No Code.
I'll quit being an ICU nurse when my work gets boring. Yesterday was one of those memorable days. My patient was very sick and might not make it past the shift. Medications and a ventilator were keeping him alive. The family was hopeful for his recovery but I have to break to them the bad news. He was getting worst and it's not looking good.
I've refrained from telling loved ones that things are bad. This case is different. All the signs of death is present. Agonal breathing, high doses of pressors (drugs that constrict veins and arteries so the organ gets perfused.) No pulse oximetry signal. (a device that reads oxygen saturation, usually place on the finger tip or in worst case scenarios, the ear lobe. A red light reads the content of oxygen delivered by the capillaries.) Lab values were worst than 12 hours ago, indicating liver and kidney failure. Blood pressure in the 80's systolic, above 90 is desired. Normal is 100-120's. Overwhelming sepsis has set in. The condition is MODS, multi organ dysfunction syndrome. Bad news.
The day was an endless attempt to keep him alive. Family members trickled in during the day sobbing and praying. The doctor was talking about no code. The family wants everything done, can't blame them. It's their father, brother, uncle, grandfather on the bed dying. The surgeon went in to see the patient and concluded that he is so unstable, anesthesia will kill him. A representative of the family signed the DNR. Do not resuscitate. Well, he's already intubations and on the vent and the drugs are the ones we use during a code. So basically, I have been coding him for 8 hours straight.
After 8 hours of pumping medications into him, his heart just gave up and died. His family surrounded him. His passing was particularly hard on his daughters. They hugged his body as if it was alive. He was a lucky man. So many people love him. The crying can rip the heart out of any human being. I carried a sad face but kept my professionalism. There are paperwork to fill, organ donation number to call, and doctors to notify of the death.
I was a little peeved at my charge nurse. She wanted to control the visitors in the room. She kept asking me to control the crowd. I told her that I'm not able to, but deep inside I'm not even trying. I'm letting them mourn their loss. I don't care if there are 20 of them there. The charge nurse employed the help of a Spanish speaking social worker. She spoke to them that we need to clean the patient and the crowd needs to be controlled. Great, I don't want to look cold to this people, I've been their advocate all through out this struggle.
There is a double standard. When one of our nurse's father passed away, they were allowed to watch the code. It was a different feeling watching loved ones watching me do chest compressions. All the managers are available, consoling and the director was even assisting with the other nurse. No such people in this patients case. Hey, I call this work benefits or perks.
I kept thinking about the double standard as I usher the family away from the body. I'm upset but nothing I can do. We let them stay for an hour but was unable to grant their request to wait for a son coming in from the east coast. He will be arriving at 9 pm and state law doesn't allow the deceased out in the open for more than 4 hours. This is due to public health reasons.
Today, we had 3 intubations in the span of 5 hours. One patient didn't make it. They coded her for 3 straight hours. I did chest compressions and I was exhausted. This was the first code on this patient, they coded her 3-4 times in 3 hours.
There is an unwritten law about sets of threes in the ICU. Death comes in a set of three. One died yesterday, one today and one more and the law is obeyed. I'm glad I'm going home. My arms are sore from doing chest compressions. I'm off tomorrow, and I will use the time to rest and hope that I don't witness the set of three again.
I'll quit being an ICU nurse when my work gets boring. Yesterday was one of those memorable days. My patient was very sick and might not make it past the shift. Medications and a ventilator were keeping him alive. The family was hopeful for his recovery but I have to break to them the bad news. He was getting worst and it's not looking good.
I've refrained from telling loved ones that things are bad. This case is different. All the signs of death is present. Agonal breathing, high doses of pressors (drugs that constrict veins and arteries so the organ gets perfused.) No pulse oximetry signal. (a device that reads oxygen saturation, usually place on the finger tip or in worst case scenarios, the ear lobe. A red light reads the content of oxygen delivered by the capillaries.) Lab values were worst than 12 hours ago, indicating liver and kidney failure. Blood pressure in the 80's systolic, above 90 is desired. Normal is 100-120's. Overwhelming sepsis has set in. The condition is MODS, multi organ dysfunction syndrome. Bad news.
The day was an endless attempt to keep him alive. Family members trickled in during the day sobbing and praying. The doctor was talking about no code. The family wants everything done, can't blame them. It's their father, brother, uncle, grandfather on the bed dying. The surgeon went in to see the patient and concluded that he is so unstable, anesthesia will kill him. A representative of the family signed the DNR. Do not resuscitate. Well, he's already intubations and on the vent and the drugs are the ones we use during a code. So basically, I have been coding him for 8 hours straight.
After 8 hours of pumping medications into him, his heart just gave up and died. His family surrounded him. His passing was particularly hard on his daughters. They hugged his body as if it was alive. He was a lucky man. So many people love him. The crying can rip the heart out of any human being. I carried a sad face but kept my professionalism. There are paperwork to fill, organ donation number to call, and doctors to notify of the death.
I was a little peeved at my charge nurse. She wanted to control the visitors in the room. She kept asking me to control the crowd. I told her that I'm not able to, but deep inside I'm not even trying. I'm letting them mourn their loss. I don't care if there are 20 of them there. The charge nurse employed the help of a Spanish speaking social worker. She spoke to them that we need to clean the patient and the crowd needs to be controlled. Great, I don't want to look cold to this people, I've been their advocate all through out this struggle.
There is a double standard. When one of our nurse's father passed away, they were allowed to watch the code. It was a different feeling watching loved ones watching me do chest compressions. All the managers are available, consoling and the director was even assisting with the other nurse. No such people in this patients case. Hey, I call this work benefits or perks.
I kept thinking about the double standard as I usher the family away from the body. I'm upset but nothing I can do. We let them stay for an hour but was unable to grant their request to wait for a son coming in from the east coast. He will be arriving at 9 pm and state law doesn't allow the deceased out in the open for more than 4 hours. This is due to public health reasons.
Today, we had 3 intubations in the span of 5 hours. One patient didn't make it. They coded her for 3 straight hours. I did chest compressions and I was exhausted. This was the first code on this patient, they coded her 3-4 times in 3 hours.
There is an unwritten law about sets of threes in the ICU. Death comes in a set of three. One died yesterday, one today and one more and the law is obeyed. I'm glad I'm going home. My arms are sore from doing chest compressions. I'm off tomorrow, and I will use the time to rest and hope that I don't witness the set of three again.
