Patient was scheduled for an elective, outpatient surgery. Woke up early to shower, and fell to the ground, breathless and weak. Wife called 911. Pt coded in ambulance. Coded again in ED. A third time in CT. Found a massive PE. tPA was given and pt was sent to ICU.
When I assumed care, pt was on Levo, heparin, bicarbonate, MIVF. No UOP despite being 8L positive. Poor neuro exam. Became more hypotensive with stable H/H, and dobutamine was started. Then he became bradycardic and lost his pulse. I was the first on his chest. His ribs were already broken. 2 rounds of CPR, and some epi, and he went into VT. 1 shock brought a rhythm back. Started epi drip. Had to add vaso, as I couldn't keep his pressure up with everything else maxed.
It looked like he was gonna code again, but I was able to speak to the family first and tell them that it wasn't a matter of if he would code again, but when. I told them that we would respect their wishes, but that we were doing our best to keep him alive and his heart couldn't take much more. And that even if we got him back he would never be the same. They decided against more CPR/shocks and elected to let him go as peacefully as possible (still intubated, sedated, and maxed on 4 pressors). He died shortly thereafter, his family surrounding him and holding his hands, instead of having his chest pounded on and electrical currents rip through his body.
I'm 5 months in as an ICU nurse, and this was by far the most unstable patient I have cared for. While it is very sad that his life ended in such a tragic and unexpected way, I am glad that I was able to help this family accept their loved one's death and allow him to slip away with some semblance of dignity and comfort.
I am not a a cryer, and maintain a healthy disconnect from my job, but as I held the wife of this man, I wept with her. As I watched his brothers say goodbye, I remember having to say goodbye to my husbands brother, who was taken from us all too quickly as well, and the tears came. I was in no way emotionally connected to this family, and my tears were not for me. I have now become a major player in the absolute worst day of their lives. They will remember my face, my words, my actions. My tears were for them. They will remember a nurse who was willing to grieve with them and recognize that my average day at work was the most horrific day they have ever experienced.
I came home that night, took a bath, drank some wine, and went to bed. I will return to work, return to another sick person, and life will go on.
They will return to an empty chair at the table, a vacant side of the bed, family photos where one is missing.
This job is sacred. We are walking the line between life and death, between hope and hopelessness, between "do everything" and "let him go".
I am proud to be an ICU nurse.