Gone but not forgotten

I returned to work on Monday after having a week+ off (yes I know I'm lucky, and it wasn't because of vacation, it's just how my schedule rolls) to find out that our clerk (the one who processes our doctor's orders for us) had died last thursday.

I was in complete shock. I couldn't believe it. She was only 51 yrs. She didn't have any pre existing chronic conditions. She was sick with the flu/terrible cold when I worked with her on the previous Friday and was telling me she was wondering whether she should work the next day because she felt so yucky.

We have lost a good woman and I will miss her. She was certainly taken too young. I do, however, feel a bit better that at least she went fast and didn't suffer (from what we've been told). That's the way I want to go when it's my time - quick and painless. One minute here, the next minute gone.

The one lie nurses will tell

We've had a string of deaths on the unit, majority of them are our DNR's and palliative pt's and surprisingly I'm still a virgin (meaning none of these ppl have died while they're in my care) and tonight when I went to work I found out that one of my pt's I had Saturday night had passed.

I was surprised and when the nurse who had the pt came onto shift I asked about the details. While talking with him we talked about how he informed the family. Another nurse was in the room when I brought this up and gave this piece of advice...

If a family member wants to know if anyone was there when they died, tell them YES - EVEN IF THAT MEANS YOU HAVE TO LIE!!! NEVER EVER tell them that they died alone. Hell, make up a story if you want to, but never tell them they died alone... it's like the #1 fear that family members have when their family member's in the hospital.

Well sure enough, we had a sudden death on our unit tonight.... and what ONE question did that family member have?! Yep, "did he die alone". Thankfully we could answer this one truthfully because she had like 4-5 nurses around her when she took her last breath.

Moral of the story - ALWAYS tell a family member that someone was there when they took their last breath, never leave them with guilt that they couldn't be there when they died. At least the family will take comfort in knowing that at least SOMEONE was around, even if that isn't the truth.

Am I losing my touch with humanity?

Lately on our unit we've had an increase in the amount of deaths. Now I understand that eveyone has to die, heck we don't live in the age of the bible/torah/quran and live to be 800 yrs+

That being said, we've also had people on our unit who are DNR (do not resuscitate) who I can't help myself in thinking that many of these people I would rather see die... but only because IMO they are suffering.

The last shift I worked was one such case - I had a patient who's not very old - I'd say youngish, on TPN (since like 2001/02), was severely emaciated, had several comorbidities and had been in and out of units (whenever he gets readmitted he gets put back on our unit for some reason - totally unrelated to the fact that our unit is for neuro pts) for like a year+.

During this last admittance, he suddenly started vomitting blood EVERYWHERE and had to have an emergency scope to have varices in his stomach banded/cauterized. When he returned back to us, he required like 6-10 units of blood, plasma, IV fluids, etc...

To see him, he was CLEARLY suffering - and I'm thankful that he passed because you could see that not only was he suffering, but so was his family.

Another pt we've had on our unit is an older patient who is also a DNR, tho has late stage dementia. She's been on our unit for several months I think and recently became a DNR, the family was in denial about her condition for so long. This woman moans CONSTANTLY, is completely delirious and is VERY difficult to take care of, emotionally and psychologically because there's nothing that we can do to settle her. Even super strong anti psychotics don't touch her. She's REALLY difficult to feed or get her to drink and therefore she's starving herself. At least with the DNR in place, we don't have to give her a feeding tube. I'm hoping that she's passed, her family is having such a hard time seeing her waste away, physically and psychologically. They cry almost every time they come to visit but know that a DNR is the best thing to do. Thank goodness!!!

We have another lady on our unit who's on restraints because she has a neuro disorder that causes these involuntary movements. Now, in our province, no LTC (long term care) facility will take a pt with restraints, and therefore must stay with us in the hospital. This family, tho will not make her a DNR. I don't understand why, or maybe the Dr hasn't talked/pushed the family into making her a DNR. It's not like this lady's condition is going to improve, it'll only get worse! It's a terminal disorder. And I certainly don't want to be pushing down on this lady's chest when the time comes that her brain is going to deteriorate to the point where she stops breathing and I have to call a code on her, because she isn't a DNR. SOOO frustrating. I am surprised tho that this family comes to the hospital DAILY - for lunch or for dinner and personally feed her. It astonishes me because you think that that would eventually fade.

My question to you folk out there.... have you ever thought about delaying calling a code on someone who should VERY obviously SHOULD be a code????

Another first

Tonight I was involved in my first code blue - the patient has been on our unit for two weeks - he wasn't very old, and was there because he fell and hit his head and had a subdural hematoma, had a craniotomy done and had a tracheostomy done. Well tonight the hospitalisst came to our unit to handle a few of our concerns and this pt was one of them.

The pt hadn't been doing well all day - don't know the exact details as this pt was obviously unstable and was therefore given to an RN, not someone I can handle... and the hospitalist decided to do a stat CT scan... found out that this person had a VERY large DVT in the one leg.

Well this person gets back up to our unit and maybe 10 minutes, the hospitalist goes into the room and next thing I know, they're calling a code blue.

Since it's my first - I go in and try to see what I can do - at the very least observe - well I stood at the door and handed out the PPE (personal protective equipment) - masks, gloves, gowns - to those who attended the code... since there waasn't anything else I could really do - can't do any of the meds, they had a respiratory therapist there already and an ICU support RN there... so I observed in my corner.

It was intersting to say the least! What an adrenalin rush - I can certainly see why some people want to be part of the code blue teams! They worked on him for 20 minutes and then pronounced him as he had had 3 pushes of epinephrine, 2 pushes of sodium bicarb, and 1 push of vasopressin.... and he wasn't profusing, they couldn't get a pulse or rhythm.... the family was CRUSSHED!!!!

I felt bad for them for sure, I couldn't even imagine losing someone THAT fast - one day there, the next day gone.... I think I should look into a living will!!! For that matter - how many of you guys out there have one?