past & present

there are certain moments in life that change you.  three years ago, a perfectly healthy 43 year old trauma patient suddenly coded and died under my care.  it's something that i've alluded to, something that certainly made me different, but also something i've never been able to bring myself to talk about.

my patient was in a rollover car accident with multiple orthopedic injuries.  he had come out of the ICU earlier that day and had promptly gotten out of bed and fallen on the floor.  he was tachy, but otherwise stable.  his chest xray was clear, so we put him on telemetry and gave him IV metoprolol.  i sat with him as i pushed his evening dose, giving it over 5 minutes exactly because i was a new nurse and that's how it was supposed to be done.  we watched the ten o'clock news together.  he was confused, but pleasantly so.  he called me baby, and i tucked him in for the night, setting his bed alarm in case he had any ideas about attempting another escape.  i left his room and sat in the nurse's station to get report on an ED admission.  as i was on the phone, his bed alarm sounded, and our aide responded.  i wrapped up report, and she came to get me.  "something's wrong with him", she said.  i went into his room and he was hyperventilating, eyes wide.  it looked like a panic attack, or a nightmare.  i asked him where he was, and he told me "jail".  he had a criminal history, so with his confusion i thought he was freaking out because he thought he was locked up.  but something still wasn't right, so i called for someone to bring me a dynamap for vitals and i called the doctor and the STAT RN.  i hooked him up to the machine and started to get vitals, turning to the doorway to yell for a coworker to grab me some more equipment.  as i listed off what i needed to her, she got a panicked look on her face.  "is he breathing?".  no, he wasn't breathing.  

i wish i remember what happened next.  i'm sure we got the ambu bag and bagged him.  and i know that someone started compressions.  the room got so packed that i couldn't move.  people were shouting out questions, only some of which i knew the answers to as i had only had the patient for that day.  at some point, the code team decided to pace him.  this is the part that i wish i could forget.  it was, to this day, the worst thing i've ever seen.  and then? nothing.  no pulse.  no respirations.  they decided to call it.  

i cried.  everyone shot me sympathetic looks on the way out of the room.  i stood, staring, against the sink while the two doctors listened for a heartbeat, then pronounced him.  my coworkers came in and helped me clean him up.  i almost told them to be careful for his broken hip.  as if it mattered.  

his family showed up, his father looked horrible.  he kept asking us what happened, and it just sounded so accusatory.  the doctors didn't know, they weren't there.  so i told him.  i told him that he was fine, and then he wasn't.  and i told him that we tried everything and it didn't work.  and i told him that it was quick, and that i was there the whole time.

it was hours after my shift, and i sat charting, trying to make sense of what had happened.  i had to call the donor network to report the death.  i had to fill out additional paperwork because he was in a vest restraint when he died.  i sat in the physician room charting while the doctors discussed the paperwork they needed to do, and the chief resident shot me a dirty look, probably wondering why i didn't work in my own space.  but i couldn't, because i couldn't stand the way my coworkers' eyes felt on me, and i couldn't handle their sympathy.  they all filed out one by one, after coming to hug me and make sure i was alright and see if they could do anything else for me.  "i'm fine" is what i told them.  i wasn't fine, and i wouldn't be fine again for quite awhile.  

i cried all the way home, then laid awake for awhile.  i slept some, and then called my parents.  then i cried some more.  then i had to go in and rehash the entire thing with the nursing director.  i cried then too.  my manager was off that day, but had heard what happened and called me on my cell phone to check up on me.  she told me that her heart sank when she heard that it was my patient who had died.  i guess she knew before i did that i wouldn't be able to handle it.    

we all know death is hard, that it makes you consider your own mortality, think uncomfortable thoughts, etc.  i was prepared for that.  what i didn't expect was the crushing guilt.  the night it happened, i actually had some peace, the feeling that everything happens for a reason and we don't get to chose the things that happen to us.  the peace was short lived.  i replayed that code in my head every day, for months.  i could see the way my patient's body twitched when he was paced, and i could hear the horrible grunting breaths that he got with the ambu bag.  i could picture his father's face, and the parade of devastated family members that came to sit at his bedside.  i remembered his two daughters who had come to visit him that day, and the way that his wife braided his hair and asked me if it was ok to use her hair cream, she didn't want to hurt anything.  and i felt horrible.  like i should have known what was going on from the moment i saw him.  like i should have done something faster, like i let my patient down. 

and slowly, the fear of seeing that kind of horror again crept into my everyday life.  no longer were things as they appeared to be.  death could be lurking around any corner.  any one of my well-appearing patients could be a ticking time bomb, just waiting to code without warning.  i freaked out about everything.  i cried all the time.  i held vigils around sick patients, afraid to leave them for fear that they would die when i was gone.  i cleared furniture from their rooms, unconsciously making more room for the code team.  i remember one patient who was tachycardic in the 140s who had a clear chest xray.  i was sure that it was a PE (this ended up being the cause of death of my patient: massive bilateral pulmonary emboli), and the doctor thought he was dry.  i looked him straight in the eye and said, "that was what you thought about ____".

it took awhile, but i got to be ok again.  time and distance from that awful code took away some of the guilt and some of the horror, but i know that i'll never forget that man.  which is why when my ED admission got called up today and the patient had the same last name, it took me back.  and i told myself that it was bound to happen sooner or later, that it was a coincidence, that i needed to not dwell on it.  my admission came up, and i settled him.  i honestly don't really know what happened to him, as the story kept changing...just that his arm had "accidentally" been cut, severing an artery.  his reputation preceded him, and i was wary the second he rolled through the door.  sure enough, the first thing he did was pick up the phone and start screaming about going to court and child support.  i did my assessment and listened to his conversation at the same time, trying to see if i could learn what actually happened to him.  he told the person on the other end of the phone where he was at, followed by "i don't even want to be here.  this is where my uncle ____ died".

i froze.  i mean what are the odds, really?  as past and present collided, i had the overwhelming urge to tell this patient that i will never forget his uncle, and to see if the family blames the hospital, blames ME for his death.  but of course i didn't.  i just went about my night like usual.

i used to wish that i could forget the night of that code, that i could wipe that man from my memory altogether.  i feel differently now.  that patient changed me.  he made me a better nurse, one who can handle the things that are terrible.  so when i came home, i took a minute to remember.

it's the least i can do.