Trying to raise my kids the best I can

Saturday, August 28, 2010

My first patient death

(Details changed for privacy)

This morning my patient was excited to go home.  She was supposed to have gone home over the weekend but they kept her because she was running a slight fever.  But this morning she had 650 mg of tylenol and then I went in to take her temperature, which was, naturally going to be down, since tylenol is an antipyretic.  And it was, so me and her roommate cheered for her that she would probably be able to go home today.

An hour or two later my patient's husband flags me down in the hallway and says that his wife isn't feeling well; that she has the chills.  I go in and she's shivering.  I feel her forhead.  It's just a tad warm.  I tell them that she does have a fever and then I went out and got her the only other blanket I could find and the vital sign cart.  I tucked her in tightly and tried to comfort her.  I took her temp which was barely even elevated.  I said that it was bound to go up as she continues to shiver and that I'd get her some tylenol right away.

Then she starts struggling for her breaths and turns over on her side.  Her husband and I know, at this point, that this is getting serious.  "What's wrong?" I ask.  She said she feels "restless", which is the sign of hypoxia.  On top of that, her lips are bluish.  I immediately stick on the pulse oximeter.  It reads 93... okaaaay.  So it's not the oxygen then, (or so I thought).  The nurse I am working with, Sasha, comes in to assess for the Tylenol.  Our patient's status is getting very shaky, so we are frantically trying to figure out the cause.   She takes the blood pressure, since that's the last vital sign I didn't take.  It's normal.  I take her blood sugar, which I was supposed to do an hour ago and hadn't gotten around to yet; maybe that was it.  But no, it was 235.  That's not a number high enough to cause this sort of reaction.  We're trying to talk the patient through the situation.  Asking her what's wrong, and to stay with us and such.  I pull out my pen light and do a neuro check via pupils, only one of her eyes is stuck closed- I think from a separate diagnosis, so it's far from complete.  There was slight dilation, but it was hard to tell, given that the room was bright.  Next thing you know, her O2 sats were at 37.  I've never seen anything like that before.  Her eyes are closed.  She looks like she's really working for each breath.  There are other nurses in the room now.  They ask me to get her oxygen.  They hand me the keys.  There are a dozen on the key chain and I don't know which one opens the closet!  But I flip through them really fast and find it.  I pull out one machine with plastic and one without and ask the staff in the hallway which one is "clean".  They say I can use both.  Sasha shows up at this point, grabs one and runs off with it.  Then she's back, frantically looking for a rebreather in the clean storage room.  We end up grabbing one out of the crash cart.

When I get back in the room her O2 Sats are about 5%.  911 had been called and the paramedics were on their way.   After all the chaos, the room is now getting rather quiet and Sasha mouths the words to me that she's going to die. There was a hushed discussion about her status.  She was DNR.  The husband had been watching from a chair.  I invited him to rub her feet.  And then a little later we brought him up to her head and Sasha gently said that she's not going to make it.  The husband was emotionless. Sasha and I were standing behind him with tears running down our faces.   Then Claire came in and explained gently to the husband that the woman had signed a paper saying she didn't want to excessive measures taken to bring her back to life.  I'll never forget that the husband said "She signed that?".  It seems like something he should have known.  And maybe he did, but in the moment, who knows what you can remember.  Staff came in with the documentation.  The husband was the Health Care Proxy, which means he can make medical decisions for her if she's incapacitated.  We asked him if he wanted to honor her DNR wishes or if he would like to change that at this time.  He honored her wishes.

The EMT's were in the room.  No one was really doing anything now though because we're all just waiting for her to pass.  One of them asked what she was there for.  I opened my notes and just rattled off her diagnoses: UTI, renal failure, bla bla, bla.  I wonder if I should have been saying those things aloud right there- you know, privacy rights and all.  It was then that my boss from administration called me out of the room.  She said they didn't want me getting too emotional in front of the husband.  She told me to go for a walk with Niki (the other new nurse).  On the way out my nurse mentor said that "it never gets easier," which, actually, I found to be comforting because a) it means I'm not just a big baby and b) it is proof that I have the compassionate heart that this field requires. 

The whole incident happened in about ten or fifteen minutes.  She went from lucid but shivering to dead in seemingly an instant.  I am so so so glad that I responded to her husband's request with a sense of urgency.  There were so many other things going on and it would have been quite normal to just kind of blow him off.  You know, "We'll bring you some Tylenol in a little bit".  But I was right there the whole time, showing great concern.  Imagine if he couldn't get attention for her until she was already unconscious?  That could have easily happened given the speed of the events.  The man would always have wondered if we could have done something for her.  But he need not wonder.  He saw us do every test and every life saving measure that we could before the patient indicated that she was really leaving this earth.

I had the honor of calling her death.  Only an RN could and I'm one of the few RN's there.  They let me do it.  I listened to her heart for one full minute.  Then I called "Time of death, 11:35am".  I even signed the death certificate.

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2 Comments:

  • At 7:21 AM, Blogger Rebecca said…

    how, you tell a great story. do you know what the cause of death was?

     
  • At 1:17 PM, Blogger Deena said…

    We think it was flash congestive heart failure

     

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