Tuesday, May 28, 2013

The Patient I Won't Forget

**Name changed for identity purposes

It has taken me months to write this post. 

Many months, actually.

There are been previous triggers that have urged me to write, however, I kept pushing them aside and saying.. "another day." Anytime I would sit to write about that night, I would stare at the blank screen. I just couldn't gather the words. And today, something just changed. I just sort of wanted to let it out and talk about. 

The patient I will never forget.

There are many, you know. Patients I won't forget. Their stories of their lives that I share. Memories of "that night" that stay with me. Their voices, their images. But with all these patients and experiences, I have always felt at peace with their outcome. I never took their stories home. I never  thought about them after leaving work. I just felt content. 

This one was different.

It was during the winter months. I was nearing 9 months pregnant, exhausted, and on my 2nd night shift in a row. We were in the report room when we first heard about the overdose coming in. Drug overdose. The amount was unheard of. We instantly did not believe it. "How could he take that many pills," we asked. "Is that even humanly possibly?" "There is no way that this is true." "I call bluff, and I call attention seeking."

"Who wants him?" A fellow nurse asked.

"I'll take him." I replied. Not realizing what I was getting myself into. Thinking this was just going to be another night to "get through." Another uneventful night like the last.

We all walked out of that report room laughing. 

He arrived around 930pm. Young guy. Alert. Talkative from the get-go. Telling me his story of why he chose to take pills, drink, and in hopes of ending his life. A break up with the girlfriend. He was scared. He was regretful. And on multiple occasions would say to me.."I do not want this to be it."

It.

The last day of hjis life, is what he meant.

I kind of brushed him off. "No Bob, this isn't it, you are doing okay, we are watching you closely, and we will do everything possible to take care of you." What I really wanted to say though... "Because I know you didn't take that many pills. You're just dealing with a heartbreak." I didn't though. I knew better. But I let the judgement get the best of me. One of my most regrettable moments.

I can close my eyes right now and see him looking at me. I should have known then. The fear in his eyes. The worry in his voice. He knew what was about to come, and I was so foolish not to catch on to what we call, "the impending doom."

We got a sitter that night, she was an angel. As I ran around doing order after order, labs after labs, talking to the physicians, calling the nephrologist in, getting the dialysis nurse to come in after hours of emergency dialysis, and being in my zone, she sat with him and put washcloths on his face, wiped his face off as he would vomit profusely, and change out his bucket time after time. Reassuring him, all would be okay. I am so thankful that she was there that night. That there was someone there with him at all times.

One family member showed up. A sister. They hadn't spoken for years. He was estranged from his family members. But she came to be there with him. She held his hand. She comforted him. 

It was about 4 in the morning. We had just finished placing the permacath in for emergency dialsyis. Bob was still throughout the procedure. He was pleasant and appropriate. 

Shoftly after though, Bob began to change. Quickly. In a matter of seconds. Diaphoretic, confused, and aggressive. Aggressive immediately turned to combative. Within seconds, 15 people are in the room. Everyone pushing the pregnant girl to the side. Security called. Trying to hold Bob down to give him medicine. Stabilize him. All while Bob is screaming.

I'm staring at the monitor. The numbers aren't looking good. I start hollering at the physician to hurry. "We need to intubate him now."


We did.


And just like that, things started to go downhill.


Bob was no longer the color he used to be. He drastically went from pink to mottled {red spots} all over. Head to toe. The numbers on the monitor were a tale-tell sign that he was rapidly declining. His heart rate in the 170's with no response to medicine. His pressure in the high 200's with no response to medicine. Guppy breathing on the vent. The "look" of death.


I call the physician into the room. What are we going to do now? He's going to code any minute now. Any minute.  I am talking to him, my eyes are on the monitor. That's when I see it. The systolic pressure all of a sudden dropped to 100's {previously in the 200's}... and his heart rate.... 180, 150, 110, 50....


"CALL A CODE," I yell.


No pulse.


And just like that, everything went crazy again. Except this time, I had a bad feeling in my stomach. With every compression, I just stood there and hoped and hope. But I just knew this was it. There was no bringing him back, and after 30 minutes, my thoughts were confirmed.


"Anyone have any other suggestions" asks the attending.


Everyone is quiet.


"Alright, guys, everyone did a good job," She says. And walks out.


And while my fellow coworkers were busy picking stuff up, unhooking wires, discontinuing medications, and comforting family... I was frozen. For whatever reason, I just could not move. I could not think. And without any control, the tears just started pouring down my face.


I muttered to a nurse that I would be back. Threw my gloves in the overflowing trashcan on my way out the door, went to the bathroom, shut the door, and just cried.


I had never cried about a patient like I did that morning.

I had never felt the way I did that morning.
I had never been so overwhelmed with emotions.

Then there was a knock on the door. It was one of my closest friends that I work with. She asked to come in. Hugged me as she closed the door. And we just talked.


I couldn't quite explain to her why this one affected me so much. Why other cases had not brought out this sort of emotion out of me. Why this particular patient's death was one that I knew would stay with me forever.


I think a lot of it had to to do with the fact that I went into that evening saying..."Easy as pie, lets just give him the attention he wants, and make it to 730." Like I said, my most regrettable moment of my career.


I think it had to do with the fact that I never saw this coming.

I never expected him to actually be telling the truth.
And I certainly never expected this outcome when he first rolled in throuh the door.

I wish I could just have a minute back with him. Just to talk to him. To hold his hand and give him some comforting words.


The other day, I saw the sitter for the first time since that day.  It instantly brought that night back to me.

We hugged. A big hug.

I told her I think about her all the time because of that night. That because of her, I am so grateful.That because of her, that patient had an angel at bedside. That because of her, I was reminded to write this story. His story.


Of the patient, the night, that changed me as a person and a nurse. And I'll never be the same because of him.

14 comments:

  1. I really hear this. I'm going into work as a clinical psychologist, and although we typically see those who overdose before and after the actual incident, I typically am able to block it out when I go home. Until I met a guy around my age with a heroin addiction and terribly sad story. Instead of remaining objective, I went home that night and just cried. Cried for the childhood that was stolen from him and for the damage he was doing to himself despite many overdoses and failed treatments. Some patients just affect you like that.

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  2. Beautifully written. I'm an addictions counselor at a residential treatment program and sometimes see the patients on their way out of treatment too early, later hearing about overdoses and suicide attempts. It never gets easier, especially after getting to know them and seeing them in a different light. Thanks for sharing this story.

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  3. I am a long time reader, and I have never commented before. I am a student nurse and also a mum of two! This story wrecked me. Thank you for writing it. I am sitting here with tears streaming down my face, and my sweet 5 year old daughter wiping them away. Life is beautiful, but it is also brutal. May we always walk the journey remembering that in a moment it can all change. Bless you.

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  4. I am a long time reader, and I have never commented before. I am a student nurse and also a mum of two! This story wrecked me. Thank you for writing it. I am sitting here with tears streaming down my face, and my sweet 5 year old daughter wiping them away. Life is beautiful, but it is also brutal. May we always walk the journey remembering that in a moment it can all change. Bless you.

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  5. He's that patient who touched you and forever left his mark, but he also taught you something! That's the beauty of our job...we are always open to learning. Bob knew you were there for him; he made eye contact with you. Hold his story close to your heart...you're a better nurse because of Bob!

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  6. Oh girl that just tore me up. I cannot even imagining doing the job that you do, and writing about that has got to be tough. You are such a good person and thank you for sharing. <3

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  7. I learned to never tell anyone saying they were going to die that it would be ok within the first year of being an EMT. I told someone a few times things were going to be alright during a 45 minute ambulance ride to the hospital, I ended up seeing their obituary in the paper the next day.

    It is amazing to me how people do have this sense of doom when their life is near the end.

    This was a powerful story and I am sure you will be glad you go the words down.

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  8. This was very emotional for me! Coming from a sister who has a brother who is in a lot of trouble with drugs right now and has tried to overdose a couple of times! So wonderful of you to share his story! xoxo

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  9. Ugh, I work on the psych floor in a hospital and I hear you. Working with these kinds of patients is one of the most emotional things I have ever done. I'm so sorry you have to experience that, but you are such an amazing nurse!!

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  10. That is so sad. I can't believe he seemed ok one moment and gone the next. All over a breakup too. Wow. Even if you did know ahead of time this was it, it wouldn't have changed the outcome. Your calmness hopefully comforted him though. You did the best you could.

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  11. This was beautifully written. I admire nurses, and what they do for us. I don't think I could handle it, but I admire those who can. You are incredible, and have a big heart, and I'm sure are one of the best nurses out there!

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  12. Wow that is so well written. You are a great nurse. He was also lucky to have you.

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  13. As a mother of a daughter who has overdosed a number of times, I want to tell you: It is never "attention seeking". This is usually the act of someone who is filled with self loathing and they need all the support and compassion that a nurse would give any other person with an illness. I cannot tell you how many nurses have looked at my daughter with disgust and dismissal. It hurts.

    I am glad that you shared this story.

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  14. I can't imagine going through something like this at work, which is why I could never be a nurse! Good for you for staying strong through these challenges and choosing a career that helps so many people!

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