Tuesday, July 2, 2013

ICU

Over a year ago, I took care of a man in this late 30's who had been diagnosed with aggressive lung cancer. He had a wife, and two children under the age of 5. His diagnosis was quick, he was receiving chemo and radiation, but within one month, he found himself in room 291 in the ICU, on the ventilator fighting for his life...for the life of his wife, kids, siblings, and parents.

I took care of him on a Friday, no plans to wean him as he simply wasn't ready. I kept him sedated, comfortable.

The next day, we did a weaning trial, but he was breathing too fast, tachycardic, etc.

By Sunday, I spoke to the intensivist, and we both felt like perhaps we should forgo the spontaneous breathing trial (SBT) and just extubate...perhaps he will fly? We just didn't think he would pass the SBT. The family was agreeable, and if he didn't  look good, we would reintubate, but he would be a DNR.

His wife was sweet. She worked as a new medical assistant in primary care, from what I remember anyway. She laughed and smiled a lot; to the point that I felt she was probably in a bit of denial. But she kept mentioning his death and how she was realistic and understood it was highly possible he would not survive this. She could only think of her two young boys.

We had the family leave, extubated him, but he was not doing well within minutes. His family all came into the room, hugs and kisses. He was gasping for air. We would reintubate in the interim.
After a long discussion over hours, the decision was made. He would be extubated, and made comfort measures only (CMO).

This scenario has played out countless times for me. I've sat with lots of people as they take their last breath, but for some reason, I lost it that day.
He required a lot of pain and anxiety medication. His father decided he would be in the room. When he came to the door, I was still trying to get his gasping under control. His father took one look from the door, like a scared puppy. I motioned for him to come in, that it was okay. He said sorry, he couldn't handle it, and quickly walked back to the waiting room. Finally, I got him comfortable.
In the end, I believe it was his brother, wife, and sister-in-law in the room when he passed. His parents could not handle it. His mother was a nurse, she was a wreck.
I was dying. I was crying, I kept having to leave the room because I was so distraught. I honestly don't know why this particular situation had struck such a cord with me.
When he finally passed, I hugged his mom, both of us in tears.
Part of me felt like a horrible nurse. I'm supposed to be professional, keep it together!
I thought about him and his family for a long time, and still to this day.
But recently I was reminded of them.

A coworker had been to her doctor's office, and apparently she met the MA, who was his wife. My coworker said his wife said I was one of the best nurses, and she still thinks of me to this day.



1 comments:

Karin RN said...

This post made my eyes teary. It hit home.