Tuesday, March 23, 2010

Death is not always...so neat...

As a nurse, I get very used to seeing death. Death is mostly expected...somebody has been sick a long time, or has a very bad diagnosis. We are not surprised at the outcome, the body wears out, life has taken it's toll, cigarettes....drinking...bad decisions, sometimes cancer and things just totally out of our control. Death is always sad, even when it is the expected outcome. We do post-mortem care...remove IV's, foley's, lines, tubes, and clean and wash the remains, it a very quiet and respectful, meaningful task. It is an honor to perform this necessary task, so the families last view of their loved one at the hospital is in as natural a state as we can achieve.

When death is unexpected...things are not quiet so neat. In the hospital there will be the wreck of the room...tubes, lines, gauze, syringes...you name it, strewn all about the room. The Resuscitation team will work with a frenzy to try to bring the patient back if their code.

This weekend, I got a taste of a different kind of death, the kind that the First Responders and EMT's see on a daily basis. I gotta say, I am glad there are people cut out for that kind of work, because I can tell you I'm NOT one of them.

We were on our way to the beach. The weather was fairly nice, 83 degree's, but it had started misting. We had our cruise control set...after all...we had a vehicle full with my niece, her fiance, her two kids and my grand-daughter...in addition to me and Dave. A jacked-up Ford club-cab passed us just flying. We caught up to him when he got behind a slower vehicle...which he promptly passed. Dave and I agreed that the dude was an accident waiting to happen, as he was passing without adequate space. We remarked to each other that if he didn't wreck, he was gonna cause somebody else to wreck. Unfortunately we were right. He went to pass another vehicle...had to jerk back into his lane, but his truck started rolling. It rolled twice across the opposite lane of traffic, and then hit the ditch and the palm trees. The driver wasn't wearing his seat belt and was ejected out of the driver-side window. He apparently was dead before leaving the truck, since there wasn't much blood....I should know, since I was the first on the scene and was the one who covered him with a bright beach towel. His cousins were with him, and Thank God, wearing seat-belts. The male had already bailed out the broken window, in shock, and told me "don't look at him, he's dead!" I told him I was a nurse and I had to look at him to see if there was anything I could do. It only took one look to see there was nothing I could do for him. He was lying on his stomach, but his head was facing me (in retrospect I realized his neck was totally broken). CPR was not an option as he no longer had a mouth, or even one whole side of his head. The man probably weighed close to 200 lb, but it looked like every bone was broken...like a child's toy...tossed into the ditch. Later, when I was assisting with the woman inside the truck, I found his left mandible lying in front of the truck on the ground...totally bloodless, fleshless, and very clean looking., and probably one of the most horrible things I could have found.

The female passenger was in shock, I had her unlock her door so I could check her out, but instead of staying in the vehicle, she of course bailed out as soon as the door was open (not that I blame her!). I gave her a beach towel to use as a blanket and sat her on the ground. EMS still hadn't arrived and neither had the police...we were out in the middle of no-where's-ville. I asked if they had been drinking...and she said no...and I believed her ...there was no odor of alcohol, or other indication that alcohol was involved. I had given the male passenger a beach towel for a blanket also...but had abandoned him to treat the female because his adrenaline level was so high...he was aggressive (SHOCK!) and I didn't want to agitate him. My sweet husband was busy fetching me towels and trying to get hold of 911.

I know it felt like forever, but EMS and the Constables were there in minutes, then the Laguna Vista Police arrived, although in fact were were a couple of miles outside of the township. A female responder, who was pretty hefty (read: muscled) just picked that lady up like she was a feather and carried her out of the brush. I was very impressed. I was also very glad to relinquish the response effort to somebody better equipped. I had no gloves, no stethoscope, no anything...just beach=towels and my brain.

DPS arrived and took our statements. The children were upset and crying...There had never been quite so close to death before. I promised them new beach towels from Wal-mart on our way to the beach, which pacified them. I, on the other hand, am still thinking about the wreck and what I could have done better or different to help the two survivors. The worse is the dead driver...who will never had that second chance to slow down and wait to pass...to have that chance to get to the beach. In a blink of an eye...his life was over. He was young, healthy and had everything to live for...and that is the saddest part of all.

Monday, March 1, 2010

Coca Cola

Had a patient in ICU, total liver failure, very sad case. Young guy not even 40 yet, probably won't live to see his next birthday, emacipated arms and legs, huge pregnant looking ascites belly. Lot's of co-existing problems, since the liver does so many things besides filter blood. The liver has a lot to do with blood coagulation and so on.

Well the little guy had a Nasal Gastric Tube and was getting feeding via the tube. I had done all the proper things like flushing the tube, checking residule, hanging new tubing and new feeding. I had noticed that the flush was a little sluggish, but nothing really concerning, until I needed to give some medication just before end of shift. I go to check residule and the tubing looks like clabbered milk. Ummmm, cannot aspirate with large barrel syringe, cannot push H20. Ok by now I'm starting to sweat. I have to unplug this sucker. Removing it and placing another is a no go because of esphogeal varcies and the high high high risk of the duke bleeding to death. The best solution is usually to place some soda in the tubing and wait then work it until it clears, the only problem there is the hospital no longer provides cola's for the patient's (budget ya know). Well, it just so happened I had a soda in my fridge stash (my dear hubby had sent it for my lunch two weeks ago, I don't drink soda so I had just saved it) so I put some down and worked and worked and worked. I was finally able to aspirate part of the feeding (which is like baby formula...only like I said clabbered). Dude asks me what I'm doing, he has been without anything to eat or drink by mouth for 20 days, I tell him I'm putting Coke Classic in his tubing to clear it. He gets a big grin and says "Coke...I'm getting Coke...wow!" It was so funny.

So this morning before I leave I go in and flush the tubing, he looks at me, raises his eyebrows hopefully and queries "Coke???". It was just so funny!