in a word, it was tragic. she shouldn't have died. it was probably TTP, resulting in a brain bleed. she came in, jaundiced with low blood counts 5 days prior, also with a history of anxiety. when i got her they told me she'd had a reaction to the ativan and benadryl from that morning. she'd been wild and bent her iv pole. so my baseline for her was agitated and somewhat delirious. H/H 6.8/18.9, platelets 22. she had 2 units of PRBCs ordered. i tried to start the first one at 2300, but she was so all over the place i struggled to get her vitals. she kept going from the bed to the chair, taking her heart monitor off, clothes off, oxygen off, sheets off the bed. i could barely keep the IV in her arm. I called Ali for backup. to try to keep her under control he threatened restraints. i just kept trying to get vitals and piece them together to make full sets for the transfusion slip. it became more and more difficult to get a blood pressure and a temperature on her. her temp was dropping and registering like 94.0. she was breathing fast, and having some vaginal bleeding (which had been going on for a while, so not a new thing). then she passed some stool that seemed to have some broken down blood in it. I paged the doctor by 2320, with no call back, really at that point still to just get something else to calm her down, as the haldol i'd given her at 2300 hadn't remotely helped. As each minute beyond that passed, i got that gut feeling that something more was wrong. around 2345, she kinda leaned back, her eyes got droopy like the haldol was kicking in, when she shut her mouth and opened her eyes super wide and glossed over. at which point i knew it was over, but hoped her heart was still beating even without her breathing. so i called for a dr pit, but kara went in there, started chest compressions, saying, "We need a code not a dr pit!!" at which point sharon wasn't at the desk, so i was turning in circles trying to figure out what the number was I had to call to call in the code. or blue alert i mean. the terminology is just difficult to keep straight when your patient is dying. i was told later that when kara went in the room, shook the patient and called her name, she took her last breath and that was it. because she'd pulled off her heart monitor, we don't know exactly what time she went down. a couple minutes after the code was called, dr joseph, respiratory, ICU nurses, ED nurses were all in there. as well as most of our floor and the code cart. ali, tammy, kizzie, richard from ICU, and kara all did compressions, vashone got her intubated. her blood sugar was 415. the only rhythm we got on her was some vfib, we shocked her once, and it was PEA from then on, through the 4 rounds of epi, 3 of atropine, sodium bicarb, vasopressin, and calcium gluconate. i felt like i held my own as the recorder and her primary nurse. i knew the patient, had been in the room with her, knew her labs, and stayed calm when the doctor rattled off questions in my direction. at 0013, the doctor called it. at one point the husband had walked in during the code, and of course he and the daughter were just in pieces. i am so thankful that kara spoke with them afterwards about funeral home arrangements and such. sigh. i think i would have just lost it had i had to do it. they aren't even from here, they are from louisiana. i don't know if they recently moved here or were on a trip, either way, how awful. uclin took the admission i was supposed to get, and i only had to care for three patients the rest of the night. and do all the paperwork. and try not to process all of it. my coworkers hugged me and tried to make sure i was ok. which, in some emotional self defense, i was. i think my brain knew not to let all that in when i still had 7 hours of work left in the shift.
when i got home, and got up the next day, i was still ok but i could FEEL the whole thing just sitting in my chest behind my heart somewhere. it wasn't til i was getting ready for work the next day that it hit me all at once. I was the one who was with her in her last hour on earth. I was not particularly comforting, but I suppose it beat being alone, i'm not sure. she kept repeating, come here come here. or help me. or look at me! and i did. and i will never forget the look in her jaundiced eyes. she was so scared. it was not a look of peace. it was of terror and desperation. i'm sorry. i don't blame myself, but i'm still so sorry. sorry her life had to end like that. sorry for her husband, and her 20 year old daughter, and her 5 year old son with the weird name that i don't even remember... something like Qi or something. sorry that i couldn't have been a comforting presence because my job was to try to save her. sorry no one caught what was going on before it was too late. sorry my job involves watching death. its scary and ugly.
i suppose it is a twisted sort of privilege of my job that i get to be there in these most private and vulnerable times in peoples lives, but god its horrifying.
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