I worked
9 out of the last 10 nights. I have been
on Spring Break from school. We need the
money and I am not allowed to do any clinical hours, so it seemed like a good
idea. I figured that I would get called
off one or two days for low census, but I didn’t. I
worked them all. It has been the most
difficult work stretch I have ever had.
I am physically and emotionally depleted. I don’t even want to go back. I feel like the angel of death has been
following me around. If you
don’t like “nursey” stuff, just feel sorry for me and stop here, but I need to
flesh this out so I can let it go.
My first
night working I had a debilitated end-stage renal disease patient. She was whiny and demanding. She played her family like a fiddle, and she
tried to play the nurses as well. I had
her two nights. The first night her
blood pressure was low and her family was worried, so they stayed in the
waiting room. The second night she was
doing fine, so her three daughters opted to go home to get some rest. The patient was livid. “If I die and they’re not even here, they’ll
spend the rest of their lives regretting that they abandoned me when I needed
them most”. Again, she was physically
fine, and we are a closed unit, so they would be in the waiting room
anyway. It just irked her that they were
going home to sleep instead of sitting in the waiting room being miserable. My second night I started with two patients,
and I admitted a third around midnight.
It is always difficult when I have 3 patients. I always feel like I’m behind schedule and
like I can’t meet the needs of three critically ill patients and keep up with
charting.
When I came in the next night, I
did not get the whiny patient back, but I quickly realized that I had jumped
out of the frying pan and into the fire.
The patient I got that night was around 300 pounds. She had a cancerous mass in her abdomen. I could only give her so much pain medication
because her blood pressure was low. She
was very uncomfortable, and she wanted to be moved every 5 minutes all night long. I would almost break my back getting her
turned and fixed, and just when we were all done, she would squish up her face
and yell, “I cain’t lay like this. You got to fix me” again. Finally I told her no. I tried to be nice, but she was not a very nice
person and it was difficult. I finally
asked her if she was really that uncomfortable or if she just liked having me
in the room with her, and she said “both”.
When I came in for my third night with her, I was looking online at
Walgreen’s for lumbar braces. I was
going to send the secretary to fetch me one.
I settled for a Thermocare patch I had in my locker. That night the lady vomited all night long. Nothing would help her for very long. She died two days later. She never had a visitor while I had her. What a miserable way for life to end.
After a night off, I went back
for more. One with chronic diarrhea =
roughly 30 butt cleanings over the 3 shifts I had her. I didn’t mind it though. She couldn’t control it,
and she was very grateful for the care she got. Just having someone thank me goes a REALLY
long way in the way I feel about what I do.
I also had a whiny 28 year-old overdose that night, so the butt
cleanings were a welcome diversion. The
next night, I took care of a delightful 81 year-old man with a GI bleed. He was self sufficient and very
personable. We got along swimmingly.
Here is where the angel of death
enters. I admitted a patient for
pneumonia around midnight the next night. She also had
chronic lymphocytic leukemia. She was on
an oxygen mask and her breathing was labored, but she was doing okay. She answered questions for me. She had fluids in the ER, but she had not
peed. Any time someone is in respiratory
trouble, they need a urinary catheter.
You don’t really think about it, but peeing uses a lot of energy, and
she needed to conserve her energy as much as possible. I got an order and asked her if it was okay
to put the catheter in. She said yes, so
I removed her pants, pantyhose and panties.
I was a bit freaked out by what I saw.
Everything was on the outside. I
f you’ve never seen a completely prolapsed uterus before, you should look it
up. It's freaky. So I called my catheter expert nursing buddy
in to help me. We asked her if it hurt,
and she said no. So M goes to put the
catheter in, and the lady draws her leg up, lays her head back, and dies. I mean she was dead. Stopped breathing, lost her pulse, pupils
unreactive. Dead. We coded her for an hour and a half, briefly
getting a rhythm back with medications, but quickly losing it again. Telling her daughter was hard. When she left the ER in the next town over
she was fine. Now she is here, and she
is dead. I spent a lot of time with that
family. The daughter told me that she
“had a feeling” that her mother was going to die earlier that day. The cause of death was listed as “probable
CVA secondary to septic shock”. So she
was already sick, and she had a massive stroke which just happened to occur as
we were putting a catheter in her. I don't think I'll ever live that one down.
The next night was fine, and
then last night was a doozy. I had a 34
year-old man who was found face down in his bathroom at home. He was in diabetic ketoacidosis, and his
blood pH was considered to be incompatible with life. He also had pneumonia. He rolled through the door just before
shift change. His heart rate was in the
150’s. He was on a ventilator getting
100% oxygen. It took me until 8:30 to get
things under control even just a little bit.
His family came back to see him.
Apparently no physician had spoken to them in hours, and I was the one
who had to tell them about his very poor prognosis. Apparently the mother had three
children. The patient had an older
brother who died in a car accident 5 years ago, and there was a younger sister who is
in jail and the mother has custody of her children. The family was rough, and they
were simple, but I had no much compassion for them. The patient rocked along until 10:45, then he
became bradycardic and lost his pulse.
We coded him and got him back.
When I went out to tell the family, the mother broke down
completely. She kept sobbing, “I can’t
do this again. God knows I can’t do this
again”. I cried with her. It really brought back the pain of watching
my mother lose her child. It is
something no one should ever have to live through, and this poor lady is going to have to
live through it twice. It makes me
wonder why life can be so painful. I
paged the on-call chaplain to come in to be with the family. By the time he got there, we had coded the
patient again. In all, we coded him 4
times during the night, and he was completely sustained on IV medications to keep his heart
going. I went into the waiting room
before I left to update the family. I
had been feeling sorry for myself because I had worked so hard. I didn’t get to eat lunch. My back was killing me. I had to stay late to
return the code cart and finish charting.
As soon as I saw the family, I felt so guilty. They had a much longer and more difficult
night than I did. I am about to take a 10-day
vacation and hopefully recover from this, but they never will. I called about him as soon as I woke up today. He died around 2:00 this afternoon.
Although I knew his chances for
survival were almost zero, I just couldn’t let that happen without knowing I
did all I could. He was 34 and healthy
other than having diabetes. What the
hell happened to this man? I could not
help feeling like I was missing something.
Was he just that septic when he arrived?
Did he have a perforated bowel?
Had he taken a drug that doesn’t show up on a drug screen? I did notice that his pulse would have about
three beats and drop one or two while appearing constant on the cardiac
monitor. I told the doctor, and he
ordered a 2D echo, but that wasn't until around 5:00 this morning. The nurse I talked to
this afternoon said he had cardiac tamponade, which is fluid built up in the
sac around the heart. It was beating
faster to compensate for its inability to push out a lot of blood with each
beat. Could an echo earlier in the shift have detected it and allowed time for
treatment? It is nagging at me. What could I have done better? I keep repeating scenarios in my mind where I
identified it and it got fixed. The
truth is that he probably would not have survived anyway, but I can’t help but
wonder. In the end, all I can do is try
to learn a lesson from it.
