Aside from all the ranting I can do about some of the patients I see, I love being a nurse. I love being at the bedside, doing things to help make people more comfortable and taking care of things that they are unable to do for themselves. I enjoy meeting new people, even on what could be the worst day of their lives to that point, and seeing them depart to either continue care as an inpatient or to go home with their process of healing started.
I see all kinds of patients, from the ages of days old to a century old… and they all have a spot in my memory somewhere and a typical patient is one I remember fondly. Sure, they don’t all have happy endings… and there are times when I wish I could go back and say a few more things to some of them, but for the most part, I know from experience that I do as much as I can for the time they are in the department.
My youngest patient was a little guy who was born on a rescue stretcher before we could even get mom to a hospital bed. It sure makes your heart race a little when you don’t work in a place that delivers lots of babies. He and mom both did fine and were transferred quickly to the post-partum unit of the hospital.
My oldest patients have been over 100. A surprising number of them have been alert and oriented. Knew who they were, who the president was and why they were at the hospital. Usually the older patients are in an ER for falls or changes in their mental status. You’d be surprised at how many little old ladies are suddenly crazy because they have a urinary tract infection. Let me tell you, I’m glad some of them aren’t very strong… I’ve been smacked by more little old women who don’t understand why I keep bothering them. Poking them with a needle or lifting a breast to place EKG stickers will sure get their attention in a hurry even after you'd tried to explain what you’re doing before you start.
Unfortunately, the memory works in a funny way… because you can’t just pick and choose who you remember as a nurse. Usually something will stand out and will jog your memory if you can associate it, but by and large… I don’t remember a lot of the non-emergencies or generally cordial patients. Sometimes I’ll remember a face or a diagnosis, other times a family member, or even a discussion about an event. Other times, you can look at me and know that I was your nurse on a previous visit and I have absolutely no recollection of you or your visit. I wish I could remember everyone, but with the amount of patients I see every day, it’s probably a good thing I don’t.
There are some I remember by name or face that I avoid getting into my rooms at every opportunity. One in particular was a drunken man who had come in and was just awful. He was rude, even as I did everything I could think of to make him comfortable. He was a difficult IV start… and he left abruptly and was very aggravated. That’s all I remember. But, I do know that as I watched him leave, I vowed that if I ever saw his name on our tracking board again, that I would avoid being his nurse if at all possible. Generally, even the upset patients aren’t ones that stick in my memory... but he was just awful enough that I knew I would have a hard time being nice to him if he ever had to return. Don’t get me wrong, I would treat him and do everything I could to make his stay as pleasant and as comfortable as I could make it if I would have him as a patient again. I just would prefer not suffering through a repeat performance if at all possible.
Then, there are the patients who you know you’ll never have again because they’ve passed away, that you wish you could spend just a little more time with. I remember a gentleman that I helped care for when I was a fairly new nurse. He wasn’t my patient as assigned, but I spent a great deal of time with him assisting the other nurse. He was cordial, had a great sense of humor, and knew that he was dying.
He had a rather non-descript history. I don’t remember anything that struck me as something that was immediately concerning, but just things that arise from being a middle-aged person who hadn’t lead a very healthy lifestyle. He talked about his two sons, and wishing that they lived closer so he could see them one last time, and he talked a little about his father and brother who had both died at the same age the patient was currently. He was generally doing well as far as his condition for the most part during the ER stay, but he would have these severe and unprovoked episodes of shortness of breath. Increased oxygen, repositioning and breathing treatments resolved the episodes as they occurred, but they continued to increase in both duration and frequency over the course of several hours.
To share a little bit about an ER visit… generally, you are hurried in, we do everything medically possible to stabilize your condition, do all the testing requested by a physician, and then monitor you for changes while we wait for those tests to result.
We were at the waiting stage of the visit, and had increased the oxygen the patient was getting and continued to monitor him. He was stable, had decent vital signs and except for the oxygen mask, he looked relatively ok. He kept making reference to being aware that he would never leave the hospital. Now, I was a fairly new nurse at this point and I couldn’t understand how this feeling of “impending doom” was a bad sign that most experienced nurses would tell you was really just that… a bad sign. I remember talking to the doctor about it…. The doctor expressed increased concern and went to reassess the patient, but there was still no change in his condition.
The patient continued to talk to the staff members, talking about his family, etc. Then, for no obvious reason, even with the oxygen on and after not talking for a little bit, he started to have severe difficulty breathing. We moved him into a “trauma room” (at this particular hospital, there were 2 trauma rooms, and while they had more equipment at the bedside, you would generally move a patient who was in significant distress to that room simply because it was bigger and more staff could be ready to assist if necessary without being cramped in a smaller area.) The move took about 30 seconds… since it was only about 20 feet from where we started, the only thing we had to do was hook him to portable oxygen, take the monitor out of the base and carry it along, and move his entire stretcher… so it was very little change for the patient other than the scenery. We repositioned him after moving, situated him to the call light, the changes in the room, and his breathing improved and he seemed to be doing better. He never complained about any pain, even when prompted, and his vital signs stayed within normal limits while he was on the oxygen.
Then, with no warning at all, much with the previous episodes, his breathing rapidly deteriorated and this time wasn’t improving with increased intervention. We had talked about interventions he wanted done, should something happen, and we immediately started the process of CPR (cardiopulmonary resuscitation). We started helping him breathe with a special mask and bag attached, and gathering the necessary supplies to put a tube into his lungs so we could put him on a ventilator. As we gave him medication so the procedure wouldn’t be painful and another to hopefully give him amnesia of the event, we laid him back on the stretcher to intubate him.
As we laid him flat, his heart stopped beating. We then immediately checked for pulses, found none and started chest compressions. He was subsequently intubated, and we performed chest compressions and gave medication to try and revive him. Our attempts at reviving him were not successful. We did CPR for a long time on that patient…. After he was pronounced dead by the ER physician, we talked about his visit. A sort of ‘after action report’ at the bedside and discussed things we may have done differently. No one could think of any intervention that we didn’t try and I think that was the first time I ever felt helpless as a nurse. There was just nothing apparent that we could have done differently to save that man’s life. In retrospect, after reviewing the tests that were done (and had not been resulted by the time he was moved to the trauma room), he had apparently had several blood clots throughout both lungs. There are things that could have been done differently, in retrospect, using a blood thinner like Heparin could have prolonged his life, but as with everything related to medicine, there is no guarantee it could have worked at all.
I will never forget that patient. I don’t remember the jokes he told, other than they were ones I had heard before and they were very corny - he thought they were quite clever though if you could judge by how many times he told them and how many nurses he told them too. But I will remember him talking about his family, his son in college and another who had just gotten a new job and had made his dad so very proud. Its knowing that you are their family when the other can't be there that makes nursing worthwhile sometimes. You are their support, their caregiver, their confidante, their advocate and their hope. Spending the last few minutes with someone is unbelievably difficult and unbelievably humbling.
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