Think Before You Speak: The Last Words Your Patient May Hear

It is important to think before you speak because you never know who may be listening. In fact, it may be the last person you expected. The following story describes how one experience changed my nursing practice and how I provide care to all of my patients. Nurses Announcements Archive Article

Think Before You Speak: The Last Words Your Patient May Hear

It was an ordinary Saturday and I was working as the day-shift charge nurse on the medical-surgical floor of a small community hospital. We were extremely busy due to it being flu and pneumonia season. As I worked actively on charting morning assessments, I heard the words "Code Blue" called over the intercom system.

It was protocol in our facility that all Registered Nurses (RNs) had to attend a code blue. During the week we had plenty of help when a code was called, but on the weekend we typically only had two RN's, a Respiratory Therapist, a clerk, and the physician.

When I arrived at the Emergency Room (ER), the ER nurse and the clerk had just gotten the patient transferred from the wheelchair to the stretcher. The ER nurse proceeded to give a report on what had happened. She said that the patient had been brought in by her husband complaining of difficulty "catching her breath" and some chest discomfort. The patient was awake and alert upon arrival to the ER, but was not able to speak. Before she could be transferred to the stretcher, however, she lost consciousness. She had no pulse and was not breathing.

We started CPR and contacted the on-call physician. Thankfully, it did not take long for him to arrive. Within a few minutes we had gotten a slow, weak pulse and had intubated her. She remained unconscious. A chest x-ray showed that both of her lungs had collapsed due to a large amount of fluid in her pleural cavity. The decision was made to insert chest tubes bilaterally.

Upon insertion of the right chest tube, a large amount of foul-smelling drainage shot out of the tube and across the trauma room. The same scenario happened when the left chest tube was inserted. Almost immediately, the patient started making an effort to breathe on her own. Her pulse rate had started to increase, but her blood pressure remained low.

She was receiving a large amount of intravenous (IV) fluids and had started to become edematous. I have always made a habit of talking to my patients even if they were unconscious. I explained to her that I was going to remove her rings because she was starting to swell, but since she was unconscious, she did not respond. I then proceeded to remove her rings, but found it to be very difficult due to the significant amount of edema that she already had in her hands. I remember telling the other RN that I was not sure if I could get them off and inquired about whether or not she thought we should cut them off. It was at this time that the patient took her right hand and grasped the rings on her left ring finger and wiggled them off. After getting them off, she reached over and handed them to me. Her eyes never opened the entire time, but she had tears streaming from them. We were all in disbelief.

I immediately started trying to calm her by explaining what was going on and informed her that we were doing everything we could to help her. She was still intubated and being bagged, but I made the decision to bring her family in one at a time, starting with her husband. When her husband entered the room, I handed the rings to him and explained what had happened. I informed him that even though she appeared unconscious, she was still able to hear him.

As he started to talk to her, the tears streamed down her face. It was truly one of the saddest things I have ever witnessed. Each one of her three children came in and were informed that she could still hear them. They spoke to her and told her that they loved her. Not long afterwards, she was airlifted to a larger hospital where she subsequently died shortly after arrival. The cause of her death was a ruptured esophagus.

I was so glad that I was able to give this family and the patient a few more minutes together. This incident also helped to solidify my beliefs in communicating with the patient even when it appears that they cannot hear the words that are being spoken to them. There are so many different experiences that I have had as a nurse, and each one has affected the kind of nurse that I have become. Some have made me stronger and some have made me realize how vulnerable I am. Although the outcome of the personal experience I described was a negative one, it made a positive impact on my nursing career and I will never forget her or the lesson she taught me. Every time I take care of a patient that I believe is unconscious, I think of her. Her death has affected the care of more people than she or her family will ever realize.

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mommy2anangel

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Thank you for sharing....it is a good reminder that patients can hear you.

A few years ago I was a supervisor on nights and I heard that dreaded....Code blue Labor and Delivery. Followed by Code Pink Labor and Delivery.

CRAP! I hate those codes...with all my years of experience these codes make my knees go briefly weak I get that warm allover fight/flight reaction as I burst into action.

It was an amniotic fluid emboli. Prime ip. MD just ruptured membranes for failure to progress. She said she couldn't breath and immediately seized.....EMD on the monitor.

We did an emergent C-section as the mother went into DIC doing CPR. The baby was blue. What a nightmare.

The baby was successfully resuscitated and flown to a level 1 while we continued to code Mom. She was hemorrhaging. We eventually got a pulse and rushed her to the ICU (much to the ICU's nurses dismay...poor dears I didn't blame them) accompanied by 2 OB nurses and several physicians who happened to be in house at 3 am.

Hours later and Some 40+ units of blood and blood products later, a Swan Ganz/a-line/multilumen/vent....I notice her hand tapping the mattress. I looked down and called her name. Her eyes flew open and she mouthed the words...."where is my baby?"

I about pee'd my pants....OMG not only is she awake...she is intact! A freaking miracle. I calld out to the MD's that she was awake...as they rolled their eyes and sauntered into the room disbelieving....they were shocked that I wasn't crazy....she was awake.

Ultimately she was stabilized enough to be flown to that level 1 ICU where her baby (and hubby) were.....they were both discharged alive and well.

She came back to say thank you with that beautiful baby...and remembered who we were. I don't think I ever cried with joy like that in all my years as a nurse.

Thank you for sharing....it is a good reminder that patients can hear you.

A few years ago I was a supervisor on nights and I heard that dreaded....Code blue Labor and Delivery. Followed by Code Pink Labor and Delivery.

CRAP! I hate those codes...with all my years of experience these codes make my knees go briefly weak I get that warm allover fight/flight reaction as I burst into action.

It was an amniotic fluid emboli. Prime ip. MD just ruptured membranes for failure to progress. She said she couldn't breath and immediately seized.....EMD on the monitor.

We did an emergent C-section as the mother went into DIC doing CPR. The baby was blue. What a nightmare.

The baby was successfully resuscitated and flown to a level 1 while we continued to code Mom. She was hemorrhaging. We eventually got a pulse and rushed her to the ICU (much to the ICU's nurses dismay...poor dears I didn't blame them) accompanied by 2 OB nurses and several physicians who happened to be in house at 3 am.

Hours later and Some 40+ units of blood and blood products later, a Swan Ganz/a-line/multilumen/vent....I notice her hand tapping the mattress. I looked down and called her name. Her eyes flew open and she mouthed the words...."where is my baby?"

I about pee'd my pants....OMG not only is she awake...she is intact! A freaking miracle. I calld out to the MD's that she was awake...as they rolled their eyes and sauntered into the room disbelieving....they were shocked that I wasn't crazy....she was awake.

Ultimately she was stabilized enough to be flown to that level 1 ICU where her baby (and hubby) were.....they were both discharged alive and well.

She came back to say thank you with that beautiful baby...and remembered who we were. I don't think I ever cried with joy like that in all my years as a nurse.

WOW.. You don't normally hear of happy endings after that dx. The OP wrote an excellent reminder for us all. All of these insightful posts are a nice refresher after some of the ridiculous ones that have come up recently. :up:

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
WOW.. You don't normally hear of happy endings after that dx. The OP wrote an excellent reminder for us all. All of these insightful posts are a nice refresher after some of the ridiculous ones that have come up recently. :up:

It was probably one of the most amazing moments I had ever witnessed as a nurse. I was at the head of the bed (I'm a hands on supervisor) straightening out the lines for the ICU nurses (oh the tangled web they weave) while they documented all the blood and stuff we were giving.....I though I heard a noise so I looked and I'll be dammed....there she was her hands tapping on the mattress rapidly. I mean she was in DIC and blood was running out of her nose....and you just KNEW....this was not going to end well.

She (and for me personally another power) fooled us....for there she was. I called her name her eyes few open and when she mouth the words.....Where is my baby.....YOu could have picked my up off that floor.

I am a BIG stickler for chit chat in the rooms of any patient. I always have been...but this really floored me.

The hearing is the last to go....be mindful of what you say.

Specializes in retired LTC.
.........I am a BIG stickler for chit chat in the rooms of any patient. I always have been...but this really floored me.

The hearing is the last to go....be mindful of what you say.

I think many of us 'senior'members' have had this type of experience. Very early in my newbie RN career, I was tube feeding by bolus gravity an unconscious, comatose pt. She had been that way for some time. I vividly remember plopping my right foot up on her hospital bedframe as I did her feeding. I said to her "I was oh so tired, just plain old tired". That lady's eyes fluttered open and clear as a bell she said "I'm so sorry'. !!!!!

She woke up in the middle of the feeding and responded to my comment. I've never forgotten that episode - it has never happened again. I will talk about anything to an unresponsive pt just to make conversation - the World Series, a presidential election, bedside pictures, etc. I always remember an early instructor lecturing us students that hearing was the last sense to fail. I've not forgotten that.

PS - what's a code pink? A baby?

Specializes in Pediatrics, Emergency, Trauma.

To echo, I had a similar experience with a pt who had a stroke; I told the family to not talk over the pt, but to include her in the conversations, as I talked to her whenever I changes her, bathed her, etc.

She woke up two days later, knew who I was and recounted every conversation that she heard; family was in shock; she simply replied: "Hearing is the last to go; I ain't gone yet!"

Excellent reminder! :yes:

Specializes in hospice.
.

PS - what's a code pink? A baby?

From the context, I'm guessing it's a code blue on a baby.

But where I worked, code pink was an abducted baby and all exits had to be covered by staff until it was called off.

Specializes in OR, Nursing Professional Development.
From the context, I'm guessing it's a code blue on a baby.

But where I worked, code pink was an abducted baby and all exits had to be covered by staff until it was called off.

This is part of the reason codes should be standardized. A code pink at my facility is a pediatric code blue- there's a different crash cart that we use with pediatric doses of medications and a braslow tape.

as for the original topic, this is one of the things that gets me as an OR nurse- people who talk loudly during induction and emergence about things the patient doesn't need to hear.

My instructor's always taught us that hearing was the last thing to go as well. I can't tell you the number of times that I had to get on to someone, as the charge nurse, because of inappropriate conversations or behaviors. One fellow nurse used to pass gas at the bedside and then act like it was nothing. I've had people complain to me about the other CNA's or nurses having conversations about their sex lives at the bedside. I'm all about professionalism and respect and it makes me wonder if they are still being taught these things in school.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I think many of us 'senior'members' have had this type of experience. Very early in my newbie RN career, I was tube feeding by bolus gravity an unconscious, comatose pt. She had been that way for some time. I vividly remember plopping my right foot up on her hospital bedframe as I did her feeding. I said to her "I was oh so tired, just plain old tired". That lady's eyes fluttered open and clear as a bell she said "I'm so sorry'. !!!!!

She woke up in the middle of the feeding and responded to my comment. I've never forgotten that episode - it has never happened again. I will talk about anything to an unresponsive pt just to make conversation - the World Series, a presidential election, bedside pictures, etc. I always remember an early instructor lecturing us students that hearing was the last sense to fail. I've not forgotten that.

PS - what's a code pink? A baby?

Where I worked code on a baby.

These stores brought me to tears.

I don't do a lot of emergent care in home health but recently came upon a medically frail patient down in her yard, unresponsive, in the rain. Her pupils were fixed and I was on the high anxiety side, cold, wet and alone didn't help, I kept her as dry as possible until the paramedics arrived and she ultimately didn't make it but I wished I had talked more to her. Hindsight and all that.

Specializes in Emergency Department.

I always seem to run out of things to say to my unconscious patients. Any tips on that? I usually cover the weather (if they've been inside a while), recent news items, and, of course, what I'm doing. Working in the ED didn't give me much time to practice those skills, but I'd like to know what you guys talk about. I'm sure I'll have more unconscious patients during and after nursing school. So, topics?