anyway, according to the wisdom that is wikipedia, the main character in the story decides to go to vegas and drink himself to death, blah blah blah, ends up *SPOILER ALERT* dying peacefully in the arms of a pretty prostitute. you know the death, that quiet kind where the character just closes his eyes and 'dies.'
well, my friends, i have been there and done that, and trust me, it was not that pretty. nor that easy.
i write the following as a testament to the awesomeness of my floor.
we got an admit to my floor from the ER. i was over on the neuro side when they wheeled the patient past me. the patient looked as yellow as those legal pads. yikes. my patient was pretty stable, so i wandered over there a little later to lend a hand and see if i could learn anything.
turns out the patient had a horrendously low hematocrit and hemoglobin, so the patient was getting transfused with a bunch of PRBC's (packed red blood cells) and FFP's (fresh frozen plasma). i was talking with the pulmonologist, Dr Dolina, when the nurse in charge of the new patient handed him a paper with the latest H & H. they were bad. bad enough for the doc to whistle and pop open his eyes.
so he ordered 4 more PRBC's and 4 more FFP's, and the fun began.
the patient's condition kept deteriorating. kept needing more and more help breathing, and the color kept getting worse. also, the patient's abdomen kept getting more and more distended. the doc was able to get a history from the patient before the patient became completely unresponsive, and discovered that the patient had a leeeeeeetle drinking problem. besides having a ruined liver from drink, there was also probably had a bleeding ulcer involved, hence the low hematocrit and hemoglobin.
i've mentioned that my patient was stable, and i was still keeping an eye on him. i'd check on him every hour, and i had another nurse covering me in case anything started beeping in his room or anything like that. the most that could happen with my patient was having the propofol run out. so i'd go check on my patient, do what i had to do, chart my stuff, then head back over to help out some more. there was always something to do.
as it became more and more apparent that this patient was seriously trying to die on us, more and more people were sticking around to help.
those of us with the most stable patient's helped the most. one time i got back and was asked to find the yellow isolation gowns and the surgical face masks with the eye protection. huh? okay. i got back to the room with the stuff, and asked why we needed it. the consensus was that in light of the belly distention, and the continued dropping of the hematocrit, and the patient's continuously increasing O2 needs, intubation was the next step, and it would probably involve a lot of bloody vomit. hence the need for the face masks with eye shields.
so i'm like, if we know the patient is gonna hurl, why don't we stick an NG tube down first? seemed like a good idea to me, but the decision was to try the intubation first and risk the vomit, because if the intubation went well, getting the NG or OG tube into the stomach would be much easier. fair enough.
intubation was a success, as in there was no vomit. by this point, i might mention, the patient had received about 12 or 15 units of blood and an equal amount of plasma. so when we placed the NG tube, it came as no surprise that we IMMEDIATELY got out 1000 mls of straight blood. without even having any suction.
bless our pulmonologist. as it became obvious that the patient was losing the blood and plasma we were pumping into his veins thru the hole in his stomach as fast as we were pumping it him, he was trying to find a way to fix it. surgery wouldn't take our patient, the patient was considered too unstable. same for endo. our only hope was interventional radiology.
we had a femoral ART line, and you could totally see how the blood and plasma helped the patient's pressures. we'd have 50's over 30's, then we'd infuse and we'd get pressures of 80's over 50's. then we'd gradually lose the pressures.
so as the night is going on, i'm still keeping an eye out on my patient and helping as much as i can with the crash admit. by this time, we've got a respiratory therapist in the room at all times, we've called over the charge nurse from another floor for back-up, and our charge nurse hasn't left the room for hours. plus, besides me, there were at least two other nurses in there pretty much at all times as well.
interventional radiology gave the word that they were willing to try and were ready to go, so the whole team, minus me, went down for the attempt to cauterize the bleeding. they had to use the big ventilator and not the transport one because the O2 needs were so great that the little one wouldn't have been able to keep up, which meant two therapists were needed. there were also two nurses hand pumping in blood and plasma all the way down the hall in a last ditch effort to keep the patient's volume up, plus three other nurse carrying charts and IV's and everything else.
the patient .......well, lets just say that the interventional radiology team was able to stop the bleeding. pressures were stable in the 120's over 70's. thats better than mine!
from what i understand however, when you get some thing like 40 units of blood and 40 units of plasma and have that much of a shock to your body, every organ system in your body takes a hit. you're looking at respiratory failure, complete kidney failure.....it's just not real pretty.
so, while the heroic efforts of our night were successful in staving off immediate death and the bleeding was stopped, the patient expired/was let go just before i came back that night for my back-to-back shift.
was it a lost cause?
the patient, it turns out, may have had a bad divorce and may have intentionally been trying to drink him/herself to death. in which case, he/she was successful. i still feel bad for the person, and at least i got to learn something.
specially that my floor and the staff are AWESOME.
man i love my job.
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