He is only 40 years old. He went to the dentist and coded. They did CPR. Sometimes that's not a good thing.
He is now in a permanent vegetative state.
He has a trach. His secretions are so thick they bubble back out. He needs suctioned hourly, if not more. But that's not why he is in the hospital. It's decubiti. He coded in July. He now has a massive stage 5 on his coccyx. Monday they will debride it. It is infected. It doesn't help that he is diabetic. His left leg now has a stage 3 on the top of the shin, and his back his covered with stage 1's. His heels are breaking down.
He has pink eye in both eyes.
His right arm is contracted.
He has a feeding tube and a foley.
He will never get better.
He will only get worse.
As I bathed him tonight I looked into his big red eyes and I saw him inside of there. He can't talk, but he was there. And the way his eyes locked on to mine was a form of communication, he was telling me he was helpless. No more than that. And he tried to move his mouth and talk but no words came out.
And I sort of hugged him, and I started to cry.
I know that I must sound crazy but I just know what he was telling me with his eyes.
And I have never felt so damn helpless myself, in all of my life.
This thread had such an impact on me. I was in customer service for almost 20 years. I had a change of life/change of career & have been in nursing for 5 years now (really just a difference in commodities!).
thisnurse has touched on an aspect that defines nursing in it's most pure & holistic sense. That is, in spite of our specialty areas, we are bound to care for the whole patient. Body, mind & soul. Who can argue the impact that emotions have on the body? How can we draw a line at simply caring for the body while the psyche is put on hold?
I too have cried......for my patients, and with them. I have also laughed, cussed & walked with them all, as the situation has warranted. Guess what? I did the same for my customers before entering nursing. This ability, if you will, transcends job titles. It is called humanity.
Let none of us lose sight of our human side & remember to bring it along as we travel through life.
This thread had such an impact on me. I was in customer service for almost 20 years. I had a change of life/change of career & have been in nursing for 5 years now (really just a difference in commodities!).
thisnurse has touched on an aspect that defines nursing in it's most pure & holistic sense. That is, in spite of our specialty areas, we are bound to care for the whole patient. Body, mind & soul. Who can argue the impact that emotions have on the body? How can we draw a line at simply caring for the body while the psyche is put on hold?
I too have cried......for my patients, and with them. I have also laughed, cussed & walked with them all, as the situation has warranted. Guess what? I did the same for my customers before entering nursing. This ability, if you will, transcends job titles. It is called humanity.
Let none of us lose sight of our human side & remember to bring it along as we travel through life.
Specializes in NICU, PICU, PCVICU and peds oncology.
I'm going to apologize in advance for the length of this post. If you don't have the time or interest to keep reading, I won't hold it against you! Last year, we admitted a toddler who had fallen head-first into a five gallon bucket of human waste. His home had no indoor plumbing, and the family had been using the bucket as a toilet. Needless to say, he was in very poor shape. He was in Bed 8, the least desirable spot for someone as sick as he was, because of its lack of space. On my first shift with him, I was appalled by how fluid overloaded he was, and how much inotropic support he was needing. His hands and feet were cool and dusky, his eyes swollen shut. The skin on his abdomen was taut and shiny; his pupils were sluggish and he didn't respond to deep pain. His ARDS was severe and he was requiring a very high level of ventilatory support. We were attempting to run CVVHD on him, but because of his size, and the necessary compromise in vas-cath size, we had no end of difficulty. Also because of his age and size, it was necessary to prime the machine with packed cells. As the day wore on, his limbs became cooler and cooler. By the end of my twelve hours with him, we were on epi at .75mcg/kg/min and the dopa was at 12.5. We had run through three units of PRBCs and five filter sets. I went home praying that he would die while I was gone.
The next morning I arrived at his bedside with my emotions firmly in check, braced for another difficult day. Over night he had continued to worsen, and by then his hands and feet had become dark purple. He was bleeding into his mouth and nose, and his line sites were all oozing. His parents were reluctant to sit at his bedside, and so I only saw them for a few minutes. At noon the hematologist came to the unit to tell us that his clotting factors were incompatible with survival. She was pretty blunt about it. After that I expected our attending intensivist to have The Talk with the family, but for reasons I will never understand, he chose not to. By 1500 we had put up the fourteenth filter set, and used the seventh unit of PRBCs. His blood pressure continued to drift, and his epi was going up by .05mcg every ten minutes. I was told to forget about the titration order and just go up as much as he needed whenever he needed it. About the same time that the fourteenth filter clotted off due to the extremely low flow rate, I put him up to 10mcg/kg/min. His limbs were black by now, the legs to the waist, and pulseless. We decided to stop the CVVHD because if we hadn't succeeded yet, we weren't going to. At 1825 he began to high pressure on the vent and the RT came over to help out. He was just preparing to hand ventilate when the circuit blew off the ventilator and the baby arrested. We got him back before our attending arrived at the bedside. He had finally spoken to the family, and they were all waiting to see the baby. I placed him on a blue pad, wrapped him in a blanket and tossed a towel over the bloodsoaked bed. We took him off the vent. He was so stiff that I had a hard time lifting him off the mattress to put him in his mom's arms. She was weeping softly; about twenty members of the extended family crowded around them, essentially trapping me between the crib, the wall and themselves. He took a few breaths, then stopped. His heart rate and blood pressure dropped slowly. His relatives were transfixed by the tracings on the monitor, so I turned down the gain and angled it so that they could no longer see it clearly. I wanted them to concentrate on him. His heart stopped at 1853.
All that day, I had been feeling more and more upset by the situation in Bed 8. Twelve years before, my own son had been in intensive care, with MODS following a series of strokes. I was not a nurse at that time, simply the Mom. He had had no urine output for several days and dialysis was looming. The unit he was in did not provide dialysis at that time, and so we would have had to move to another hospital. He was comatose and jaundiced. We had The Talk. I was prepared for what was to come... and then his creatinine peaked just below the threshold set by the nephrologist and he began to pee. I brought him home, a different child, but alive, eleven weeks later. As I cared for my patient, I found myself reliving those days in 1989, and trying to rationalize our intensivist's reluctance to discontinue. I just couldn't understand it. I still can't.
As this was proceeding in Bed 8, the decision had been made to discontinue for the teenaged boy with CP in Bed 7 who had suffered a severe and prolonged seizure which had left him in a vegetative state. He had been extubated several hours earlier. To that point, I hadn't really paid much attention to him, and hadn't even taken a good look at him. Someone at his bedside dropped something and I glanced over my shoulder to see what it was. In that split second, the glimpse I had of him shocked me to the core... he looked exactly like my son does now, right down to the high cheekbones and five o'clock shadow. It was all I could do not to burst into tears. When I looked again, the resemblance was gone.
I cried in my car. I sat in the parkade and cried. Then I drove home and sat in the driveway and cried. Once I had pulled myself together, I went into the house and crawled into bed with my son. He was a little nervous, but didn't say anything. After several minutes, he kissed my cheek and whispered, "I love you, Mom."
That day will go to my grave with me. If I ever find myself feeling a little too detached, I think of the three boys who, each in their own way, touched my heart that day.
janfrn, talk about crying in your tea! You just made me remember acutely why I left ICU. Most of my patients were trauma's somehow, at the end of my time there I began to regularly have nightmares about my children on vents, and I knew it was definately time to go.
janfrn, I did a few years in peds icu and it was not easy!! Right after my little girl (Not my own child, just came to feel like that) died in the unit, we had another child, a 14 year old with Downs who had an AV Canal repair, and he was doing very poorly as well. Both of these families were from South America, my girl's grandmom had come here with her and Michael had his parents. Michael's parents spoke English very well, and I will never forget the day Yadska, my girl died, we went up to see grandma on peds during the final hours-long code. Michael's dad was there and interpreted. Michael's dad could not handle hearing she was dying at all. A few days later Michael coded and died. I will never to this day forget the sounds of his father sobbing. His mother was catatonic, but his father, it was chilling to hear his sobs.
I cried both of those days, but the day I cried the hardest was the eve before Yadska's surgery, because I knew she wouldn't survive the surgery. I and another nurse were not allowed to participate in her care or the code. I am glad my coworkers cared enough to realize we couldn't have done it.
i cared for michael for the night before he was being discharged back to the nursing home.
he was very restless for some reason and he sounded "different". his breathing always had a certain rythm to it and that was off. his vitals were normal, his sat was good, and yet something was wrong. he was grabbing on to me and desperately trying to talk. he was pointing down at his leg. there was nothing wrong. when i suctioned him it made no difference. i could hear fluids in there but couldnt get anything out.
i tried again and i got "chunks" of blood. solid secretions. after i got that crap out, it was just blood tinged mucous followed by his normal foamy guck. his breathing sounded better buthe was still restless. he was sitting up and grabbing on to my arm.i could see the anger and frustration in his eyes. he tried so damn hard to tell me something. it was the first time i ever saw him move on his own accord.
i called the doc and reported what had happened. she came to see him while i was in report and wrote nothing. i was absolutely furious. no xrays, on RT consult, no labs... nothing.
then one of my coworkers made the mistake of telling me there was nothing that doc COULD do. and asked what i thought she should have done.
i went off.
it was then i realized that i could not care for michael after that point. i was letting the case get to me personally and i realized that my feelings were going to cloud my professional judgement and hinder care.
if he hadnt been discharged the next day i would have asked to not be assigned to him any more.
of course i would have kept tabs on him and gone in to see him, i just wouldnt have been able to provide care. its our job to see things from an unbiased perspective. i knew i was no longer capable of that.
the up side to it was that its evident he CAN hear, see and understand. maybe in time he will be expressive again.
i learned so much from him, and from all of you. thanks all for your stories and understanding. our unit is made up mostly of clinicians. its so nice to know there are so many NURSES still out there.
By 1500 we had put up the fourteenth filter set, and used the seventh unit of PRBCs. His blood pressure continued to drift, and his epi was going up by .05mcg every ten minutes. I was told to forget about the titration order and just go up as much as he needed whenever he needed it. About the same time that the fourteenth filter clotted off due to the extremely low flow rate, I put him up to 10mcg/kg/min. His limbs were black by now, the legs to the waist, and pulseless. We decided to stop the CVVHD because if we hadn't succeeded yet, we weren't going to. At 1825 he began to high pressure on the vent and the RT came over to help out. He was just preparing to hand ventilate when the circuit blew off the ventilator and the baby arrested. We got him back before our attending arrived at the bedside. He had finally spoken to the family, and they were all waiting to see the baby. I placed him on a blue pad, wrapped him in a blanket and tossed a towel over the bloodsoaked bed. We took him off the vent. He was so stiff that I had a hard time lifting him off the mattress to put him in his mom's arms. She was weeping softly; about twenty members of the extended family crowded around them, essentially trapping me between the crib, the wall and themselves. He took a few breaths, then stopped. His heart rate and blood pressure dropped slowly. His relatives were transfixed by the tracings on the monitor, so I turned down the gain and angled it so that they could no longer see it clearly. I wanted them to concentrate on him. His heart stopped at 1853.
nightingale, RN
2,404 Posts
Hi Rick:
How have ya been?
((((Cen35)))))) Thank you for sharing your story....
Bonnie