Wednesday, January 09, 2008

oh what a night

Disclaimer: Please stop reading now if you don't deal well with death or have lost a loved one recently. There is probably another blog more suited to your needs right now and I urge you to visit them rather than linger here.


Call me good or (philosophical debates aside) call it luck, but in my twelve years as a nurse I've never had a patient die unexpectedly while under my care. Of course various patients have died along the way, but their deaths were relatively peaceful and anticipated and I was able to offer comfort and dignity in their last moments. I find these ministrations rewarding and meaningful and I don't shy away from them. For me it is an honour to be there in a person's final hours.

Still, it came as something of a shock to find a patient obviously dead at 4am last night. I knew the moment I stepped behind the curtain, but as she was still listed for resuscitation I had to respond to the emergency and call a code. She'd been unwell for some time and we could not revive her. As we pulled up the sheet and recorded the time of death our heads were spinning. Night shifts run on skeleton staff so there was no chance to sit with the patient and pay our respects. It was immediately on to the tasks left undone during the emergency.

At 5am I helped turn a patient and was not happy with her condition. She had deteriorated significantly during the course of the night so I asked the doctor to come and review her. At 6:15am we called another code. After 15 minutes this patient too was declared deceased, in the bed right next to the first patient. Again there was no time to contemplate, reflect, or honour the long, full life of this patient. We had little choice but to madly try to complete our duties before the morning staff arrived.

The whole episode seemed quite surreal. Two patients in one night, right next to each other? Unheard of, at least in this small place. Then there was the automatic defibrillator that kept telling us in a mechanical voice to stop CPR while it analysed a heart rhythm we knew did not exist. As I shut the lid to silence it, the strident voice called out 'open lid to continue CPR' and we couldn't help but laugh wryly at the incongruity of the situation. Then there was the nurse on another ward, who could not have failed to hear the code called over the hospital PA, but still kept phoning and asking for assistance with a relatively minor problem they had. Things became more absurd when other patients, oblivious to the mayhem, buzzed for blankets, bed pans, clean sheets, panadol. I stared at them dazedly - blankets, bedpans, clean sheets and panadol in the midst of pandemonium as we attempted to cheat death? I dished out requests quickly and quietly, asking for patience as we sought to recover from each crisis.

When the night finally ended we four nurses ducked down to the local cafe for a drink and debrief before heading home to sleep and do it all again tonight.

Only I'm not doing it again tonight, because as it turns out I couldn't sleep. I kept seeing the dead, pondering what we did, wondering if we could have done more as my heart raced. Calm balm, soothing music, reading to tire me out... nothing worked. I repeatedly dropped off to sleep for a few minutes before waking with a start and returning to the night's events in my mind.

So while I seemed to cope at the time and accept the patient's deaths (they were old, unwell, one can't keep people alive forever), the emotional toll played out in my head today. What a terrible way to die. What an indignity. What a miserable end. And what of the families, rudely awoken with the sad news? And the other patients in the room who endured the events behind rustling curtains? Unpleasant. Disturbing.

Twelve years code free, but what a horrible way to end the run. Miserable. Unpleasant. Hideous. I know it had to happen some time, but I'd like another twelve years event free. Please.