DNI

We had a lady in the unit who was loved by her family. They were not quite ready to let her go. In fact, they requested that everything be done for her, except intubation. Unfortunately, she was in respiratory failure. So overnight, her sats began to go from the 90's on a bipap machine to the 80's, then to the 60's and so on. Her fingers were purple, but she had a strong pulse generated by her pacemaker. The daughter was called in because it was obvious that we would have to code this lady. The charge nurse pulled the crash cart into the room and RT was called. Once they had the ambu-bag set up, CPR was started. Drugs were pushed. Her BP came up from the epi push. She had agonal breathing, and unfortunately the efforts to keep her alive without intubation failed. The family came in the room to say their final goodbyes, and she passed on quietly.

I had a hard time understanding why the family wanted CPR but not intubation when the patient was in obvious respiratory failure. I don't know if it was a lack of understanding of the procedures, but generally in this situation, intubation is probably the only thing that would have kept her alive, but she would never have come off of it. Perhaps that is what they were told, and thus the decision not to have intubation. But CPR on a respiratory failure? Did the doctor not fully explain? How come there aren't booklets or pamphlets that will explain this to families and patients, in terms that they can understand? Maybe there are, but I have not seen them. People have spent so much time watching patients miraculously saved on tv shows, and this just isn't reflective of what really happens. When the body is in multi-organ failure, time is minimal and probably not even CPR or intubation will be able to save the person, only prolong the inevitable.

If I were a politically active person, I would be all for pushing for the patient's right to be comfortable in the end. I also believe that if doctors were there on the floors having to care for these patients like nurses do, so many more things would be done to provide comfort measures at the end of life. Especially for DNR patients. I guess I will end my rant here... I understand that ethics is a major player in the above situations for everyone involved. Just sometimes it can be frustrating to watch a person suffer.

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On a different note, I get to fully transfer to the ICU as an extern in September. I am so excited!! I have spent the last 6 months out on the med-surg floor, and I am ready for some new areas to explore. I plan on spending the rest of the summer trying to learn the rhythms and ekg's. I have already learned a little bit, but not nearly enough! Though I can pick out a PVC, not that is too difficult really. I just need more experience, plus learning how to recognize the different lead views etc that is shown on the monitor. I am even thinking of purchasing a book to study up on it. It's not that I don't have a ton of things to already finish the rest of the summer. I have to finish my project for the fall. Have a great idea for that. I also need to go down to the school and finish some computer modules that are due this fall as well. Am doing great in my pharm class... our final is coming up soon. Otherwise, have a wonderful rest of July. I am taking a break from blogging unless something fantastic happens in the meantime before school begins.

it's a girl!

I finally got to go to OB for the first time last night. What a refreshing experience!! And to go there and find a lady about to give birth. Since we are starting on our OB/Maternal-Neonatal rotation in the fall, I jumped on the experience as soon as I found out. It took 2 hours of grueling pushing to finally get the baby out.. a whopping 9 lbs! And her first baby... but it was so beautiful. Beautiful in the sense that a new life has joined the world and beautiful in that it was so nice to see healthy young people instead of our normal elderly patients on the regular floor. I really love to work in the unit, but I really enjoyed working with the moms and babies as well. I do hope I get to do it again sometime in the future. I am up way past my bedtime, but will add more to the story later when I can get my thoughts completely together. :)

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On another note.. my youngest son's baseball team won their first All-Star game yesterday. Congrats to all of the boys on the team and hoping for another win tonight in the tournament!
Unfortunately, they lost the next two games and were defeated :( I am so proud of my son for his outstanding performance though. It is really something when the coach of the other team comes up to tell him what a good ballplayer he is :))

A Final Goodbye

Tonight one of our long term patients passed away. He had been there right around a month, so we all knew him and his family quite well. At the 4 am rounds, nothing seemed to be out of sorts. Vitals were good. A half an hour later, the son comes out of the room and says that there was some blood around his IV site. I went in to have a look as my preceptor was taping her report. I didn't see anything that was unusual. Sometimes blood comes back with a flush, which had just been done a bit earlier. The son was worried he might be in some pain, so I gently asked the patient, who was not very verbal, to try to squeeze my hand. This was to see if he could follow commands. He squeezed my hand several times. So I asked him to give a good tight squeeze if he was in pain, but he did not differ in how he squeezed. I told the son that sometimes about 3 or 4 in the morning he would wake up for about 30 min to an hour and have a spell where get got a little out of sorts, but it usually passed. The son left the room for a few minutes, and I decided to wet a cool wash cloth and hold it on his forehead for a minute. I wiped his face off and the edge of his hair. Lifted up his non-rebreather mask and wiped his face under it. I could tell that this had a great calming effect on him. I held his hand and told him that he was a special man who had family that loved him very much, that they had been here with him every day. I began to notice a change in his breathing, so I watched closely for a minute. I knew that it was time. I zipped out to the hall to get my preceptor, whom I could hear at the nurse's station and told her to move it in there. She came in and a had a quick look and took off to get the son. I told the patient that his son was just outside and he would like to say goodbye before he left us for good. I told him everything was okay; he was not alone. He looked at me for a moment and shut his eyes. The son came in a bit confused, and I told him that his father was about to pass on. He immediately began to tell his father what a pleasure it was to be his son, that he was proud of him and to go be with his mother. His father took 3 more breaths before he left this world. I told the son to keep talking because hearing was the last thing to go, that it meant a lot to be able to tell someone you love them and to say goodbye. The son was amazing. I hoped that my children would do the same for me when it is my time to pass on. A few minutes later, my preceptor comes back in, checks for heart sounds. I told her there had been no respirations for about 5 minutes now. She told the son then that his father had for sure passed on. And he finally cried. And so did we. I always wondered how I would handle such a death, now I know. I am proud of myself for being there with the patient so he did not have to be alone. I am just thankful that he is suffering no longer. May he rest in peace at last.