The Patient and the Grave

"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.

When You Send Someone Home to Die

Many hospitals have little cards they send home to patients after they’re discharged, where everyone on the unit or anyone providing care signs with little things like “Good luck!” or “Take care!” Or, a lot of the time, they just write their name and call it good.

But what do you write on the card of the patient that you’re sending home to die? 

You spent hours talking with him at 3am while he told you how he nearly became a professional boxer before a car crash took out his shoulder and forced him into trucking, and about the love of his life, a feisty little Dachshund named Jasmine who was a “one man kinda woman”, and wouldn’t hesitate to serve him divorce papers, if she got the chance.

You chased his blood pressure at 1am with Dopamine, watching like a hawk as it ever so slowly crept back up, watching everything about him even when he was too tired to sit up and stay awake and keep an eye on himself.

You noticed that the as needed Roxicodone made him super drowsy, so initially you considered only the 5mg, but he hadn’t slept in three days because of the pain in his lungs from the cancer, so you gave him the full 10mg when he can have it and listened to him snore the night away. 

He offered you his apple and orange when his appetite for dinner never really came, because he noticed you sitting the other night charting without food, and wanted you to have food while you had to be stuck in front of the computer.

He told you a few times that your husband was a lucky man, and spent the night ending every thank you with very genuine “darling”, “dear”, and “sweetheart”.

 You know he’s going home with hospice care to a house with no family, his neighbors are his power of attorney because he doesn’t have family, and he’ll barely have enough money to get his new prescriptions for Oxycontin IR. The discharge papers given him less than six months to live, if that. 

You’re happy, in a way, knowing he’ll be able to go home, in his own bed, with his best girl at his side, and not have to die alone surrounded by cold machinery at the hospital. You’re relieved, knowing he won’t have to suffer that.

But you still don’t know what to write on that card, how to sum up a lifetime and no time at all within four white corners. 

And really, you probably never will.