I came on at 7p on Sunday night, first night of 3 in a row. Received report on a 79 yo male patient that had multiple issues: Heart cath found 5 vessel collapse except the LAD, possibly go for CABG. Dayshift battled hypotension with SBP in 70's. IV contrast dye shot the kidneys-crea 0.9 to 4.9 in 2 days. MD ordered fluid boluses with Lasix in between them and to infuse 100 ml/hr. Finally got SBP above 100. Very little urine output of course but MD said that his kidneys will soon wake up, keep the fluids going. His abdomen was distended and firm and was the same from admission. Pt had good bowel sounds and no other complaints. Sunday morning CT showed swollen liver, pancreas, and intestines; only treatment would be surgery. The pt decided to make himself a complete DNR after everything going on. Okay, I can deal with that.
I go to meet the patient with the day shift nurse and he is laughing, cheerful, in a good mood, has family around, no distress at all and no complaints. He doesn't even look like he is 79, more like 63. I made sure to listen to his lungs for crackles and his bowels, o2 sat 96% on 2 LNC, no issues at all. Okay, so my thoughts are he isn't going to die tonight. Hopefully he can get some good rest since he had a busy day.
At 1950 I go to take his IV morphine and his PO meds. No crackles, no chest pain, no distress....we are joking back and forth, everybody is happy. Family goes to dinner and who is left is his niece and son. At 2020, family calls out and says he is c/o SOA. I knew immediately what was going on. I called respiratory for a non-rebreather. I go into the room and I can definitely hear the crackles without auscultation. I turned off the IV fluids, o2 sat in the 70's. I walk out and call the MD on call. He was very nice on the phone and talked for about 10 min. Told me that there is nothing I can do because the DNR order and keep him comfortable with morphine and to double the dose. (sigh) Alrighty....I call chaplain. Got the IV morphine, and when I am walking out, I glance up at the monitor and he was already having EKG changes. I run to the room and ask the family to step out so I can talk to them.
Most of the family left and the son and I were left. The pt was gray, diaphoretic, and staring up at the ceiling. I called his name and he looked at me and I asked him if he was okay and he stated, "Ally, I am okay." I slammed the morphine and tried to get his blood pressure. I took my stethoscope and listened to his lungs and he then aspirated and fluids started pouring out from his mouth and nose onto my gloved hands and all over his front. I stepped back in shock. The son started to cry as I washed my hands, then bowed my head, grabbed the son's hand and said a prayer. (Son told me he wasn't going to tell anyone what happened at the end.) The niece walked in and joined us. I asked them to step out so that I may do post-mortem care. I was alone in the room and then I just started balling. The tears started to pour out and I was angry. I kept telling myself there was more I could do. He basically drowned and that image is forever in my mind. I was so sad for the family and felt bad for sending the family to dinner and telling them that he was comfortable and to go enjoy themselves since they were there for 3 days straight in the hospital. I was so confused and so upset. It all happened so fast, like in 15 min. I get tore up just thinking about it now.
Then the daughter came running in and I immediately stopped her. I stepped right in front of her view. He was such a mess that I DID NOT want her to see her father that way. She screamed at me saying that I told her to go to dinner and that he was going to be okay. I told her that I was so sorry. She was so hysterical. She noticed that I had been crying and asked me why I was crying, he wasn't my father. I kept apologizing to her. She asked if he went peacefully and I told her he wasn't in any pain, that is what also the son told the others. She finally walked out and me and the techs provided post-mortem care.
After the paperwork was done and the funeral came to take the patient, the hysterical daughter called me into the hall and apologized up and down to me for the way she acted. I told her not to worry about it, thats the least of her concerns. I was happy to be his nurse and I wished them the best and would pray for her and the family. About 3 am later that night, the daughter calls and sounds belligerent asking me all these questions what happened. I told her I wasn't able to talk about what happened and needed to talk to his doctor. I received calls the next night from the family but we decided to just say that I wasn't that night and to send a thank you card.
This has been really rough. I came home and just cried. The boyfriend was so helpful and just let me vent so kudos to him :) Some of my co workers weren't very helpful so this is why I get on here. So thanks for listening. Nursing has its ups and downs and this was a down moment. I know we deal with death but hey, we are human beings and we, nurses, can cry too
