a couple of the hardest days ever....

*disclaimer* this blog is long winded so hang on...

Since I'm a nurse and since I work in a Cardiac Critical Care Unit, it should go without saying that I experience a lot of death. I have seen death in all shapes, sizes, creeds, and colors. I've seen beautiful ones where an old woman was gently eased to sleep in the arms of her sweetheart of 63 years as he whispered "wait for me at the gait baby" in her ear. I've watched a young man scream in agony, the most gut wrenching scream as his 23 yr old fiance and unborn child slipped away. I've gotten messy during CODES where the doctors and nurses have fought for hours to reverse/stop the inevitable. I've worked on people for days, keeping vigil, changes IVs, and seeing them through close calls. I've seen families wrestle with last wishes and nagging reality. I've turned off breathing machines and stopped life sustaining drips. Through it all, I've cried, been disappointed, relieved, tired, scared, mad, touched, blessed, and in the presence of God. Usually I walk away from a death feeling as though it was an effort well made; that we did all we could have possibly done or we allowed for dignity in those last moments. Never have I felt so helpless as I have the past 2 days.

I had the honor of taking care of a man with whom I, from the moment we met, felt connected to. He was homeless, had no family to speak of and was VERY sick. His personality was priceless. He was happy despite his dire situation and I could sense a peace in his spirit...kinda like he was just along for the ride. Not a care in the world it seemed, although I'm sure he had his fair share of trials and worries.

I'll try not to bore you with medical terms but just to give you an idea of how sick he was... he had what we call 3 vessel disease. This means the 3 main arteries that supply oxygenated blood to your heart muscle were occluded. It was determined that each vessel was 95% blocked meaning he need Bypass Surgery (open heart surgery). Unfortunately he also had some other health problems that made it impossible for him to have this surgery. His lungs were so stiff from years of smoking that they would not support him well enough for him to survive. There was nothing we could do. So my job was to keep him comfortable, control his pain and help him breathe. Easy enough right?

During my first night with him, we started off fine. His breathing was a bit labored but he assured me he was OK; that he normally breathed that way. He didn't seem to be distressed but I was unnerved by how hard it was for him to breathe. I kept an eye on his O2 sats and tried not to worry. Well...he didn't stay OK for long. A heart that is deprived of oxygen gets angry and wants attention and that is exactly what his did. the doctors had to place a device in his aorta to try and give his heart a break as well as supply it with more oxygen. This device requires the patient lie flat on their back and not move AT ALL. At one point his heart rate grew as high as 175 beats per minute. (normal is 60-90) His blood pressure was 60/40 (normal is 120/80). He began to experience pain and have a harder time breathing. Here's where it gets hard for me. Can you imagine lying flat on your back with your tummy (his was big) putting pressure on your already stressed lungs while your heart is beating like you've run a marathon and you have muscle cramps up and down your back and legs from not moving for over 12 hours? he was in agony. he kept reaching out for someone to hold his hand and help him through his misery. He was begging me to make his pain stop. My hands were tied. I gave him meds to slow his heart and increase his blood pressure to keep him alive but because his pressure was so low, pain medicine was out of the question. I would have killed him.

So there I stood for hours with this man at death's door, wanting peace, wanting relief, begging for help...I had everything he needed and it was just out of my reach. I felt utterly helpless and the deepest part of my core ached to help him. I felt like I was watching someone drown and I just couldn't throw the life preserver far enough. I have all the skills and medicines to save his life but I can't use them. All I could do was hold his hand, wipe the cold sweat away, and apologize to him for allowing him to suffer. I wanted desperately to do more...to do something different. After a couple of hours stifled panic, I got his pressure up enough to give him some medicine to ease the pain. Soon after I hear him calling for me. I entered the room to find a completely different man. He was smiling from ear to ear and reaching for me. "There she is!", he said. "I just wanted to tell you I feel good". "Whatever you gave me, I feel so good now". All i could do was smile through the tears. I felt better too.

My second night with him was alot different. His heart was back in "normal" rhythm. His blood pressure was unstable, but supported by medications. He slept a lot because we found a medicine that didn't effect his blood pressure. He decided to allow his death to occur naturally so there would be no heroic measures, only peace and comfort. He was scared at times though. He asked me not to leave him alone. So I sat with him and watched him sleep, catching his eye every now and again as he checked to make sure he wasn't alone. His heart and breathing began to slow at 4:30 this morning and I held his hand as it all stopped. He wasn't alone and he doesn't hurt anymore. I am relieved for him and thankful that I wasn't as helpless in the end.