Tuesday, August 4, 2009

Things that go wrong, even when you do everything right.

Really, just with odds in life, something like this was bound to happen at some point. The last night I worked, we got this patient on an ambulance. Adorable little old lady- she was about 81, with the complaint that she had run out of blood pressure medicine and that she had started to get a headache and feel bad. She ended up going in one of my team members rooms and we all went in and helped get her triaged and set up. Her pressure was pretty high, but she only rated her pain at about a 3. She wasn't stressed out, and was laughing and joking with us- the only reason she had really come to the ER because one of her in-laws had come over to take her blood pressure and had seen how high it was. We didn't even start a line on her- we put on a heart monitor and the doc ordered a head CT and was probably just going to give her a pill for the pressure and send her home with a prescription.
My teammate got another patient who was pretty sick while this lady was in CT, so I was walking over to help her when I looked over and saw the patient shaking and vomiting on her stretcher. The CT tech said that it looked like she had just had a seizure. We wheeled her back into the room and my charge nurse and I put her on a heart monitor- some really weird junctional rhythm popped up, and she was snoring and unresponsive to pain at this point. I ran to get the doctor, and by the time I got back in the room she was having agonal respirations, like people get when they're trying to die. We moved her into one of the trauma rooms and felt for a pulse- there wasn't one. At this point it became a full on code- we started compressions and the doctor came in an intubated her- we pushed all kinds of drugs until she converted to V-Fib (as my ACLs instructor so eloquently told us, one of the "oh shit" rhythms), which we finally shocked her out of after about 5 cycles of CPR. Unfortunately, she converted to asystole (flatlined), and after 17 minutes, we called it at request of the family.
I understand and deal pretty well with death most of the time, since it's pretty much a given part of where I work. But it's unusual and really eerie to have someone talking to you and feeling fine for one minute and then 15 minutes later, you're doing CPR on them. Almost all of our CPRs come in as CPRs in progress, and the rest generally happen after a patient is already very sick and on their way down. Situations like that don't really lend themselves to you getting to know that patient as a person. You don't get to see them interact with their loved ones or to see what their personality is really like. It was different with this lady- just with a short interaction, you could tell that she was really neat and funny. Apparently, when the medical examiner called the doctor that had been taking care of her, he cried upon hearing that she was gone. Our trauma nurse had a good way of looking at it in that she didn't suffer, and she was living independently until the end of her life. It's just weird to feel like there's something you should have or could have done, some sign you should have caught, that might have allowed the patient to live. I tend to be hard on myself anyway, so naturally I felt like her death was somehow a result of my negiligence since I had collected all her information. I again figured out how blessed I was to be part of such a great team- my charge nurse and the more experienced nurse on my team were both so supportive and reassuring that there was nothing I could have done and that they both would have done all of the same things.


  1. When it's your time, it's your time. She was in the right place at the right time...it didn't matter...it was her time to go. At least she was joking & smiling in her last hours alive.

  2. Yes, difficult. I have seen this happen several times in L&D....with pregnant moms...it is very difficult.