Journey's End

My first patient passed away on me this past Thursday, February 8th, 2007. It was an event that I hoped might never come. I don't mean to say that I'm afraid of death, but more that I knew it wouldn't be easy for me nor the patient's loved ones.

I was honored to care for someone who was well-loved and, from what I hear, was a very nice man. By the time we received the patient, at the beginning of the shift, plans were under way for him to moved home in hospice care. Hospice care is basically end-of-life care. No curative measures or life-prolonging treatments are given.

Around 3pm, the patient's heart began to slow down to 42 bpm. We went into the room to see the patient. He had been unresponsive for the majority of the day, partially due to the pain medicine we gave and partially due to his multi-system organ failure. The wife was there and my nurse told her that she might want to stay; she was planning on leaving. About fifteen minutes later the heart rate was down into the 20s. Fifteen more minutes and he passed away, his hand being held by his wife of almost 60 years with her telling him how much she loved him. It was really hard to watch, but at the same time I had so much joy because he was loved and didn't die alone.

Later that night when I got home I told Shannon all about it. As I was trying to process the death, I realized how much I fear dying alone. I was so happy to see that he wasn't alone in some hospital room with a million tubes coming from his body. Shannon and just held each other for while, silent. We thanked God for the relationship that He's given us and the new life growing inside Shannon's belly.

When the patient passed two other nurses had to come into the room to pronounce death. Then the physician was notified, orders were received and paperwork was filled out. The family came to see their patriarch. And I continued caring for my other two patients. It was probably the most difficult day I ever experienced. I longed so much to be in the room with them. I didn't want to go back to work and let such an important moment go by. I wanted to honor this man who I'd heard only seven words from my entire life. I'd only known of him for eight hours, but he was still a creation of God, subject to the curse of death. I wanted to mourn his passing. Yet I did my job. I knew it was what I had to do and what was best. The other patients needed medications and I had to finish writing notes.

I don't know why, but I felt like that was one of the times I'd been closest to God, both physically and spiritually. As he died his soul left his body was either bid welcome or denied entrance to Heaven. God was in that room in a different way than in our every day to day life. It was an honor to be there as one more soul came to its journey's end.

The New Job

It seems like the last month was full of new things. And this month is shaping up in quite the same manner. I began my new job at Alvarado this past Saturday and worked again yesterday, Monday. I'm a Nurse Extern in the DOU; it's basically a step-down unit from the ICU. The nursing ratio is 3 patients per nurse. ICU is a 2:1 ratio. Med-Surg floors (the basic nursing floor of all hospitals) is 5:1 in most San Diego hospitals, but I think the California regulation might be 6:1. Back east the ratios are as high as 8:1, but since California is more litigious than any other place in the world!!!! we have to take more time out to chart so that we don't get sued if something wrong happens ( incidentally takes more time away from patient care, go figure). But, I digress...

The DOU is fun. I like all the nurses I get to work with. I'm following Linda and Joe, two exceptional nurses who have a good head for taking care of their patients while keeping everyone involved in their patients' care well-informed of their current status (this is very important usually and more so in the DOU). I had a patient who was on a ventilator yesterday. He had a mass removed from his lungs which was exacerbated by COPD (emphysema in his case). I really enjoyed taking care of this patient because I saw him progress throughout the day. I think he surprised himself in how far he was able to walk. We put him on a less invasive ventilation setting in the morning, which he tolerated well, and then put him on a Trach Collar, which means their is no longer any machine operating, only oxygen being blown near his trach. The machine helps the patient breath by creating a positive air pressure. We normally breath by negative air pressure (we create a vacuum in our chest when we breathe, which sucks air in). So what he did yesterday was a vast improvement for him. AND considering how small the trach tube is to begin with also emphasizes this point. My nurse compared it to trying to breathe through a straw. Well, maybe an over-sized slurpee straw (see above pic)!

I tried to choose tame, non-gross pictures this time, so hopefully they're more interesting than overwhelming. Above is a ventilator (not the same model we use, this is more bulky), top right is a drawing of what someone looks like with just a trach tube in, bottom left is a trach tube, and bottom right is a drawing of where the trach tube goes. The hole where the tube enters is called the tracheostomy (stoma = "hole" and trach refers to the windpipe). Click on the images to make them bigger.

I'm really looking forward to learning more. I feel slightly overwhelmed by all the new info and the huge responsibility of keeping someone alive, but I feel like I'm able to bear it. But, yes, I need God's help so much. I can't do this without him. I don't want this to just be a job. I want this to be worship. Come Lord Jesus.