Death

Death is something that has or will touch all of our lives at one time or another. As nurses our lives are touched by death more often than most. It is a hard experience no matter how many times you go through it, and as a brand spankin new grad it is especially hard (I think). I saw my share of death as a tech/extern on my unit, but it never hit me the way it did last week. We have had a run of patients that have done very poorly postoperatively, and therefore have ended up staying in our unit for more than the typical 2-3 days. One patient in particular had been on the unit since the week of my hospital orientation. This patient was a poor surgical candidate to begin with, and had multiple issues post op (unstable rhythms, unstable respiratory status with multiple intubations, and acute renal failure). The patient was a candidate for a LVAD (basically a short term artificialy pump to take the workload off of the heart), but the surgeons decided against it. Anyways...suffice it to say that after many years of noncompliance with medications and health issues, this patient was not doing well after surgery. In the 3 weeks that I have been orienting on the floor, I was in and out of this patients room for manny different reasons, but I was never assigned directly to this patient. The patient had sustained runs of Vtach my first night on orientation, so we spent a bunch of time in there trying to get a more stable rhythm (pt was extubated and communicating that first night). The patient was on SLED (a form of continuous dialysis) by my second night of orientation, so we spent time in the room learning about the concepts of SLED and how to run the machine (pt was reintubated by this time, but could still respond to commands). On my 3rd night of orientation, the patient coded and we had to do compressions. I arrived at work on my 4th night of orientation, and took report on my patient. I noticed a bunch of family around the room of the patient I had spent so much time with. I wondered what was going on, but had my own patient to deal with, so I did not wander down to investigate. As the evening wore on, the family came and went, and hospital coordinators, doctors, and nurses were all milling around outside of the room. Finally when my patient was resting, I wandered down to see what was going on. Turns out the family had decided to make the patient a DNR and to terminally extubate the following morning. Apparently a terminal extubation is a big deal and requires lots of doctor consults, and a crazy number of signatures. Now as an aside, the nurse caring for this particular patient was not at the top of the list of caring and compassionate people. He is a very knowledgable and thorough nurse, but not the type that holds the patients hand. After the family made the decision, and went home for the night, the nurse spent probably 90 minutes spit shining the patient. When I went in to help him turn, I asked him what he was doing in there for so long, and he said that he wanted to make sure that the patient spent their last moments clean and comfortable. That really touched me coming form someone that I looked at as a very thorough nurse, but not the touchy feely type. He was talking to the patient and saying how everything was going to be ok soom and that there would be no more pain. he explained how we would be sure to make the patient comfortable. I was touched that he made the extra effort to talk to the patient and make sure they they knew everything was going to be ok. We hadn't been out of the room for more than 10 minutes when the monitors started alarming...the patient had a heart rate of 44 and dropping. We went into the room, the nurse took the patients hand and said it is all going to be ok now...it is ok to go. Within 3 minutes, the patient was gone. This was a first for me in many ways. It was the first patient that I had previously interacted with that I spent the last minutes of their life with (we see a fair amount of death, but usually the ones that don't make it never recover consciousness after surgery and we never really interact with them). It was the first time I saw that even nurses that are not the touchy feely type have compassion...they just show it in different ways. It was the first time I put my stethescope to a patients chest and did not hear heart tones. It was the first time I was the one to say "they are gone". Life is full of firsts, and I will always remember the patients who's last moments gave me so many firsts.