There but for the grace of....

handyrn · Sep 8, 2011

One of the saddest (and scariest) patient stories I have is that of a little boy. When he was not quite a year old (still only crawling) his dad dropped him off at daycare. About 10 minutes later the boy was unconscious. The EMS was called and he was taken to the hospital. After a month or so on a ventilator with no brain activity they finally did a chest X-ray with the mother's insistance and found a little plastic toy lodged in his lung. He had aspirated it. It had been on the floor of the daycare along with all the other toys.

At the time I took care of the boy he was 10 years old, in his home, still on a ventilator.

xtxrn, ASN, RN · Sep 8, 2011

One of the saddest (and scariest) patient stories I have is that of a little boy. When he was not quite a year old (still only crawling) his dad dropped him off at daycare. About 10 minutes later the boy was unconscious. The EMS was called and he was taken to the hospital. After a month or so on a ventilator with no brain activity they finally did a chest X-ray with the mother's insistance and found a little plastic toy lodged in his lung. He had aspirated it. It had been on the floor of the daycare along with all the other toys.
At the time I took care of the boy he was 10 years old, in his home, still on a ventilator.

NO CXR for a month on a vent? It probably would not have effected the outcome, but they would have KNOWN :eek:

That is really sad :heartbeat

incurable_optimism · Sep 8, 2011

I am still in nursing school, and I have only been to two nursing homes. But, there is one patient I will never forget. She was in her 80's, dementia. Not sure what else was going on with her as she was not a patient assigned to me. She believed that she had bugs crawling all over her and would scream for a nurse to come put her medicine/lotion on her. She would sit out in the hallway screaming "NURSE!" To the nurses who were on this floor every night (and most of my fellow students) this was annoying and they had grown to ignore her. To me though, I knew this was a woman who truly believed she had things on her and needed help. So I would go in her room and put lotion on her and just scratch her head. She loved it. The other students thought I was crazy, they walked past her room and said "Are you serious?" But it made her feel so much better, and she would sit there the whole time going "Oh you're such a good nurse. You're going to be the best nurse ever" That woman always put a smile on my face. And I'll never forget her...or the fact that sometimes just taking a minute to do something small for a patient makes a world of difference.

Also, there was another patient at a different facility, who was covered in wounds from not being turned. He was a total care. I took care of this patient for 8 weeks. Without going into too much detail, there were some circumstances going on that made the RN and CNA's avoid his room at all cost. He was doing horribly. I went to my teacher who took it from there. We had some changes put into place and some new orders from the wound doctor and the last week I was there the pt looked a million times better then the first week I saw him. He was freshly shaved, smiling and telling me he would miss me. I will never ever forget that man. Or the many lessons I learned while taking care of him.

xtxrn, ASN, RN · Sep 8, 2011

I am still in nursing school, and I have only been to two nursing homes. But, there is one patient I will never forget. She was in her 80's, dementia. Not sure what else was going on with her as she was not a patient assigned to me. She believed that she had bugs crawling all over her and would scream for a nurse to come put her medicine/lotion on her. She would sit out in the hallway screaming "NURSE!" To the nurses who were on this floor every night (and most of my fellow students) this was annoying and they had grown to ignore her. To me though, I knew this was a woman who truly believed she had things on her and needed help. So I would go in her room and put lotion on her and just scratch her head. She loved it. The other students thought I was crazy, they walked past her room and said "Are you serious?" But it made her feel so much better, and she would sit there the whole time going "Oh you're such a good nurse. You're going to be the best nurse ever" That woman always put a smile on my face. And I'll never forget her...or the fact that sometimes just taking a minute to do something small for a patient makes a world of difference.

Also, there was another patient at a different facility, who was covered in wounds from not being turned. He was a total care. I took care of this patient for 8 weeks. Without going into too much detail, there were some circumstances going on that made the RN and CNA's avoid his room at all cost. He was doing horribly. I went to my teacher who took it from there. We had some changes put into place and some new orders from the wound doctor and the last week I was there the pt looked a million times better then the first week I saw him. He was freshly shaved, smiling and telling me he would miss me. I will never ever forget that man. Or the many lessons I learned while taking care of him.

That reminded me of a little lady (demented from here to the moon). She'd come by the nurses station every night before bed and want to talk to her mother (who would have been about 117 if she were alive). I was VERY new, and reality orientation was still the thing to do (and a nasty thing to do to someone). So I tried to reason with her :uhoh3: . Finally, in frustration, I unplugged the phone from the jack, put it on the nursing station counter, and told her to go ahead and call her mom....so she did!! And smiled, on her way down the hall to bed. We had an unspoken arrangement when I was on, that as soon as I saw her coming, I'd unplug the phone and put it where she could get it. She never squawked about going to bed again :)

mama_d, BSN, RN · Sep 8, 2011

Oh goodness, so many come to mind...

I've worked with oncology pts for a while now, so most are from that group.

V was a frequent flyer, as some come to be eventually...we'd had her from diagnosis through chemo-related hospitalizations to the end. She was one of those women who are full of **** and vinegar, but she had a wicked dry sense of humor to go along with it. She had previously been vented, and knew she was lucky to have come off of it, and did not want that again. I was there the night that she started to go into respiratory failure again, and was told by the intensivist that without the vent, she'd die later that day. It was so hard to tell her good-bye when I left that morning. We were both crying, and I had already stayed over a while, and she told me to go home and be with my kids b/c they were too young to understand that I was missing out on time with them for a tough old bird they'd never met.

Had one whose dtr was an "expert" b/c she could google. The pt had cancer everywhere, and was unresponsive except for constant moaning, tachy in the 140's, elevated BPs...and no matter how much I educated, talked, cajoled, I could not convince her that he was in pain and needed morphine. When I told her that no matter what we did or didn't do, her dad only had days at the most to live, she got in my face and started screaming at me about how I was not God and I couldn't know. That man died a slow painful death b/c the wife, who was POA, didn't have the cajones to stand up to her daughter and put her foot down...she listened to whatever the dtr said b/c she didn't want to make waves. I don't think I've ever wanted to slap some sense into someone so badly in my career as I wanted to with that self-centered obnoxious brat of a dtr. When I was trying to comfort the other siblings and talk with them about how different people deal with grief in different ways, they all told me that the dtr was always like that and this was not out of the ordinary behavior for her. By the time the pt died they were not speaking to one another, all over a little morphine...it made me feel like a failure. Logically, I knew it wasn't on me, but I do what I do to help those kinds of pts die as comfortable as possible and he suffered to the end.

When I was working as a tech in post-partum, one of my pts started freaking out on me..grabbed the nurse, got vitals, etc. This was before there were such things as RRT, so it took a lot longer than it does now to get stuff moving, even though she was satting in the 60's on a NRB. She ended up vented and on a heart transplant list due to post-partum cardiomyopathy. She lucked out and they found a match in less than a month.

Had a pt for four nights in a row who had come from a SNF. Her legs were atrocious...old dead skin was just falling off in chunks. My tech and I spent the better part of two nights washing, lotioning, scrubbing, repeat until all that dead skin was off. While we worked, we sang songs, taught her current slang, and shared stories about raising kids. The next time she was admitted, she had a different nurse, so I went in to chat with her briefly...and I'm so glad I did, b/c we ended up coding her less than an hour later and although we got a rhythm back in record time, she died the next shift.

C was a frequent flyer for years, after a massive stroke. She wanted to be a DNR according to directives, but her dtr was POA and kept her a full code. By the time she finally died, she was demented, deaf, blind, had bilat AKAs and bilat amputations below her elbows, had a PEG with recurrent aspiration pneumonia, and had a Stage 4 from hip to hip and buttocks to mid-back. We were all so frustrated with the dtr b/c she was never there to see what she was putting the pt through by keeping her a full code. Oh, she was dialysis too b/c all the abx we had to have her on for repeated sepsis killed her kidneys.

There's more, but I'll leave it at that. Seems like the ones I remember the most are those who really made me go "Now that's why I'm a nurse" or those who were so frustrating b/c I had the ability to ease suffering but was thwarted by family who just didn't get it.

Esme12, ASN, BSN, RN · Sep 8, 2011

One that got me at the time and still bothers me when I hear a kid scream "Dad!" at a park was a guy, 40ish. Went to a potluck after church, had heart burn, progressed to chest pain, came to the ER with a NSTEMI. Looked stable, otherwise healthy, a young 40 in good shape. He wasn't my direct patient but I was doing the admission database while the primary did the assessment. His wife was kidding him, saying, "No more cheeseburgers for you, you've had your last french fry" and the guy just kidding and saying, "Aw, God, let me just die now," good vitals, EKG looked a little wonky, but nothing that jumped out at us or the doc...I mean, you tell me I'm having a MI, I'm going to be tachycardic too, you know? A couple of kids, one of them the cutest little boy I'd seen in a long time, ice blond hair, blue eyes, I kidded with them that they were going to be beating the little girls off with sticks in another 10 years. Just a nice family.
We get finished, and don't even get back to the nurse's station before the unit secretary sticks her head around the corner and yells, "Go back!" As we're turning, the wife and kids come out of the room screaming. He'd stood up to go the the bathroom as opposed to using the urinal, and down he went. He was gone when we hit the room. Never responded to anything we did, never got a shockable rhythm, we hit him with everything in the cart, and he was just...gone. We never got any kind of perfusion. The code lasted forever, and in the background you could hear the kids and wife crying in the hallway. God bless'm, the one of the family of the person across the hall was a minister, picked up on the Code Blue, and got the wife into a chair and was comforting her, she refused to go to the conference room. I'll never forget when the doc said, "Okay, if no one else has any suggestions...." He walked out of the room and didn't say anything at all and the wife started screaming. But what I remember more than anything was the little boy saying, "Not my daddy! Not my Daddy! Daddy! Daddy!" We were all crying.
The family had an autopsy done, mainly to find out if there was anything genetic for the sake of the pt's siblings and his kids. Turned out he'd had several "silent" MIs, and had an area of necrosis in one of the ventricles, and it just pulled apart. Nothing we could've done, fixed, he was a time bomb waiting to go off.
I can still hear that little boy screaming.

:hug:

DookieMeisterRN · Sep 8, 2011

Not long ago I had a pt with interstitial lung disease who had totally maxed out his O2 options, chest tubes helped for a few days for a pneumothorax but there was little that could be done, he was totally bed ridden within a week literally unable to breathe and scared to death. I spent so much time with him and much of it was just being there .

I took care of him and supported his wife for over 3 weeks. I wish I could have been there for his passing. The nurse who had been there with him had shared in his care quite a bit too and I couldn't have asked for a more compassionate person as her, so for that, I am happy.

It was heartbreaking that he decided to pass by simply removing his oxygen. Of course he had a gtt to ease the pain and anxiety but I just cannot even imagine how much willpower that must have took to decide to let go and stick to his plan. I don't know if I could ever be that brave.

His wife of 25 years was able to lay next to him and hold him as he continued his journey, they were so connected and complete with each other. I've taken care of numerous sad cases of different types of cancers but for some reason this couple really got to me.

Definitely makes me understand the quote "life is not measured by the number of breaths we take but by the moments that take our breath away".

Jenni811, RN · Sep 8, 2011

The other one was a 17 yo with AML, whose family did not agree to blood transfusions due to religion.
He came in with a hct of 9, and bled from everywhere for 3 days before he finally died. He had younger siblings, 2 of whom did not agree with the parents religion, and verbalized it. They were of the opinion that he also did not believe the same as his parents.
We looked at appointing a guardian, however he had previously verbalized that he wanted to follow his parents wishes.
It was very hard to watch him, and his large extended family-many of whom did not share the same beliefs, come to wish him peace on his journey.

thats a tough one. Had he been one more year older he would have been able to make his own decision.

Jenni811, RN · Sep 8, 2011

When i worked as a CNA at a nursing home, about 4 years ago. I worked down the dementia unit. I worked at a facility where they would send the dementia patients that were uncontrollable in other facilities. The other facilities in our area are EXTREMELY upscale and tolerate nothing.

It also was second to psych patients that needed to be in long term psychiatric care.

Anyway...we had a gentleman that was maybe in his 60/70's, cant remember. But a younger dementia patient. He would spend his WHOLE day looking for food. Ok, we fed this guy, he got a lot of food. trust me, we did not starve the man. But he would be on the floor, sniffing like a dog for food. He would bargain with other demented residents for their food "I'll let you use the good wheel chair if you give me your jello."

The entire day was spent looking for any scrap of food he could find. One time one of the CNA's was at the desk charting, drinking a bottle of gatorade and he came up "What do you want for that drink?? Want this? (as he lifted up his shirt and pointed to his briefs hanging out of jeans) you'll never have to go to the bathroom again"

he cracked me up :)

Esme12, ASN, BSN, RN · Sep 8, 2011

I have seen many things in 25 years of nursing. Some happy, some sad, and some so horrifying that I wondered about the salvation of man.

Many years ago there was this 20 something with 2 small little girls. She was diagnosed with ovarian cancer with metastasis to the bone.....pelvis, spine, femur's, and skull. It was everywhere. :eek: Some mental giant, persuaded this poor woman, into having surgery to "stabilize" her spine so she could sit in a wheelchair. :mad: She was in skeletal traction in crutchfield tongs, on one of those old rocker beds, tubed and on a vent FOR WEEKS!!! When we finally were able to extubate her it became clear she was not going to leave the hospital.

She and I became very close and one day we were talking about death and dying while I was washing her hair. We were both in our 20's so it was a new subject for us. We talked about religion and god and whether there was a heaven. I asked her if she could have whatever she wanted what would that be........she said she wanted her babies with her , a six pack of beer, and a Mr.T's pizza.

The following night....... I came into work with a six pack of beer, a pizza, and her children. (these were the days no children were allowed). Low and behold I get busted by Sister Mary.....she caught me everytime I was doing something outside the rules. "Good evening my dear, what have we here" as she glared at my stuff. "Good evening Sister" I told her it was for my sister and her husband for dinner and they'd be picking it up with the kids. "Well, alright then" she said......they all had the best time that night while we pulled the blinds in her room and hid the kids from the nuns. During the night my patient said good bye to her husband and her babies, thanked me for being her friend and for her wonderful evening with her family.

As she took her last breaths I hear Sister behind me....."God forgives little white lies when the reason is good" as I stood there crying my patient said...."I believe there's a heaven and I'm not afraid......"

Neither am I.....

xtxrn, ASN, RN · Sep 8, 2011

I have seen many things in 25 years of nursing. Some happy, some sad, and some so horrifying that I wondered about the salvation of man.
Many years ago there was this 20 something with 2 small little girls. She was diagnosed with ovarian cancer with metastasis to the bone.....pelvis, spine, femur's, and skull. It was everywhere. Some mental giant, persuaded this poor woman, into having surgery to "stabilize" her spine so she could sit in a wheelchair. She was in skeletal traction in crutchfield tongs, on one of those old rocker beds, tubed and on a vent FOR WEEKS!!! When we finally were able to extubate her it became clear she was not going to leave the hospital.
She and I became very close and one day we were talking about death and dying while I was washing her hair. We were both in our 20's so it was a new subject for us. We talked about religion and god and whether there was a heaven. I asked her if she could have whatever she wanted what would that be........she said she wanted her babies with her , a six pack of beer, and a Mr.T's pizza.
The following night....... I came into work with a six pack of beer, a pizza, and her children. (these were the days no children were allowed). Low and behold I get busted by Sister Mary.....she caught me everytime I was doing something outside the rules. "Good evening my dear, what have we here" as she glared at my stuff. "Good evening Sister" I told her it was for my sister and her husband for dinner and they'd be picking it up with the kids. "Well, alright then" she said......they all had the best time that night while we pulled the blinds in her room and hid the kids from the nuns. During the night my patient said good bye to her husband and her babies, thanked me for being her friend and for her wonderful evening with her family.
As she took her last breaths I hear Sister behind me....."God forgives little white lies when the reason is good" as I stood there crying my patient said...."I believe there's a heaven and I'm not afraid......"
Neither am I.....

I made it until this.... You did something that nobody could ever put a price on. :hug:

Esme12, ASN, BSN, RN · Sep 8, 2011

I made it until this.... You did something that nobody could ever put a price on. :hug:

Right back at cha!!! I have no clue why I put 25 years....it's been 32 and counting... :lol2: