5 West Nursing

My patient is really sick… he could go anytime soon.

When I took report he was already in bad shape, although still alert and oriented, he is intubated and on the vent. I do my best to relax him and allay his fears. I couldn’t imagine what he might be going through… laying there, intubated, and on pressors, knowing that you might not make it through the night is just frightening. “It’s OK sir” I said, as the IV pump alarm goes off signaling the end of another bag of Neo-synephrine. I can see that every time an alarm went off, his heart rate would go up even more. “It’s OK, just relax, it’s only the IV pump.”

A few hours pass and I can tell that he won’t make it. This is the first time I’m taking care of someone who may actually die on my shift. “How ironic”, I through to myself. Yesterday I was just thinking, “I’ve never had anybody die on me before.” Today might be the day. My colleague, a veteran ICU nurse of 18 years says he won’t make it. My patient was going into septic shock with multi-organ failure… no urine output, on pressors, BP hardly holding, etc. He’s still awake… it’s just a matter of time now.

As I took my break I can’t help but wonder how he was like when he was still in good health. According to the history, he drank heavily which explains the liver cirrhosis. He put the bottle down a year ago, however, the damage have already been done. Unfortunately he is reaping the fruits of his longtime drinking habit. The harvest is not a good one. After my break I noted that his heart rate was going down with increased irregularity. He stares blankly at the ceiling, barely responding to me now. I call his family to come in, “he’s deteriorating and he may go soon.” I told them.

When they arrive I can see the despair in their eyes. There’s nothing much they can do now but look on helplessly. I wonder if any of them warned him on the dangers of drinking while he was yet healthy. I’m sure they did. He probably told them “yes, I’ll quit… but not today.” It’s sad to see a life ending like this… he seems to be a kind, gentle man. Then it happened…

The monitors go off for the last time. I check lead placements and confirmed that he was in asystole. No pulse, no blood pressure, monitor shows a flat line, although still “breathing” from the vent, he’s gone. “Is that it?”, asks his sister who held his hand the whole time. “I’m afraid so.” They had just came in from out of town earlier that afternoon, and after a conference with the physician placed him on DNR status. I call the doctor in… time of death 0245. After a few minutes, the family leaves. Postmortem care is underway. I started out with one patient and ended with none. I guess I’m going home early today.

As I drive home I couldn’t help but wonder about how it would be living your final moments. What thought would be going through your mind, what you would have done different in your life. I think about my family, my children, and the life I lived. Ten years ago I wouldn’t be thinking of these things. I realize that as we grow older, our thoughts change. All of a sudden life is just but a fleeting moment. Unfortunately we are all too consumed pursuing the trivial things in life… career, money, prestige. I guess it comes down to this… when you go, what what impact has your life had to those around you? Have you ever thought about your final moments?