New Man of the House

JBMmom, MSN, NP

They sat huddled outside the room, three chairs facing the glass doors, an isolation cart as a makeshift table for the boxes of tissues. We had turned his head to face the door side of the room before the scheduled two hour head turn, so they wouldn't be looking at the back of his short salt and pepper hair. Eyes a little swollen after almost 14 hours proned, on the sixth day in a row of proning. His tongue was a bit swollen, I had been using vaseline gauze to try to keep it moist, at one point his teeth had dug into the top and bottom causing more swelling, and even trying to push his tongue back behind his teeth every two hours with the mouth care swabs, it would just swell back out after a few minutes. We covered him with a gown to hide the ice packs in his armpits, his groin and on his neck, the temperature flashing 103.8 on the monitor. If they really used their imagination, maybe they could envision that he was sleeping comfortably, husband and father to the wife, son, and daughter huddled together in the hall.

And, he could have been mistaken for sleeping were it not for the endotracheal tube coming out of his mouth, the orogastric tube next to it dumping dark brown liquid into a container at the bedside. We moved the catheter and rectal tube bags to the other side of the bed and out of view. His short hair didn't require much attention, just a quick run over with a damp washcloth to wipe the sweat. Maybe they could faintly hear the 90s rock and roll that was playing in the room to give him something normal from his life before.

His course had been familiar to many of us, but certainly must have been so confusing to the family. He's coming down on oxygen requirements and we're waking him up a little bit one day, then the next day he's requiring more oxygen and we've had to increase sedation to keep him working with the ventilator. Finally this morning at 4am I had to make the call. His wife answered the phone, voice a little shaky, most likely from a combination of arousal from sleep and seeing the caller ID announce ***** Hospital was calling. I explained that her husband's condition had become increasingly unstable overnight and we had reason to anticipate that he may go into cardiac/respiratory arrest in the next few hours. His oxygen levels had been in the 60s to mid 80s for going on an hour. Temperature and heart rate rising (maybe cause and effect?), and we couldn't provide any more support on the ventilator. The doctor would be in soon and if she wanted to come in and see her husband and talk with the doctor we could make an exception to visiting hour restrictions. She said of course, she would get her son and daughter and be there as soon as they could arrive.

I met them in the lobby. A small woman, hunched over, but not with age- she's only in her 40s, like her husband. Her daughter clutched her arm, simultaneously urging her on and gripping with fear. I introduced myself and asked whether I could get them anything. The daughter, maybe in her late teens or early 20s blurted out "can you get me my daddy back" and burst into tears. We walked slowly to the elevator and back up to the floor. I removed the pen that was discreetly holding the visitor door open, we were so short staffed that night that no one would be available to answer the phone and open the door. The three chairs were set by the room, and another nurse ushered mom into the middle chair as she was overcome with sobs. I was walking with the daughter who approached the room, but stopped at the sight of her father and let out a heart-wrenching cry as her knees buckled and she nearly crumpled to the floor.

All the while the son/brother stood a couple steps to the side. He quietly sat in the chair next to mom and we were finally able to help his sister sit on mom's opposite side. Suddenly the space in our 12 bed unit seemed to shrink to a tenth of the size. Sobs and wails filled the air, and it seemed insensitive, albeit it necessary, to go about the daily tasks of the morning, providing care for the 11 other patients, answering phones, and talking with each other about what needed to be done.

The doctor approached the family and spoke in a low and compassionate voice. After a few minutes there were more sobs, a little quieter this time, and he came over to announce he would change the code status to DNR. We all breathed a small sigh of relief knowing we wouldn't have to unprone and do CPR, our bodies dripping with sweat in the PPE with his days-long fever seeming to raise the room temperature to that of a tropical getaway. Not that we wouldn't have done it happily if we thought it would bring any meaningful success. But as of yet, we have not had a successful resuscitation of COVID patients that reach this stage.

I came over to see if they had thought of any other questions for the doctor, or for me. Mom and daughter expressed so much thanks, despite the look of understanding that we would not be able to return their husband and dad to them as we all hoped.

Then he looked up, most likely a little grateful that the mask almost obscured the quiver of his jaw, but the shine of tears in his eyes and the crack in his voice conveyed the change in his world he now realized he faced. He would face challenges in the days, months, and years ahead. Emotional, financial, even physical, could he fill the shoes of his larger than life father? He wouldn't know until it happened, but he knew then that by day's end ... he would be the man of house.

New Man of the House

About JBMmom, MSN, NP

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