When I started that day it seemed the paramount thing to me just to get rid of the dress bypassing my state board exams. My clinical rotations had become routine stuff after two years. My mentor hardly bothered to check on me anymore. I thought I was ready to be released into the real world of nursing, until that day!
Hectic! Four call lights were ringing and they were all my patients. The aide on my rotation was taking extra long time to give a bed bath when I needed her help, it seemed to me. I had a pain shot in one hand, but I looked into room 369 on my way past to say, "Sylvia, I'll be right with you." I turned off her call light.
When I came out from giving the shot, Sylvia's light was on again. I stepped in. She was sitting on the edge of her bed with her arms on her raised side table, gasping for breath as she had been for the eight days she had been in the hospital. She was what we called a frequent flyer with advanced COPD. She usually rallied after a week or two in the hospital and went home again.
"I need a little round thing out of this drawer," Sylvia told me. The drawer on her nightstand was open and I fumbled through it, wondering when the aide was going to be available to do this stuff I didn't have time to do. I couldn't see anything round in the drawer. After eight days the drawer was quite full of papers and silverware, jam and salt and pepper packets, whatever Sylvia wanted to hang onto. It was so hard for Sylvia to get air to talk that all conversation with her had to be yes, no questions and I was in a hurry. I told her I'd be back. I turned off her call light as I went out the door.
When I came out from giving the next pain shot, three call lights were ringing. One of them was Sylvia's. The aide was nowhere to be seen. I felt a little impatient. I put on my smile and stopped to wash my hands as I entered the room. A deep COPD grunt of disapproval came from Sylvia. She did not have time for me to wash my hands the grunt said. "Now," Sylvia gasped, "you find it!"
I began to ask questions as I dumped the drawer on the top of the stand. I showed her as I put each thing back in the drawer, one at a time. "Is it a pen or pencil?"
No, her eyes said.
Her eyes registered frustration.
"Shorter than a pen?"
Yes her relieved eyes told me.
By then I was to the bottom of the stack. The only thing in the whole drawer that could be called round was her glasses case, and it wasn't really round. I held it up.
Sylvia motioned for me to put it in the drawer and flipped her hand towards the door as if she was the queen and I was a disobedient servant whom she had no further use for and she was sending me out of the room.
"Your breathing is much worse," I told her, "I checked and you have taken everything you can take but the nebulizer. I'll bring it to you right away." I was surprised how much air and energy Sylvia was able to muster to spit out a very decided and upset, "No!"
"You don't want your nebulizer?" I asked with genuine surprise.
"No!" This time it was louder and more determined than before. "Just find the round thing," Sylvia hissed at me with a gasp between each word.
"I'll be back after I give another shot," I told her. I had to work to keep the impatience out of my voice.
By the time I had the shot ready, Sylvia's light was on again. It was still on when I was done. The aide wasn't back yet. I stepped in the room again and went to Sylvia's closet telling her, "I'll look some more, but I don't really know what I'm looking for. It would help if you could tell me more about it."
I came up with nothing round and I had gone through the whole room now. I could see nothing yellow anywhere. Tears came to Sylvia's eyes, and I understood see she was trapped in her body and helpless and didn't even have enough energy to cuss at me. I softened as we stared at each other. I told her, "There is a very patient man down the hall who has been waiting for a pain shot. I need to take care of him, and then I will come and ask you some more questions and try to understand what you need unless the aide can come first. One of us will come, okay?"
It was not okay. She shook her head. She grunted about the man who didn't need me as much as she did. She was serious and she was helpless. As for me, I was starting to feel like maybe I did need my uniform and it seemed to fit a little better than it had earlier in the day. It took more than a change of dress and passing exams to make a nurse I was thinking.
After I gave the next pain shot there was only one light ringing. It was Sylvia's. I heaved a very big, impatient sigh and tried hard to remember the lesson in class on how to deal with difficult patients. Cooled down, I went to Sylvia's room more relaxed. It was quiet. Nobody was waiting for me this time when I went in. I could spend some time with her. She was lying back in her bed!
It was extra quiet. It wasn't just because I turned off her call light. There was no wheezing sounds - no difficult breathing sounds. In a flash, I was at the bedside taking Sylvia's carotid pulse. It was barely there. I grabbed at the automatic BP cuff, put it on her arm and hit the button with one hand while I got the bed ready for CPR with the other. I had heard a faint breath when I put my ear to her nose. As I picked up the phone to call for help the BP read 30/10. Then it hit me with a repulsive shudder that rocked me from head to toe. DNR. Sylvia was a do not resuscitate patient. I quickly checked her pulse again. Nothing. I hit the blood pressure button. As my mentor flew through the door into the room, the blood pressure monitor read nothing. No heartbeat. No breath. No blood pressure. I have never felt more frustrated in my life in twenty years than I did at that moment when I was not allowed to start CPR. I even thought of trying it, just in case, for a split second. My mentor looked like she felt about how I did.
The doctor came in right away. The family was called. The mentor, aide and I cleaned Sylvia of her incontinent bowel and bladder mess and got her all ready for the family visit. We put on crisp clean sheets and combed her hair and made everything look as natural as we could for the farewell. We were in a hurry to have it done, knowing the family was rushing to get there to say their good-byes.
"Why rushing?" I wanted to know. They were the ones who didn't want her resuscitated. They had all agreed. Now they were rushing to see her when it was too late for anything but good by. "How could they do a DNR?" I asked again. It was so upsetting to me. I looked at the mentor as we left the room. "The only other thing I feel bad about is that I didn't find her little round thing," I told her.
"Her nebulizer?" my mentor asked me.
"Sylvia calls her nebulizer a little round thing. She always sneaks one in from home. The doctor knew her condition would improve with the new stuff and he also knows she didn't take hers as it is prescribed so she wasn't supposed to have any at the bedside, but she always gets one smuggled in from home. She doesn't like the new stuff. Last night the aide found her contraband and put it in her glasses case. We were going to ask the doctor what to do this morning."
I stayed behind in the room as the mentor went out. I opened the drawer and took out the glasses case. I shook the little round thing out of the case. It had a yellow band around it. It seemed to me my student uniform fit me perfectly.
I had an examination to make before I ever faced nursing board exams. I had to examine me and what life is all about. What rights do patients have? What rights did I have? Why didn't we start CPR? If I had found the nebulizer what would I have done? How would I have treated the patient? If she had found it, would it have given her a little more relief? Would it have given her minutes to live? Would it have held her over to her IV dose? Would she be wheezing away right this minute?
"I'm sorry Sylvia. I'm sorry I didn't find your little round thing. I'm sorry you died in here all alone. Your need was more important than the patient man down the hall waiting for his shot just like you told me with your eyes. I didn't believe you and I am sorry, Sylvia."