Two codes in one day, saved one and lost one.

[NurseMom2016]

Fair warning, this is very long winded. This is the first day As a nurse I have driven home and cried over the loss of a patient. So bear with me! And please no criticism. I have criticized myself more than enough I feel.

Let me start out with a little bit of background info: I have been a nurse almost four years. I work on a busy cardiac telemetry unit. I charge this unit and the new one next door on our floor about 75% of the time, (52 beds total and 12-13 nurses on the floor) as well as the telemetry room. I have been charging about a year now. I usually enjoy the busy workflow.

On monday, the morning started out with a code situation about an hour into the shift on the smaller new unit. The primary nurse recognized that this patient was in very bad condition and acted correctly. Luckily, I happened to be making rounds on that unit at the time and heard the code buzzer go off and I was able to get in there quickly. He had very agonal respirations (think fish-out-of-water) and even though he had a rhythm on the monitor, there was no pulse and we initiated CPR and the code blue. I told the primary nurse to get the bipap on him, which was already at the bedside and turned on in standby mode, while I initiated compressions and waited for more help to arrive (it was only the two of us in the room at that point). We coded him for right under five minutes and got him to the ICU within 10. I felt really great after this code (which I usually don't, I am very self critical, and even when the person lives I tend to focus on what I did wrong). I felt I had extra confidence after this code and was very proud of myself and the primary nurse for handling the situation the way we did.

The SECOND code of the day happened around 1300, right as I was about to sit down for lunch. Now, as both of these units are separated, they have two different call light systems. I felt so bad that I didn't even know this code was going on until they called it overhead in the hospital(which sometimes can be up to a whole minute after it is initiated). The code alarm was going off on the small unit, but I couldn't hear it because I happened to be at the other end of the main unit in a another patients room. This man was a 57 year old man who had been with us for about three weeks, and we all knew him. He had numerous PEs, a DVT, and had recently had a large hematoma evacuated from around the incision site of a recent ACD (incision on the front of the neck). He had an IVC filter as well. So any time we tried to put him on anti coagulation, he developed these life-threatening nosebleeds, and he would have blood coming out of his mouth. He required rhino rockets and blood transfusions several times. So the physicians decided to send him to an LTAC to start more gradually on anti coagulation. He was supposed to leave that day. The primary nurse had already called report to the LTAC and he was scheduled to be transported in about an hour and a half. (This was all conveyed to me after the code by the primary nurse). He was up getting dressed to leave, and needed to go to the restroom. The wife told the tech to leave, she had it handled. A few seconds later she comes out screaming, they go in to find him slumped on the toilet, and they get him onto the bathroom floor and hit the code button. When I arrive they are doing CPR in the bathroom floor. He had a blanket under his back and shoulders from when they got him to the floor, so we slid him out near the bed and lifted him up onto the bed. We coded him for over 30 minutes. Round after round of epi given. We could never shock, he only ever had PEA. Over the commotion in the room, you could hear the wife in the hallway crying. I still wasn't emotionally bothered at this point. I was focused on the situation at hand. I was also recording, as well as directing very green nursing students into the code to do a round of compressions. Even when the docs asked everyone if they were ok with calling it, I still wasn't bothered. What bothered me was looking over on the couch in the room, and seeing a bag half packed, getting ready to leave the hospital. It wasn't until then that I felt sick at my stomach. Then, at that moment in the hallway, you hear an awful, gut wrenching wail from his wife. I lost it-I have NEVER lost it when a patient has died. Even when we call the code and the spouse is there, I don't cry-I have never really had an issue with this. I looked at the tech still in the room with me, and asked her if she could help me hurry and get the crash cart out of the room so I wouldn't have to witness her coming into the room. My gosh, they were packing their bags to leave, and now this poor woman is having to plan a funeral. I had to excuse myself to the restroom as I heard the wife crying when she went into the room. I had to go in there and let loose for just a few minutes. I had no idea why I was so emotional over this one situation, when I have experienced numerous others that have been similar or worse.

I felt like a failure that day. The primary nurse was a strong nurse, and I ended up handling a two of her other patients to free her up some to handle the post mortem paperwork and other things that had to be done, but I let her handle it. I went home feeling like a failure, praying for this poor wife that I couldn't even go and comfort for 30 seconds because I was so afraid that I would start to cry too. I had taken care of him just the week prior, and she kept offering to bring me a Starbucks, if there was anything I wanted from the cafeteria, etc. this woman was so nice and I couldn't even find it in myself to go and just hug her, pat her back, nothing.

Have any of you ever experienced something like this? Don't get me wrong. I do not consider myself some cold hearted nurse who never cries with their patients. I do, but I hate doing it, I hate that they see me cry. This whole situation has just bothered me. I can't stop thinking of his poor wife and what she must be going through. For some reason that day, I just couldn't handle it.