5 minutes.

It was a relatively quiet night in the Unit. One had a possible PE and was alert and oriented. One was on a trach-vent and very well-behaved. One was in with sepsis s/p not going to dialysis with consistent low bp's, and had mrsa in the blood as well. So after a a fairly quiet evening thus far AND being able to to do actual nursing stuff rather than just simply cna stuff, I was quite enjoying myself. It was my first night in the Unit as well.

The nurse that I was assigned to and I worked on her assessments. We had to draw a blood culture from our trach pt d/t an elevated temp. So we were getting ready to put in the order and were discussing about how to draw blood from a cvc line - flush, draw and discard, then you draw the blood for keeps. This was just around 9pm. Then we hear a splash and the other nurse yells out to my charge nurse. We get up and look in the room of the sepsis pt to see blood everywhere. From the pt all the way to the edge of the door. So I run to get my "haz-mat" suit on (will explain in a minute)... my charge nurse immediately starts calling the doctor and getting meds and fluids for the room and calling the family. The pt only had a saline lock. I grab some pads to spread out over the floor to be able to walk into the room and immediately am told to suction while the other nurse gets the fluids ready to bolus wide open. As I am suctioning, the pt continues to vomit up copius amounts of blood. Clots the size of grapefruits come out. But the more I suction, the more the blood keeps on coming. The pt rolled the eyes, lurched forward, and then collapsed. And all we could do was continue to suction and stand there and watch that last final moment. The pt was a DNR. And it took exactly 5 minutes for them to bleed out and die.

However, there was no time to reflect. No time to call a code. There was no code; there was only 5 minutes. And in another 5 minutes, the family would be there. The experience was adrenalizing, and it would not end yet. We had to clean up that room and the patient so that the family did not see their beloved in such a shocking state. There wasn't time to think about it, we just started soaking up the blood from the floor, from the door, from the wall, from under the bed, from under the patient, from all over the front of the patient. Blood was absolutely everywhere. Yet as a team, we got it done. And the patient suffered no more. And the family did not have to suffer from the sight of all of the blood.

You always hear that a person can bleed out in 5 minutes, but it is just one of those facts that you store away in the back of the mind. You believe it, because they tell you it is so. Even though a small part of you wants to not really believe it, as it is such a short time. But that 5 minutes seemed like eternity. And until I saw it for myself, I was part skeptic. Now I believe completely.

As for the cause, it was a ruptured esophageal varices. Had there been time, we would have gotten the GI doc in there asap. Had there not have been a DNR, we might have had been able to try to do more to keep the pt alive. But we only had the 5 minutes of acute hemorrhage and it was over.

Now for some of the other side of the story... right before the "splash" the other nurse said that the pt said to "call 911" then it all began. Amazing how people just know, isn't it? But as we were scrambling around in our isolation gear to get this or that, especially for the clean up.. our alert and oriented patient was able to view the goings on. That door was shut, but there was no time to worry about blocking the line of sight. We had a medical emergency. So after it was all done... that other pt told me that they knew something bad must have happened as we were all running around in our haz-mat suits. It was actually posed more as a question, and I politely had to tell them that I was sorry, but I am unable to talk about that. 5 minutes later, they were calling for the chaplain to visit. Of course that pt was okay, no impending doom. Just fear. Fear that they too now knew just how quickly death can take a person.