Sacred Moments

the holidaze are interesting times to work in healthcare. all the people with seniority are at home, and as far as scheduled things, doc's try to avoid doing elective stuff right beforehand so they don't have to round on peeps/get called during this special time.

so the patient population is those peeps that are REALLY sick, and you generally have skeleton/rookie/newer/less experienced people taking care of them.

i have been a nurse for a little over a year, and i work on a floor with a wealth of experience, so yeah, i worked a lot of holidaze.

on one of those holidaze, i had a patient die. i don't want to say that i 'lost' him, rather, i 'let him go.'

basically, the dood had been stringing lights (at 96!) had found a nest of bugs (some of which he may have been allergic to-) done the 'i-found-bugs-i'm-allergic-to' dance, while still on the ladder, and down goes frazier.

he was lucky he only broke a coupla ribs, his hip and humerus. unfortunately, at that advanced age, it usually only takes one little thing like that to push people over the edge, and in the end, it was the pneumonia that did him in. 96 years old, frequent, productive, ineffective cough. NOT clearing his own secretions. cause of death could have been listed as 'booger.'

he was DNR (do not resuscitate) NCR (no cardiac resuscitation, meaning no cardiac stuff, like cardioversion or cardiac drips), as well as DNI (do not intubate). thank the good Lord for that.

within the bounds of these limitations, because of course being code status DNR, DNI, and NCR does not mean 'do not treat,' we were doing everything else we could for him. antibiotics, frequent suctioning, BiPAP.

he mucus plugged the night before Thanksgiving eve. i noticed his O2 saturation line was going squirrelly on me, so i walked into his room to check it's position, thinking maybe it has slipped off of his finger. normally, this guys had rales and rhonchi (unnatural noises your lungs make when there is stuff in them that shouldn't be, like lotso' boogers) so loud that you could hear them without a stethoscope just walking into the room.

when i walked in, there was silence. the only sound was of the BiPAP, trying ineffectually to push air into this guys lungs. that meant that he had mucus plugged, or gotten boogers so backed up in his lungs that it had occluded his airway, hence the inability to 'move air,' hence the silence. he was still alert, and was in fact waving his arms around and still had good color.

i like working my particular weekend in part because matching my 6-in-a-row shifts is the worlds best RT, or respiratory therapist. if you need an ART line, a ABG, a stat intubation, this is your man. Bartholomew is the MAN. anyways, i called him, and between the nursing team and him, we pulled the guy back. at one point, the color on this dood was so bad, he could have been the fourth member of the blue man group. but we got him back, he was alert and oriented and back to where he was before.

almost.

during this ....... event, things had gotten so hairy i wasn't sure if he was gonna pull out, so i had asked our charge nurse to notify family. if the hospital is calling you at 4 in th AM, it is hardly ever a good thing.

a coupla of the kids had shown up by the time we'd pulled old dad thru, and so i explained to them what had happened and what we'd done and basically told them that it would probably happen again, and that there was no way to know when it would happen, and that one of those times, we would probably loose him.

before he mucus plugged that first time, he was the chipperiest 96 year old you ever met. man, he was WITH it. all into college basketball and the foosball and everything.

after the first mucus plug, he just slept a lot.

by midnight on Thanksgiving, when he mucus plugged for the fourth time in 20 hours, we were pulling up more than just sticky yellow boogers. we were getting blood back as well, and we couldn't get the offending plug free. the family came again, and once we pulled all ventilation support, he only lasted 10 minutes. just long enough to tell his family he loved them, and it was time for him to sleep.

i imagine that there have got to be no better words to hear from a dying parent. the love part is self-explanatory, but the key is the 'i'm ready to go.' i feel like it absolves the children of any feelings of responsibility for allowing death to take it's natural course. and i admire the bravery, courage and self restraint the kids displayed in honoring their dad's wishes. the difficult thing in those circumstances is that at any time, any of the kids could have changed course and asked or demanded intubation, cardioversion or reversal of any of the parameters i mentioned earlier. they did not, and the Death came as peacefully as it could have, under those circumstances.

in those final moments, i administered some comfort measure doses of ativan and morphine, and left them to be with their dad alone.

what do you do when your dad dies on a holiday? how many holidays does it take before it does't kill you when people talk about it?

anyways, i got to be in the room again while somebody passed thru to the other side.

sometimes i wish i still remembered how to cry.