This weekend was another one of those that just broke my heart. My job does that to me sometimes, and yet I won't give up. A friend of mine said to me on the phone the other night "You need to get out of there, it's so bad for you". Well....maybe...maybe not. I could blog all day and still not be able to put into words what this job has done for me as a human being.
Even if we weren't understaffed, it would have been hell this weekend. Actually it could have been worse. We had two orientees on board on the acute side, so they were like extra hands. If they weren't there, it would have been a nightmare. There was the usual bullshit going on...Dialysis in the corner pocket, a chronic vent at the end of the hall, G's patient had a sheath which they came and took out, and of course she started hemorraging, dropped her blood pressure and demanded alot of nursing care. Barbie got an admission in DT's who tried to kick her in the face and was levitating off the bed so we had to call security to come up for that. Our patient near the nurses station was pretty much status quo, and the lady next to him was the same, but awake and what we rudely call "needy". That pretty much means she's critically ill and very scared and uses her call bell alot. Hell, I probably would too if I was her, and I don't think I would like to be labeled as "needy" because of it.
And in the middle of all that we had two deaths in progress. Our patient was one of them. She was 92 years old, and the family withdrew care. Really she was only on a little bit of levophed. We shut it off at 5pm and she went pretty quickly. Her breathing became very slow and shallow, her blood pressure dropped immediately ( and then I stopped looking at it) and then her heart slowed down and stopped. It only took about ten minutes. The family hadn't spent more than maybe 10 minutes with her all weekend, and they didn't want to be with her when she died. I was orienting P, so the two of us pulled up chairs next to the bed and held her hands and stroked her head. I told her to go someplace better than the MICU. One of the Kathy's came in and stood with us also. The chaplain came up and said a prayer. P cried and I got a little teary (I mostly held it in...I cried later in the car on the way home). The chaplain took some time to talk to P, and she mentioned how upsetting it was to her that the family didn't come in. She didn't die alone, we were there, but she died with no one familiar around her, no one to tell her they loved her, no voices or sights that she knew. How sad. But it was peaceful. She just left us quietly. Afterwards, I called the family to let them know she was gone.
The other death, in contrast, went on for three days and it was like a war zone in that room. A young woman, 42 years old. Septic. She was awake for the first day and a half, and she was terrified. And we couldn't do anything to stop it, although we tried everything we knew. Her room was full of doctors and nurses and family and the chaplain. We did CVVH, her pH was 6.9, she was vented. There were about 8 IV pumps in the room, she ended up on two bicarb drips, a calcium drip, Levophed, Dopamine, Vasopressin... They started her on Xigris. She turned purple from her toes to her belly. Her hands turned purple. She went into DIC. I called on Monday to see if she had died overnight and she was still "alive". They didn't let her go until early monday evening. I got a phone call. I had been thinking about her all day. I actually woke up in the morning thinking about her. It affected me, I guess because I had taken care of her the two weeks before and we had talked, she had told me how scared she was, and how it wasn't fair. Her death wasn't fair. It wasn't peaceful. She fought it. We fought it.
Yesterday at work, we were still trying to get over it. Everyone was remembering her. It was just one of those times when you wondered what was the point? What were we doing to these people? And then I walked around the corner and saw that the corner pocket, who we also thought wasn't going to make it, had been extubated and was sitting in bed using her incentive spirometer and drinking decaf coffee. I stuck my head in the room and said "you look fabulous". Her daughter was there and said to me... "I know you all had a horrible weekend and are upset ( she kind of nodded in the direction of the war zone) But sometimes you do make miracles happen and you do wonderful work." Later that night, my patient started hemorrhaging. I took him downstairs for a study to see where the bleeding was coming from. He asked if I would stay with him and hold his hand. The procedure took almost two hours and I stood next to him and the radiation the whole time and held his hand. We had a lovely conversation about his wife, and our dogs,and his family. Every once in awhile he would look at me and smile. He reached up and rubbed my cheek.
And so yesterday is one of the reasons why I don't quit my job.