Happy 2009, everyone! First off, I would like to apologize to my thousands of loyal followers for my lack of posting in the last several weeks. I am very sorry to let you down. With the holidays and finishing up my critical care nursing residency program, I have been very busy. But now I am DONE! With the residency, that is. Beginning tomorrow evening, I will have my first shift without having someone hovering over me, watching my every move. I am excited, but very nervous at the same time. Now if I make a mistake, there is no one to catch it. It's all on me. Needless to say, I will only be taking care of the most stable of patients in the ICU, if I can help it!
My last shift in residency was on Sunday, and it seemed only fitting that I had my first patient death. That may sound kind of grim to some people, but it was like a natural transgression. I started off taking care of very stable patients and gradually transitioned onto sicker and sicker patients, to finally one that was so sick that there was nothing left that could be done.
He already looked like a dead man from the moment I started that shift. His skin was mottled, extremities were cold. You couldn't feel any of his pulses. Pulse oximetry monitoring wouldn't work on him since his peripheral blood circulation was non-existent.He was on three different vasoactive drips to keep his blood pressure up. He was maxed out on two of the medications, and so our only option was to gradually go up on the third until that one was maxed out. And from there, we just waited for him to go.
It was a bit tense, standing in the room with the family members, all staring at the monitor, watching his heart go into arrythmias. Brief runs of ventricular tachycardia. Blood pressure kept dropping. I had to just turn off all the alarms on the monitor because the constant blaring was just a reminder of how quickly this man was going down.
Onces the blood pressure dropped into the 30s and 40s, my preceptor and I attempted to find either a carotid or femoral pulse. Nothing. Decided to page the on-call doc to examine the patient, because at this point, he probably really was dead. On-call doc was just an intern. Idiot intern. He didn't show up for nearly 20 minutes. He couldn't feel any pulses either and decided to call it. "So, is there like a form or something I need to sign?" he asked me. "I don't know. You're the doctor," I replied.
The respiratory therapist came in and disconnected him from the ventilator, while me and my preceptor turned off the numerous IV pumps, turned off the monitor. I'm not sure why I expected the man to move or breathe or anything like that, but of course he didn't. Everything was still, quiet. He was dead.
After all the necessary paperwork was completed, I went to get the keys to the morgue and a gurney on which to put the body. By the time we zipped him into the body bag, it had been almost three hours since he was officially declared dead. I was surprised that his body was stiff. Weird.
But it got even weirder. After unlocking the door to the morgue, there was yet another door to unlock, which was the door to the cooler. Yes, it was about the size of a walk-in refrigerator at a restaurant. Not nearly as big as you would expect for a hospital as large as the one at which I work. Four or five other gurneys with adult-sized bodies were in there. To the right, there were shelves with plastic storage containers that had tiny, baby-sized body bags. And there was a big red barrel that said "Placentas Only."
The third key was to open up the box where my dead patient's chart would go. And then I had to sign him into the morgue; much like you would sign someone into a doctor's office or a meeting.
So there you have it. My job, my work as a nurse. Well, only a small part of it. A small, strange part of it.