"Student, you do not study to pass the test. You study to
prepare for the day when you are the only thing between a patient and
the grave." - Mark Reid
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One
day, you will have a patient that you will keep for weeks from going
into that grave. You will see him through multiple bleeds
post-operatively related to his cancer and chemotherapy and tissue
weakness. You will transfer him from the floor to ICU to step down and
back, and you will keep him from that edge, time and time again.
You
will keep his blood pressure high enough, his output adequate enough,
you will make sure he’s safe walking to the bathroom. You will keep a
hawk-eye out for him eating or drinking, making sure he doesn’t
aspirate, especially when his newly-established PEG tube feedings start.
You will keep his non-skid socks on, keep him in a room across from the
ICU nurse’s desk, and always educate and remind him that yes, that
button with the nurse’s hat is the button he needs to press for help.
You’ll
sit with him for nights in a row, or go in multiple times to help him
even when he’s not always assigned to you, and listen to his stories.
You’ll get called “darlin’” a whole lot, get some kisses on the hand,
and laugh while giving him a hard time about being a “crusty old man who
just won’t give up.” You’ll watch him carefully get everyone’s name
down on a list, and stay up in his chair for hours, hand-writing cards
to everyone on the unit who has taken care of him.
But one night,
while you sit in step-down ICU with a new nurse after a stable night
with him getting ready to go home the next day, you will suddenly hear
him yell for help. You’ll walk in, thinking it’s the urinal again, and
you will wonder if you stepped into the wrong room.
There will be
blood everywhere, on the wall, on the bed, on the telemetry monitor,
the call light, and him. This crusty old man who just won’t give up,
will be retching, gurgling, coughing, and hacking up more blood than
you’re sure you’ve ever seen in one place, and you will be rather
shocked he isn’t swimming in it already. The new nurse you have with you
will freeze, and give you the widest eyes she’s probably ever had in
her life, and you’ll hope that yours aren’t that big, because you know
that you’re it.
You’ll hand her a basin, grab the suction off the
wall, double check that yes, he’s a DNR, and start paging everyone you
can think off. People will run in and out, trying to help your crusty
old man to breathe, and he will look at each one in sheer panic, and
continue coughing and gurgling and retching and yelling for help, all
while putting out clots the size of softballs and adding enough blood to
the floor and your scrubs to make it look like the scene of a horror
film.
He’ll make 10 minutes of this before he gradually slows,
his efforts to breathe become agonal, and his eyes no longer open to
look into yours for reassurance, just down to tiredly spit out more and
more blood that still comes. You’ll see that line before the grave come
up, and you’ll know that you can’t get him back from the line this time,
that nothing you’ll do will bring him back. So you will override some
verbal orders for morphine and Valium, and get them into him as quickly
as possible, watching his eyes close and his efforts soften as they both
hit his system.
15 minutes after you entered the room, he fades
away, with three nurses holding his hands and hoping that the Valium
they managed to get in did something for him to perhaps not have been
quite as panicked. You will look around, and wonder what war zone you’ve
managed to find yourself. You’ll start to automatically think of the
checklist you now have to do with the body, but you’ll look down one
more time at his face, all the wrinkles and the missing teeth and the
laugh lines, and you’ll ache so much for someone who did not get to die
peacefully.
You’ll also feel with that relief
for him, relief for his wife, that she didn’t have to experience what
you and all the nurses around you did. You’ll all team up to wipe down
the walls, floor, monitors, bed, and him. You’ll pick up the stack of
cards, so white and crisp before and now covered with spatters of blood,
and you’ll hold them gently and reverently before throwing them into
biohazard bags.
You will call his family, finish charting, and
make sure everything is taken care of. You will tap the shoulder of that
new nurse, and walk with her to the staff bathroom to wash blood and
clots off her arms, because she’s apparently forgotten that her arms
still existed.
You’ll leave the hospital, and it
will be peaceful, pretty even, outside. The sky will be blue, the drive
home will be quiet, the world will be moving on. You’ll go home and try
to sleep before your next shift, but your dreams will be filled with
codes and blood and yelling and panic, and you’ll wake up after three
hours and give up on the return to sleep.
Yet you will still show
up to work that night, walking slowly past the room that’s now clean
and sparkling and no longer smells of iron and copper and death. You’ll
start the shift, and it won’t be any different than any other shift.
You
will be different, though. Your dreams will be filled with blood and
panicked eyes for a long while, and you’ll carry that with you, even
though no one else will see it. Your other patients won’t notice, and
will make it home, away from their own graves, to stay on earth a bit
longer, thanks to your work on that shift.
You will do all that,
and you’ll really see, more clearly than anyone, that keeping patients
from that gray line isn’t always the most important goal; sometimes,
it’s seeing the line coming up and doing everything you can to make that
leap off the edge a little bit better than it could have been.
You
will feel more than know, as you walk through the beautiful sunshine
outside into a world that doesn’t know the death you just faced down,
that the power you hold to help someone die is just as beautiful and
important as your power to help someone live.
You’re a nurse, and that is, after all, just what nurses do.