Room 1: The First Patient I Ever Lost

8765547_cb84ee4533_zI’m no stranger to patient death. If you’re going to be a nurse (or anyone in the medical field for that matter), it’s something you will deal with routinely. This post is in reference to a patient who suffered a critical event while under my direct supervision and did not survive, about five years ago. I was a rookie who had seen death a hundred times under the care of another person, but I’d never personally lost a patient.

Mr. Z was a drunk. He was a frequent flyer. He would use the money he should have been spending on his seizure medications to buy booze. Then he would get wasted, have violent seizures, and his wife would bring him to the ER. He would come up swinging, too, fists throwing out wild haymakers at all of us after the seizures subsided. We’d have to restrain him. Then he’d come to his senses and apologize profusely. This happened once every few weeks.

In my mind, I can still see his wife, always casually strolling through the ER to the waiting room as we began treating him. She’d be carrying a small suitcase and a blanket, preparing for another few nights in the hospital.

On one such occasion, Mr. Z was abnormally lethargic. He didn’t do his usual Mike Tyson routine after his seizure. Dr. Y ordered a CT scan of his head. I approached Room 1 to transport him to the radiology department. He was asleep when I entered. His blood pressure was a little low, but his pulse and respirations were normal.

The radiology tech accompanied me, and we wheeled him down the hall on the stretcher; the whole trip took less than five minutes. I kept track of his heart rate and respirations throughout. He remained stable. We slid him onto the examination table.

And just like that, he stopped breathing. I quickly checked for a pulse. Nothing. We quickly slid him back onto the ER stretcher, where I began CPR. I ordered the CT tech to call back to the ER and prepare for a Code Blue (patient not breathing). She made the call and steered the stretcher back to the ER with me perched on the side, doing compressions the whole way.

My team were at the ready as we wheeled Mr. Z back to Room 1 and went swiftly to work. Despite our best efforts, within fifteen minutes, it became obvious he wasn’t going to make it. Dr. Y announced the time of death. It all had happened so fast. I was dumbfounded.

Dr. Y, a seasoned veteran of medicine, cast a glance across the room and immediately sensed my struggle to process what had just happened. She marched toward me with purpose, grasped me firmly by the shoulders, looked into my eyes, and stated,

“It’s not your fault.”

I looked cluelessly into her eyes.

“It’s not. Your. Fault.” She repeated again.

I wept.

“Tripp. It’s not. Your. Fault.” She was insistent this time, firm.

I nodded. I stepped outside, pulled myself together and finished out the shift. I’ve often pondered why I was so upset, and over the years it has become apparent to me. We treat human beings, without question, without prejudice, without judgment. Whatever your race, your gender, your sexuality, your background, we will treat you.

As an emergency nurse, whenever I feel myself compartmentalizing inefficiently, feeling burned out, exhibiting jaded behavior, getting frustrated, I reflect back on Mr. Z in Room 1, and I am reminded that human beings are human beings. A life is a life. And a life lost before its time is a tragedy. Period.

To my dear fellow nurses this 2017 Nurses Week, you sometimes carry the weight of the world on your shoulders. You are a special breed. You see more disturbing images in a typical week than most people will see in a lifetime. You are loved, you are adored, and you are a vital part of the transformation of this world. Take time to accept the gratitude and appreciation that is declared to you, for you are all rockstars.

Cheers.

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Life and Death: A Different Sort Of Birthday

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3408605763_92d0bc3049_b   5th of July, 2015. Before dawn. Most of the east coast is still sleeping.

In my typical fashion, I reach a lazy hand over the bedside table and smack the snooze button for the tenth time, annoyed at the damned ear-piercing alarm for performing the job I assigned to it. I finally muster the strength to drag my carcass out of bed to prep for another 12-hour round of mental taxation as an ER charge nurse.

Silence.

I live with my folks currently, so I take extra care not to disturb anyone as I do my morning routine. It’s a Sunday at that, so I won’t be crossing morning paths with my dad on our respective ways to work. I trudge down the hallway into the kitchen, scarf a few spoonfuls of Apple Jacks, down a glass of water, pop half a 5-Hour Energy (I know, I know; I’m an over-caffeinated work in progress), and quietly shut myself into the bathroom, still half asleep.

I kneel and turn the cold bath faucet on as part of my wakeup routine, to shock myself awake, and to tame my chaotic morning mane. A few seconds before plunging my head under the running water, I could swear I hear the muffled sound of my dad yelling in the next room. Weird. They usually sleep in on Sundays. I turn the water off and listen.

Silence.

We have this geriatric Rat terrier who, whilst in her prime, once tried to check out permanently via school bus tire. After miraculously sustaining zero injuries, the skid marks across her back faded, and she lived many more years. We’ve considered admitting her into a canine nursing home on account of her half dozen life-threatening diagnoses. Dear Lord, I thought, she’s finally hopped the twig to Abraham’s bosom.

I rise to make sure everything is OK. Of a sudden, before my hand reaches the door, it swings violently open, my dad gripping the knob with white knuckles, breathing heavily . . . focused . . . alarmed.

“Hey. Can you come check on your mom?”

My heart skips a beat as the adrenaline permeates. We rush to the bedroom, where I find her lying in bed, cold, listless, pale, sweating . . . and not breathing. I recognize the signs of cardiac failure immediately. I’m struck with a fear.

Stop. Breathe. Keep it together.

I collect my thoughts as my dad dials 911. He begins a series of trips in and out of the house, alternating between flagging down the ambulance and checking on his beloved wife.

“Hey mom! How you doing?” I shout in jovial terror, struggling to maintain my positivity as I put my fingertips to the side of her neck. I feel a very faint, very slow pulse. “Hey Mom!” I shout again.

She suddenly takes a shallow breathe, moans and whispers faintly, “I’m fine. I feel a little sick. Don’t call the ambulance.” Good. At least she’s herself. Even near death, she’s worried about stressing us.

Then she mumbles that she thinks she’s going to pass out. I watch the life slowly depart from her eyes. She stops breathing again. I instinctively look for the patient Code Cart which contains every life-saving medication known to man, shock pads, heart monitor, oxygen, compression board, intravenous setup. But alas, I’m not in the ER. All I have are my hands and my scrambled brain. I refocus and reach to lower her to the floor. I prepare to start compressions on my mom. Just before I lift her, she takes another shallow breath.

“Ugh. I feel just awful. I’ll be fine. Really. You don’t need to call anyone.”

I put a hand to her cheek and look into her heavy eyes. I take a deep breath and control a lingering tear as I pull it back together.

“Mom, I need you to trust me.”

She hesitates. I see irony in her eyes: This wonderful woman, to whom I’ve entrusted my life for so many years, now asked to place her life into my hands.

“OK, Tripp. I trust you.” Her lip quivers as she fights a tear, that dreadfully liberating release of control. Once more the life fades from her eyes. Once more I prepare for compressions. Once more she takes in a breath and comes back. We ride this roller coaster four to five times for what seems like an eternity.

My dad finally rushes in with the EMS crew. Mom seems to be returning to her senses, and is fully conversational by the time they lift her into the back of the ambulance. I step into the truck to tell her I love her and that she’s in good hands. The paramedic, a personal friend, runs a cardiac monitor strip and we both agree on the probable diagnosis.

We slam the back doors, the engine revs and they speed away as the day breaks, lights flashing. I trot back inside to help my dad get some things packed for a hospital stay. Of a sudden, the world stops as an hour of suppressed chaotic emotions surge to the conscious surface. We hug each other briefly, have a small meltdown, pull it back together and finish packing for a few romantic nights of white walls, sterile breezes, incessant beeping and waiting. Lots of waiting.

The cardiologists did stellar work on a heart so big that she probably feels guilty for “burdening her family” as she reads this post, as if she had any control over the electrical impulses of her own heart. There is no burden, only love. And we’re glad mom decided to stick around a while longer. Her recent birthday reignites my utmost gratitude for life.

Take heart my friends. We can live in fear of what we cannot change, or we can live with gratitude for what we would never change. Be bold. Seek to cherish your life and your loved ones, not out of fear of losing them, but out of simple love for every precious moment.

Thank you, mom. I love you dearly.

Image by J E Smith at https://www.flickr.com/photos/statusfrustration/3408605763