My skin is really thick. I've seen a lot of things between being a nurse and a paramedic. I've seen abuse, neglect and death before. Today, I got a patient from the emergency room with a massive infarct. The report I got never could have prepared me well for this patient. He truly broke my heart.
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When he arrived to the floor, I couldn't honestly tell if he was breathing. His gaze was fully deviated, he was contracted to one side, and had incredibly shallow, labored mouth breathing. I pulled him from the stretcher to the bed, got down to his eye level, held his hand and said "I'm allison, I'm going to be your nurse today." he pulled his hand away from me, completely frightened, and yelped out. I asked him a series of questions, but he had no answers. Just a wide eyed, terrified, deviated stare.
He was 88 years old and he looked like he was a survivor from auschwitz. He was so emaciated, he may have weighed 80 pounds soaking wet.... Upon assessment, I could actually see his guidewires from his pacemaker bulging through his skin. His skin turgor was so poor and he was so dehydrated that we were unable to place a peripheral line... And after two sticks from me, I gave up. He had been hurt enough.
His body was covered head to toe in bruises, in various stages of healing. They looked like palm prints and hand prints. His skin was totally ecchymotic and he had so many skin tears it took 12 pages of wound photos to document them all. His skin peeled back like the skin on a banana just by touching it... And on his back and his shoulders, a purple hand print that was probably very fresh.
I turned him over to assess his back. He yelped out again. His orifice was excoriated and bleeding and was probably the size of an apricot or small plum... It appeared that something was forced in it. He shook in fear and moaned loudly as the cna and I gave him a good bath, combed his matted hair, put him in a clean gown and applied lotion to soothe his dry skin.
I called the abuse hotline. I never intended to point a finger of blame... But someone had forgotten to treat this man like a human being. Social services came and did their own assessment and took lots of photos. He continued to moan, louder and louder. He pulled away every time we touched him as if we were going to hurt him. What happened apparently was he was at a nursing home until his medicare ran out... But made too much for medicaid, so he had been paying a "caregiver" to see to his needs at home. I didn't see this caregiver.. And I'm glad I didn't.. Because I may have said something very bad.
Lab called.... His troponin was 17. His infarct had spread to over 4 leads. His bp was dropping and his urine output was 0. I chased the doctor down to the icu to get a hospice referral and a dnr. I was not about to have to call a code on this man. The least I could have done was to get him a comfortable death. Paperwork was signed and hospice came to see the patient and agreed to take him at the end of my shift this evening.
I documented and documented. I turned him every hour, swabbed his mouth, made sure his skin was clean and dry, and went and sat for just a minute by the bed, to make sure he knew that if I he wanted to go, I would be there to sit with him. I didn't want him to die alone, not like that.
The paramedics came to pick him up and bring him to the hospice home. I signed his papers and helped them place him on the stretcher. He just kept moaning, and letting out these yelping noises. I walked them to the elevator and grabbed his hand and said "they are going to take you to the hospice house, so you can be cared for and comforted. It's ok to let go now." his eyes didn't move, but I knew he knew I was there.... Because tears started rolling down his cheeks.
And without saying a word for 12 hours, my patient made me cry.
May god bless him. I hope his ending is peaceful and that he is moved on to a much better place than was ever provided to him here. Today, I remembered why I became a nurse.
