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Losing A Patient

April 10, 2012 Leave a comment

As healthcare workers, we always know that there is a possibility that one of our patients will die on us. 

I began my nursing career in surgical intensive care in a very large teaching trauma center in San Antonio, Texas following a critical care internship.  The patients we got in the SICU were major traumas—a woman thrown under a train by a jealous boyfriend or tied to the tracks by an irate pimp—or arms cut off by a husband; a 14 year old boy who dove into a “too shallow” pool to retrieve his baseball hat while horsing around with his cronies and now faces a lifetime as a quadriplegic and so on. One day I came into the unit, looked around and marched straight out and to the DON’s office where I put my application in to work charge nurse recovery.  Those patients were asleep and as soon as they woke up, they were off to their rooms. Minimum exposure to sadness, to trauma (all intensive care patients left the OR and went straight to the SICU). From there I went to the Operating Room.  Those patients were ASLEEP the whole time I took care of them. So after being a trauma junkie I entered the world of wellness nursing in the guise of same day surgery.  And I fell in love with it.

 

Oh, I have faced death in my beloved world of otherwise healthy patients.  There was the patient we lost—a 46 year old healthy woman who came in for a vein stripping and died because the esophagus was intubated rather than the trachea.  There was the 45 year old woman who came into another center for multiple plastic procedures and after 11 and ½ hours of surgery died upon exiting her car in her driveway of multiple pulmonary emboli. We had the 86 year old who was oxygen dependent, and who wasn’t given oxygen during his stay in the center; consequently exiting the operating room with no vital signs.  Nothing prepares you for such a loss.  You are never fully prepared.  We live in a world of wellness where our patients are, even with all their underlying health issues, truly Class I & II ASAs who consider themselves otherwise healthy.  We see them that way.  We admit them, take their histories, their vital signs, listen to their stories, meet their care persons, laugh with them, get frustrated, give them instructions, put them in the car and wave at them as they leave.  “There we go, another one bites the dust!”, I used to say jokingly as I marked their name off the schedule, did a little jig of happiness and sang a little.  We had returned another patient to his family, to his social world better than when he came in…another success.  We become conditioned that this is the way it IS!  This is the way it SHOULD BE…and it is.  We become, gradually, complacent that it will ALWAYS be that way.  We let down our guard.  We start going on automatic pilot.  We become drones addicted to the routine of everyday life in our busy surgery centers. AND THEN….it happens…and it is catastrophic…a child dies on our table….we work frantically…we do everything we know to do…everything we have learned…everything we have been taught to save this child…to bring him back so we can deliver him safely to his family….but it doesn’t work.  We are left with the horrific impact….the horror of facing the family…the family with…now…empty arms.

 

I remember once when working recovery having a 3 year old little girl brought to me from the OR wrapped in a pink blanket.  Her long black lashes lay silent on her cold, still body.  A little child with major heart defects whose only chance of living was to try to correct them…but she couldn’t hang on…I believe God wanted her too much.  As I carried her in my arms to the morgue down the back steps I was faced with her parents coming up the stairs from the cafeteria.  I just sat down with them right there and handed them their baby.  We held one another and cried.  There is nothing else that can be done.

 

Stephanie broke down in tears when she heard of the loss at one of our surgery centers.  I tossed and turned all night.  We had them bring in a grief counselor for the staff.  Stephanie reminded me that every time a patient comes into our centers, holds out their wrists and we affix a wristband, that patient is now “at risk”.  We must never forget that and must stay alert and ever ready.  Go in peace, Little One.

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