Just Raven

I haven’t written about my work, the daily doings of it, in a long time here. Somethings happened over my weekend that need a place here. Life counts. Don’t ever forget it.

Some folks who come here don’t know what it is I do for a living. I work as an LNA in specialty hospital/rehab center. I work weekends, 6am to 10pm Saturday and 6am to 10 pm Sunday. It’s a long weekend too- these back to back double shifts are at best a very trying time, at worst they can brutal. I’ve worked this weekend shift for about two years now; before that I did the M-F thing. I’ve been at the same place for 14 years now; I know all the different units and the patients, staff, doctors…others. We hang out together after work, before work, all the time…LOL We’re like a big family.

We had a patient admitted to us about a month and a half ago…a young man who had been in an auto accident, speeding, on drugs and drinking…got thrown from the car many hundreds of feet and ended up losing both temporal lobes and the skull bones supporting them. Both sides of his head crushed in, with the actual skull bones being surgically implanted into his abdomen where they are best located (typical medical thing, this is.)
He’s been in a level 3 coma eversince. Due to the nature of his injuries which are proufoundly severe, the kid requires total life support: Ventilator, trach, J tube for feeding, cranial pressure relieving drains (tubes), spinal fluid shunts (drains), bile/liver drains…catheters and tubes and wires all coming and going into parts of his body….special IV lines and ports. He was hospitalized of course right after the accident and stayed there for two weeks before coming to us; he caught MRSA while in that hospital. So he was also dealing with needing special IV antibiotics to help rid his body of these awful infections. Isolated in a room with controlled temps and air ventilation systems, he existed a in lonely clinical enviroment.

Saturday he was doing as well as can be expected: His VS were within normal limits; his labs came back (3 times each day) normal; his tone and color were good. We monitor every body system there is. He needed 1:1 care because of the complexity of his monitoring. Even with mechanical ventilation, his lungs were not able to produce enough oxygen for his body. The complex heart/lung loop- the process of taking 02 poor blood and pumping it through the heart and into the lungs to bring the 02 level up to the richness the body requires, was no longer an automatic function of his body. He lost the part of his brain that controls this. He has had several bouts of bacterial pneumonia- the most recent a week and half ago. Just a kid still, aged 17, he died in my arms yesterday at the end of a harrowing event where his heart just stopped.

Patients in coma require stimulation. We believe that those who at a different level of conscieness can hear us, hear all the noise the machines make…hear music and tv and just about everything. We’ve all heard of people waking up from their coma only to tell us what they experienced. Medical staff have become acutely aware of this. This patient was no different in the need for stimulation. There are many theraputic things we do to meet this goal: medications, controlled sensations created by even more machines, pain-evoking apparatus (NO it’s not torture at all)…and then we have simple methods- bathing with scented soaps, music on, heated linens, air fresheners (different scents), flavored mouth gels…things that are designed to elicit some reaction from the patient.

Saturday I spent some time with this patient; reading newspaper articles to him and a few chapters from his favorite books. Sometimes we have to do things many people would find offensive, especially with young men. His Mom told us her son had the typical liking to Playboy type magazines…so….I read some of the stuff from a recent edition to him, and told him HE HAS TO WAKE to see the HOT CHICKS LOL. He didn’t respond to that. BUT, when I read about the Superbowl game coming up, his fingers moved and he turned his head-no easy feat considering it was being supported by a neck brace and a HALO frame. This is one strong boy, I thought. I decided come hell or high water I would watch some of the game with him Sunday night.

It never happened. Sunday morning he was within all the normal limits (as we say in this line of work); his equipment and fittings all working properly. He was “junky” though- needed a lot of suctioning all day. He de-statted several times and we managed to get him back to the required 02 levels each time. We turned him and repostioned him every two hours, which helps move things around within his lungs. We had to be careful though, not only did he have a broken skull, but both legs, an arm and his collarbone were smashed in the accident. Full of pins to keep everything lined up, he was attached to a traction device as well. We have special beds that rotate, 360 degrees. It’s a time consuming thing to do. All the pumps and tubes and wires must be carefully moved as well.

Around dinner time his 02 machine started alarming. Not the typical alarm that tells us the levels are going down; this was a more ominous alarm that tells us there is NO 02 passing through his system. It happens shortly before the heart monitors begin alarming, telling us many things. This time the heart monitor told us his heart had stopped. Just like that. No S waves first, then T waves. No arrhythmias, nothing irregular - which is what usually happens and gives us precious moments to get things going.

Everyone came, running. The alarms are heard throughout the unit. One of the doctors happened to be eating with the staff.

It’s not like you can do CPR on a patient like this. The traction and frames have to be removed. A helmet has to be placed over the head wounds. We didn’t have time to do that. When it’s like this, all we have are medications and cardiac defibrillation. I stood back and watched, as this was now under the direction of the doctor who was the only one qualified to do what had to be done. He removed the HALO frame so we could don the helmet; then we turned the traction devices off, removed all the pins and wires from his chest and the MD did the defibrillation. Nothing. It didn’t work. They drew up the heart starting medications and pushed them through. Nothing. It didn’t work either. More defibrillation. More meds. Nothing.

I realized early in this event that the patient was not going to make it. Some things, we just know.
I stood back for a few moments but then, after the HALO was off, I moved in and held the boy; hugged him and told him not to give up, to come to us, to take a breath…I reminded, through burning eyes, that we had a date that night to watch the game. Pittsburgh would win…I held his cold hands and realized he was dead…and the nurse in me told me to accept and move on. But he had no one there with him. No one wants to die alone. Death is a process, just because the heart stops doesn’t mean the mind and soul have stopped. Clinical death is when the heart has ceased. Actual complete death can take another 2- 5 minutes. So I held him for that time and longer.

Everyone left the room except the doctor, who stood with me and said a prayer. He helped me prepare the body, one of the less than desirable aspects of my job: it’s called post mortem care. Soon the EMT’s arrived they have to respond to a code no matter what. We didn’t need them this time. A little while later the local funeral home vehicle arrived and they took my patient. I stayed in the room. Had a look around, all the mess everywhere. You don’t even realize how messy these things are: Blood and mucous everywhere- on me, my hands, the walls, the ceilings….floor covered with all the apparatus of a code; tubes and containers and wrappings all over. These rooms always need a very clinically radical cleaning after these events. I called the people responsible for this. Then I told my co workers I was heading off for a break.

These things make you think. With all the events happening all over the world it’s hard to think the death of one patient can have an effect. I’ve seen death up close and personal, many many times. Each and every time it hurts; it breaks the heart and leaves a void that cannot be filled. I’ve said it before here: Nursing staff are supposed to be professional and NOT get attached or involved with their patients. The robot mentality. Not me. I can’t and won’t be a robot, cold, careless and mechanical. Never. When some one is at their hour of death, and no one else is around for them, I will be there. I don’t care what people say and think. No one should ever be alone when they die.