End of life care

upDownGraphAs I stood next to my patient’s bed in his dimly-lit, muted room, I waited for the inevitable.

I could hear the faint sound of the vent and the quiet beep of the telemetry monitor.

It was my third clinical day in the ICU as a nursing student.

I knew all of my patients were sick, but I knew this patient was the sickest of the sick.

My instructors were preparing me for critical care, teaching me the ins and outs of the equipment and the different types of assessments, like the Glasgow Coma Scale and SIRS.

However, they couldn’t prepare me for everything.

My patient, an elderly gentlemen suffering from respiratory and end stage renal failure, was quickly approaching death.

It almost seemed that if you listened closely enough, you could hear Death galloping towards him on his pale gray horse, scythe in hand, preparing to strike.

My patient was too unstable for dialysis; his body swelling till it couldn’t swell anymore.

His hands and feet looked like balloons and his scrotum burst.

As a student nurse, I’d never witnessed this before.  And I didn’t like it. It gave me a sense of foreboding and death.

At the beginning of my shift, my patient was a full code.

I expected the vent and the reams of drips to keep him alive.

Sure, he had a few runs of v-tach, but they only came in bursts, always quickly returning to sinus rhythm.

Then, without notice, the family decided to pull the plug.

At first, I didn’t understand.  I didn’t realize the magnitude of the family’s decision.

I guess it just didn’t register, and I didn’t appreciate the implications of the decision for me, his nurse.

As I was charting, my instructor sat beside me.

“He’s your patient; I’ll give you the honors.  Respiratory is on the way; they’ll extubate him.”

“You’ll give me the honors, what do you mean?” I asked, naively.

“We’re withdrawing care.  He’s your patient. You’re going to shut everything down, discontinue the drips,” he muttered.

“Okay, tell me what to do.”  We walked into the room. My patient was awake, his big brown eyes darting about.

“Isn’t his family here? Aren’t they coming?” I asked.

“Nope, they told us over the phone.”

“What?  They’re not going to be here?  Christ.  Do we have someone to sit with him? He shouldn’t be alone.”

“No, we don’t have enough staff.”

I sat there, stunned.

Sheepishly, I began turning off the plethora of drips keeping him alive.

I didn’t know what was going to immediately happen as I turned off the pumps.

I stared at the telemetry monitor, waiting for the long line of demise.

I expected him to flat line, his blood pressure suddenly bottoming out, and his heart stopping.

As I withdrew care in a daze, Respiratory arrived, turning off his vent, removing his tube of life.

As I stood there and stared into his eyes, I tried to explain what was going to happen.

Although, I think he already knew.  Tears percolated from the corners of my eyes, streams of tears rolling softly down my cheeks.

My instructor rested his hand on my shoulder, and attempted to silently reassure me.

I stood next to my patient’s bed for hours, gently holding his hand.  My instructor gave me permission to stay with him as he left this realm for the next.

And I, unknowingly, became Death.

There wasn’t a gray horse galloping towards him. Death didn’t wear a black robe, wielding a scythe.

Instead, Death wore red scrubs, bearing a stethoscope.

As I stood there, looking into his eyes, waiting for asystole, I became a nurse.

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