hi everyone
long time reader, little time poster, yada yada!
i work in older people's health, we are basically a medical ward in a general public hospital that caters for 65+, and theoretically we are supposed to be an a, t&r ward - but we all know how much the official title matters, right? people are people, people get sick, and people need us to care for them.
anyway, we've had a 'character' in the ward over the last couple of years - recidivist smoker, lives in tenous social circumstances, multiple medical problems, including severe pvd with consequences including a R) BKA. her mobility was shocking, and she was not able to stand for more than 10 seconds with the help of 2 assistants.
it was acknowledged during the several times she was a patient on the ward that she was not an easy person to nurse, due to her social circumstances and her adamant and vocal nature. (euphemisms, i loves ye!)
anyway, tonight, she was my patient. when i had left her last night, she had had an episode of malaena, and told everyone concerned, including medical staff, that she was DNR, and didn't want anything done.
when i got to work today, i frankly did not expect her to be there.
when i arrived at work, she had two iv lines going, and had received 40mg iv omeprazole, 2 units of FFP, 2 units of RBC and was due another unit of RBC. also she was having continuous fluids throughout this time.
anyway - after the third unit of blood, she seemed to be holding her own. no further malaena, her colour looked far better than it had the night before, but i knew we were in the 'see saw'. in fact, the consultant asked me what i thought, and i heard the words ' circling the drain' come out of my mouth.
i went to my dinner break, and when i got back to the ward i went in to visit her. she told me she felt sick, and then proceeded to spectacularly vomit bright red blood everywhere. i called in the other senior RN (her and i were the 'grown ups' on that night), and over the next half an hour, we stayed with her and soothed her as she continued to vomit large amounts of fresh blood, and continued to pass PR malaena.
the on call house surgeon came, and our fantastic consultant arrived too. i stayed at my patient's head, and attended the ongoing (and frankly, terrifying) gouts of fresh blood issuing from her mouth, and the other RN and the consultant helped turn her, and make her comfortable. the end was inevitable, and as her respiratory distress increased, we gave her some morphine, which went a long way to soothing her. she knew she was dying, and yet was incredibly calm and resigned about it. she passed away, calmly, half an hour after she initially started vomiting.
i felt privileged to have been there, and a part of this complex event. her family situation was complicated, to say the least, and even though we had spelled out her condition over the day, none of them wanted to be there.
having known her for a while, and having cared for her over these last few years, the other RN and I felt some sort of, i don't know, completion? in caring for her whilst dying in such an unpleasant and graphic way. she knew who we were, and knew why we were all there, and knew what we were doing for her.
this work is hard. but we are that certain type of person who does it for a reason. i am glad i was able to do this today.
i felt proud to be with her, stroking her hair and soothing her as she transitioned from one state to the next, and i commend each and every one of us who does this difficult job.
thanks for reading. chirst
MoopleRN
240 Posts
You and your patient were very lucky to have each other at that time.