exception. I was nearing the end of my third shift when the nurses aid called to me to help her change one of our patients that had soiled himself. By the time we got there, he was unresponsive.
Finding a patient in this state is always hard. Our instincts kick in and we immediately act.
I yelled for help from the other nurses around me. I was desperately trying to feel for a pulse, to no avail. I rolled him on his side and someone put the backboard under him. I started compressions, pressing into his chest, counting aloud as I went.
After the first round of compressions, someone else took over. As the patients nurse, it is your job to report to the emergency code team what was going on, who the patient was, his history, what happened leading up to this event, lab values, vital signs prior, etc.
The report to the code team went something like this:
43-year old male. History of mild mental retardation, poorly controlled diabetes, cystic masses found at the esophageal-gastric junction, originally admitted from a nursing facility for low blood sugar and unresponsiveness. En route to the hospital he suffered a PEA arrest (electrical conduction in the heart but no actual pulse). Upon arrival he was intubated and code cool protocol was initiated (a method of cooling the body in order to slow brain metabolism in hopes of preserving brain and cardiac function). He came out of ICU to our floor after successful re-warming and extubation. He had persistent and growing pleural effusions (fluid in the lining of the lung) on both sides, but had been tapped that afternoon and almost a liter was removed off the left. He was being worked up for possible malignancy as several necrotic tissue masses were found in his left upper chest tissue.
After almost twenty minutes of coding him, he finally had a pulse. He was intubated and we took him to ICU, where he coded again. After almost 30 minutes of coding him, it was called and time of death was announced at 7:02 pm.
I stood at the foot of his bed, after witnessing and participating in the trauma that is coding a patient, staring at his lifeless body, replaying in my mind all of the time I got to spend with him in his last days.
I cried pushing the bed from ICU back to my unit.
I cried walking out to my car, leaving almost two hours late to finish up paperwork and charting.
I cried the whole way home.
You see, what that report, and the handwritten "code blue sheet" that gets filled out after each code or the "discharge" summary after a patient passes, what they all had missing were all the moments in between. What they failed to capture were the real time events, the most important details.
He was regaining orientation and able to converse better. He was still very simple, almost childlike and I honestly felt maternal caring for him. He was making jokes and eating. He was beginning to understand the severity of what was happening to his body and the picture of poor prognosis the doctors were painting.
Those factual occurrences missed out on the three days I spent with him, feeding him, talking with him, bathing him, helping him stand and get to a chair.
On my second day with him, right before I was supposed to give report to the oncoming night nurse, I went in to check on him and he seemed sad.
"What's wrong, my friend," I asked.
Tears began to fill his eyes. He had a hard time forming words and would stutter at times, so he was having difficulties.
"I...I...I...I'm worried."
I was standing to his left and immwdiately knelt down beside the bed so that we were face to face. Something inside me took over and before I knew it, I said, "My friend, we serve a big God. He knows what is going on with you and He loves you. He is in control and He knows you need Him."
"I hope so," he stammered. He closed his eyes and a few giant tears rolled down his cheeks.
"I know you are worried, and God knows you are worried. I am going to pray that He gives you comfort and peace tonight. I pray that you will feel His presence and His big arms around you."
All he could say was, "Thank you."
I will never forget those precious moments with him. I will forever picture his face in my head, closing his eyes to fight back tears. He was worried about the procedure he was undergoing the next day, the one that would precede his death.
I will never forget holding his hand before I left for home the second night. I will never forget praying for him. I will always wonder if it was enough, if my words were the right words to impact a simple mans life. I will always wonder if I will see him again in Heaven.
The written, summarized facts and lab values and report sheets and vital signs do not accurately depict the relationships built. They do not adequately capture the bond between nurse and patient. They do not reflect the mark our patients make on our lives, or the trauma to our psyche that occurs when one of our patients passes.
Rest in peace, my sweet little man, until we meet again.
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