After being off for a few days, I went back to work at my cover-all ICU. I had the typical two, vented patients, who were very much fluff and turns.
Around 9 pm on my first night back, a twenty-something-year-old male from the ER arrives. The ER nurse gave our nurse report, stating the patient was breathing a little fast. We are all thinking 25-30 breaths a minute, sounds reasonable. Finally, the patient arrives, and we hook him up to our monitors and get him settled. But the guy is breathing 50 times a minute and satting 85% on a 100% bipap.
He didn’t look good. I got down on one knee and stroked this guy's hair, and told him that he was in the ICU and we would take care of him.
He seemed to understand but was terrified. While holding his hand I told him that he needed to focus on his breathing; we needed to get a new IV in him so we could get him some medicine to relax. I also told him that once he was calm, we would bring his partner back to see him.
This patient was rapidly declining—he was in ARDS and soon to be in septic shock. Because he was not calming down, we told him that he needed to be intubated. He was scared and got a little combative, but in no way do I blame him.
Finally, we got the OK to intubate and it all proceeded rapidly. Once he settled down, his partner came back. My charge nurse discussed with him the possibility of contacting the family. He said that the patient didn't want the family contacted, but he was going to do the right thing and call them.
Within a few days, the patient was still on CRRT but not doing so well. The partner had been kicked out by the brother, which made me sad. That partner had been there every night at his bedside, keeping him company, talking to him, caring for him. Yet he was kicked out for doing the right thing.
But the patient was assigned an amazing nurse. She had him on 4 different pressor drips, and by the end of the night would add one more while managing CRRT and another patient. The patient was paralyzed and rapidly declining, but this nurse was determined to get the partner to say his goodbye to the patient. She managed those drips like a well-played Beethoven sonata; she worked hard to keep the patient alive.
Finally, at 4am, she sneaked the partner past security (with the help of our charge nurse and a caring security officer), the family, and everyone else who didn't want him there, to say his goodbye.
After sneaking the partner out, within 45 minutes the patient died.
Some people question whether people really wait for their loved ones; after tonight I believe they do. I'm still very young in my career but that night I learned a lot about what I want. I want to be like that nurse—and when I'm dying I want to have that nurse.
She is not the perfect nurse, because the perfect nurse would not get involved with family issues. But those imperfections make her perfect to me. I never thought I would be affected.