easter sunday

the first time i heard screaming during the shift i worked on easter turned out to be some sort of prayer revival.  the second time was the pure hood antics that our unit is famous for.  

we were all minding our own business at shift change when we heard the following: "YOU DISRESPECTING ME (n-word, string of swearing).  THAT'S WHY YOU IN HERE, THAT'S WHY YOU GOT THOSE WOUNDS 'CAUSE YOU DISRESPECTING ME!!".  assuming that someone is about to get the beat down, we promptly called security.  we all gathered outside the door to hear what was going on, expecting this to be some sort of baby mama drama, etc.  much to my surprise, it turns out that the very upset visitor screaming at the patient was actually his mother.  apparently someone had a few too many drinkies at the easter barbecue and decided to come to the hospital for a nice visit totally sauced.  lovely.  

at this point she was crying hysterically and had to be removed from the room by security.  she was so obviously impaired that the officers asked her if she was taking any drugs.  she blamed the whole thing on being drunk, yelling "IT'S THE ALCOHOL!!  THE ALCOHOL MAKE YOU DO THINGS...IT MAKE YOU SAY THINGS!!" and continuing to be hysterical.  poor security took her outside to "get some air" and i thought she left.  about 20 minutes later i get a phone call.  apparently security had been sitting with this lady in the lobby the whole time, and was calling to ask when her daughter (her ride, who had so wisely driven her trashed mom to the hospital) was planning on leaving.  i went to the room and tried to tactfully ask the daughter when she was planning on heading out as her mom was "upset" (aka completely wasted).  after staring at me for a minute like i was stupid, she told me that she wasn't about to "waste her gas drivin all the way out here to be here 10 minute" and that her mom "gon have to wait".  then she proceeding to sit in the room for another 25 minutes until the security officer came back to the room to get her.    

1. don't bring your drunk mom to the hospital

2. seriously, you won't take her home?  aren't you embarrassed at all that security has been babysitting her for the past 45 minutes?

3. and on a holy day?  for shame.  

so the moral of the story is...save the hard drinking for christmas.   or something.  

on passing

i knew that he was dying from the moment i met him.  i was surprised because he didn't look bad on paper when i was getting report, but in person it was clear.  he was an elderly man who had fallen and broken multiple bones in his face, neck, and back.  i could see hear crackly lung sounds the second i stepped into the doorway.  he fought the oxygen mask that was cranked up all the way, and the respiratory treatment he was getting did not appear to be helping.  his color was terrible, his foley had no urine despite diuretics, and it was pretty obvious where this was going.  my suspicions were confirmed when i got vitals and saw an oxygen level in the 70s maxed out on O2.

even in a world where it's somehow ok to try to keep brain-dead people alive, this man was not going to make it.  the question at this point was how he was going to die.  would it be in a few days intubated in the ICU, sedated and maxed out on pressers?  or would it be under my care in a few hours?

the day shift RN and i went to the back room to talk to trauma.  everyone knew that the patient had a terrible prognosis, but i don't think anyone realized how little time we had.  "he is dying now" i told them.  "we need to make sure the family knows what's going on".

the family had been at his bedside the entire time, watching him struggle.  that's a terrible thing to see, but despite their own feelings they were doing the best they could to hold it together.  a granddaughter was holding his hand so he wouldn't pull the oxygen mask off his face.  i stood on his other side doing the same.

i held his hand for over an hour.  my wonderful coworkers took control of the rest of my patients so i could see things through until the end.  trauma came to see the patient, and in quiet panic went to call the palliative care team.  i wasn't sure they would make it in time.

both teams made it to the bedside shortly thereafter.  they were compassionate and clear about what was going on.  the family talked amongst themselves and decided that he wouldn't want to live like this, and they would follow his wishes not to be intubated.  the palliative care team ordered a small dose of IV pain meds and i gave them.

a half hour later, the restlessness stopped.  he took a final breath surrounded by his family, and he died.

i had been about to give him some more meds because he was agitated, waving his arms up towards the ceiling when he hadn't been doing that before.  now it seems to me that he saw something, and was reaching for it.

but of course we can't be sure of that.

his death was hard to watch, especially for the family.  but overall i would say that it was a good way to go.  suddenly and quickly, after almost 90 years of a good life.  a few short months behind his sweet wife who, according to his family, was his reason for living.  there are worse ways than this.

it's a sacred and sobering thing, to be involved in the dying process.  how to guide a family through it is not something that they teach you in nursing school.  it's another one of those things that you pick up as you go along.  more so than anything else, you put aside professional boundaries and just be a human being...a person who has experienced loss personally, and who can empathize.  you do everything you can to make the experience easier, and if you can't, you acknowledge the fact that you know it's really hard.

from the moment i met the patient to the moment he died was a short two hours.  but i've learned that you don't forget important things, no matter how briefly they lasted.