Work has been so strange lately. It's not even Hell Season yet. For those of you who don't realize what that is, Hell Season usually hits around November and lasts through March or April--in other words, flu season. In other words, the best of times and worst of times to for a respiratory therapist. The best because I will earn about 3 times more than I usually do in the off season because the hospital is usually full of respiratory patients and the overtime is there for the taking. And I am opportunistic. Sick people need our care, staffing has to be up to accomodate them, and I am all about more moola! On the downside, I have not yet maneuvered Hell Season as a Nursing Mom. I had another night last night where I went 8 hours without pumping because I was just too busy, and this is way before it is supposed to be as such. Will my boobs survive? I don't know. We shall see. But you can expect more posts about work.
Last night I got a call from an RN friend from the SICU, warning me that I should start heading that way, that my patient was getting ready to code. I get there and he is off of his ventilator and the nurse is bagging him. I take over and am bagging him when we lose his pulse. The big blue button is pressed to alert the troops, and the rest of the code team arrives. We resuscitate this patient for over 50 minutes. During that time, we get his pulse back only to lose it again. His wife is brought in to say her goodbyes and also to see that we are doing everything. She is obviously very distressed and calls his daughters. And we call it: Time of Death 04:46. The rest of the team leaves the room except for me and his assigned nurse. I tell the nurse to turn the oxygen off from the connection on the wall and the loud hiss of it stops and there is silence. I detach the bag from his endotracheal tube and lay it on his chest. And then I hear it: noisy breathing. I look down and he is spontaneously breathing. And not the agonal, uncoordinated breathing of the dying. No, this man is breathing. So I try to discreetly get the nurse's attention, who calls the resident back in. And they check him. Good pulse, good blood prssure. Just like that. He came back. The Lazarus Syndrome. I've heard of it happening may times. This was just the first time it happened to me. So we hook him back up to the ventilator and tuck the blankets back around him and leave the room with out resuscitation equipment. Just like that, as if nothing had happend. Totally bizzare.
Meanwhile, in an adjacent unit of the hospital, there is a patient who is breaking my heart. An elderly gentleman who knows he is dying and has signed a DNR order. And he begged me and begged me to help him die, and all I could offer him was treatment to prolong his life. I have to tell him both sides: that it could be considered life-saving treatment, but that it also could be short-term to help him through until he can breathe a little easier. And bless him, he doesn't want it and I can see that, but I think he is worried about what I want to hear more than he is about how he wants to die. And it breaks my heart. He keeps asking the nurse and I to just make it go quicker, and I can't. We ask if he wants us to call in his family and he says no. "I've been married for 64 years to the love of my life," he says, "and I don't want her to go through this. Just call her when I'm gone." True selflessness. He wasn't worried about her being there to hold his hand. Instead he took the hands of a young nurse and a respiratory therapist, both strangers to him, and that was enough for him. I had to stand there and do nothing while he started to slowly slip away. I couldn't call a code or intubate or breathe for him. There were no chest compressions or life-saving cardioactive drugs. And now I can't get him out of my mind.
We spend years of our lives learning how to save a life. That's what I do. Well, the biggest part of what I do, anyway. I'm sorry if that sounds like the swagger of a cocky healthcare provider with a God complex. It really is just the fact of my occupation. And they teach us of the legalities of our role: what constitutes extraordinary measures, medical futility and more. But then there is the side of this for which they do not prepare us: standing by and doing nothing. Holding a hand as our patient dies when we are trained and geared toward doing anything and everything to prevent it. And in that moment, just like my patient, I have to let go. One would think that the resuscitations and other life-saving moments would be the greatest challenge, but they really aren't for me. What happened with this guy--well that is the hardest part. Having the ability to keep him breathing an his heart beating and not doing it. Letting go.