Within this last year, my life crossed paths with a woman who had come into the hospital for abdominal surgery. As she was transferred from the surgical floor into the ICU at the beginning of my shift I noticed her bright eyes, her slow, kind smile and her long salt and pepper hair. While I was getting her settled and completing my assessment; she shared with me stories about her life in the town she lived, her family, and her plans for the future. While she was chatting with me and telling me about herself, with slight hesitation, I could tell she was normally a reserved and quiet woman. Without her family present at her bedside; what she needed was an ally, and a friend.
That is the amazing part of being a nurse. The part of the job you can’t define, write about in a textbook, or teach. It is about the moments when people know life and death are colliding and right there, in that room, it is only them and you. You need each other. She needed to know me so she can trust me to tell her the truth about what was going on. I need to know about her so I would know what to advocate for in the event she couldn’t speak for herself.
The job, the struggles, the triumphs, and the heartbreak wouldn’t exist without humanity. Humanity, compassion, and empathy grow slowly in relationships through shared experiences. In the situation where we had just met; I could tell she was working on building trust between the two of us right away.
Once she got into her room, I worked on making her comfortable and her breathing as easy as possible. It was a couple of hours before we were able to be scheduled for CT scan and in that time I really got the opportunity to see her true character. She wasn’t my only patient that day, though she was the one that worried me the most. I made great effort to keep checking in on her and making sure her condition and assessment hadn’t changed. She was profoundly grateful. It’s frightening to be alone in a hospital room while you know you don’t feel well and you can feel your condition changing. She never let on how frightened she must have been. As information came available for what was going on with her, the doctors or I went in and talk with her about it. She listened and processed everything we were saying. She took all of the information as it came. Careful not to create any further scenarios and fears in her own head with pieces of information still missing. She was careful to understand everything we were saying and ask questions about what the next step was. She was steady, intelligent, and very well-reasoned.
We went for CT scan to rule out a pulmonary embolism. A blood clot that traveled from her lower extremities to her lungs. This was the presumptive diagnosis that her doctors were all assuming and prescribing treatments for accordingly. There was much discussion between her surgeons and the ICU doctors that, if she had a pulmonary embolism could we safely prescribe blood thinners for her…. She was such a fresh surgical patient that her risk of bleeding was so high; but without anticoagulation she could die.
When we got back from CT scan it was confirmed. Though not just one pulmonary embolism, but many and large ones. The doctors came in very shortly after we returned from the imaging department to tell her the news. Her overall condition hadn’t changed. The amount of oxygen she was on was the same, her breathing wasn’t any more labored, her vital signs were unchanged. The sense of urgency wasn’t there in decision-making yet. She methodically asked what was the next step in the treatment plan.
A technologist came to the bedside to do a cardiac echo. While standing in the room watching; I could see the very large clot moving around in the right atrium of her heart-something nobody expected. My knees went immediately weak and I felt my stomach turn over as I knew immediately what I was looking at. It wasn’t a matter of “if” any longer: but when.
The cascade of events that happened and the time frame in which they occurred, while they are forever locked in my mind, went by in a flurried blur. Shortly after learning of the clot in her heart, a very strong clot busting medication had been ordered by the physician and the decision was made to start a second anticoagulant.
As the doctor told her the plan, I held her hand. She didn’t look at me, she looked straight at him with an expression of complete surrender and I felt myself do the same.
Within minutes of the discussion at her bedside she started having pain for the first time that day. As I gave her IV pain medication, the pain in her chest and her arms was escalating. As I was standing at her bedside and looking at the monitor, she yelled “Michelle, something’s wrong!” I turned around and instantly her body went rigid and then limp.
I started CPR and called the code team. We did continuous CPR for one hour and the events of that hour are punctuated in my mind by statements, events, and medication, and the times all of it occurred. Forty minutes into the code, I remember the nursing supervisor asking me if I was ok. Only then did I realize there were tears running down my face. All I could reply was “She’s an amazing lady.”
Her family and her husband were able to get to the hospital and together they were inspiring-watching them care for her and each other. She did make it through until the time I left a few hours later. I wasn’t scheduled to be back for over a week and when I returned, her chart was off my computerized patient list; a sign only that her body had succumbed to this post-op complication.
It is difficult to go through something like that with another person and not have the closure of knowing what the rest of her hospitalization was like and hoping her passing was peaceful. In the magnitude of the loss her family sustained, I wish peace and strength for them everyday.