Yesterday morning at about 0315 I was working a shift in the ER. We had an ambulance bring in an older lady (about 88) who had fallen earlier in the night (around 1 am). She was followed into the room by her cute little husband was not in the best of health either. I knew that we had a real problem on our hands when I saw her color and the fact she was not leaving her oxygen on her face. I knew she was in trouble. She looked to be on deaths door step and she had just become one of my patients.
I was the only one in the room with her besides the medics who were standing in the doorway waiting to give report to the nurse. I wasn't about to wait for anyone to ask or tell me to do something to help, so I started an IV just as the nurse came into the room. Now another thing... the nurse (Dani) assigned to this particular room and patient had only worked in the ER for about 8 hours.... EVER.... this was her first shift in the ER, she came for the world of pediatrics in the NICU and PICU. The ER is a totally different beast to try and tame. As soon as Dani looked at our patient, the color nearly ran out of her face as well as the charge nurse that came into the room to take a look and see if we needed anything. Dani called for a doctor to come into the room, and as soon as the doctor came into the room he asked that we move the patient to another room (trauma 1, a bigger room with all the cool tricks of the trade).
Not long after we moved this cute little grandma into the new room, the doctor came in and told her cute husband that we were going to give his wife some medicine to put her to sleep so we could put a tube down her throat to help her breath. The husband agreed and we got a chair and set it in the corner of the room so he could be in there wife his wife of many years. I was standing at "grandmas" head while Dani gave the medications to get her asleep so we could intubate her. After a few seconds of putting the medication into the IV, the little grandma opened her eyes and looked at me and tried to mutter something, then her eyes closed and she was in a medically induced coma. You need to understand something about the medications we gave her, one is to paralyze her (including the ability to breath on her own) and the other is to make her sleep. I continued to stand at her head and breath for her while the respiratory therapist got ready to intubate her. As I stood there and continued to breath life into her, the oddest things ran through my head. I thought " I have a human life in my hands, if I were to stop breathing for her...she would die."
After a few minutes the doctor asked if anyone could feel a pulse, but no one could. She had a rhythm on the monitor, but not a palpable pule. The doctor ordered us to start compressions (CPR) so the nurse did. As the nurse began to press on this grandmas chest, I looked over at the cute "grandpa" and saw that he had tears welling up in his eyes. He knew something was not right, but I don't think he totally understood and comprehend what was truly happening. I walked over and I knelt down and talked to "grandpa". I asked if he wanted to stay in the room or if he wanted to step out, and all he said was "I could make a call." So I helped grandpa up from his chair and grabbed his little bag of oxygen and we slowly walked out of the room to make a call. I asked for the number and I asked grandpa who I would be asking for. It was his daughter. The first time we called, there was no answer. But I knew that it was very early in the morning and I tried back again thinking they may not have heard the phone. This time I got grandpas daughter on the phone and told her who I was and that her dad wanted to talk to her. As I stood there listening to his talk to his daughter, that is when I knew that he didn't fully understand how serious this really was. He told his daughter to "talk to the nurse" and he handed me the phone. As an EMT, I don't have the authority to tell someone what is really going on, so I told his daughter that I think it would be really helpful that someone come to the hospital and stay with grandpa. She said that she couldn't because she had to get up early because she had to work that next morning. I couldn't tell her that we were doing CPR and that it didn't look good. The mom said that her daughter was a nurse on the 3rd floor of the hospital and she would try and get a hold of her and have her come see grandpa.
After getting off the phone, I asked grandpa if he wanted to stay outside or go back into the room with his wife, and he wanted to go be with his wife. We walked back into the hectic room and I helped grandpa back into his chair.
After a few minutes of doing CPR, your arms and wrists get a little sore from trying to press so hard on the chest that you need a break. I could tell at that point the nurse was getting pretty tired, so I took over compressions. I couldn't help but look at grandpa several times and the tears were still in his eyes as he watched us. It broke my heart. Finally I saw a young girl about 25-30 years old that I knew didn't work in the ER come into the room and walk over to grandpa, her eyes were huge. She too didn't know the real extent of the situation because I couldn't tell her mom on the phone. What a shocker for her as well. She walked grandpa out of the room and into the hall, and as she looked up I caught her eyes and I told her thank you for coming, she smiled and said "you're welcome".
Well, I continued to do compressions and the doctor told me to stop so they could see if there was a pulse. There was, so I stopped. Then the doctor told me to continue. We had 2 ER docs in the room talking back and forth about trying different things, trying to collaborate to come up with something that may help her live through this part of life. This went on for about 45 more minutes. We were getting her ready to be transferred to ICU, and it was only me and the nurse in the room when we saw her heart rate drop to 35. Well, we started compressions again and called for the doctor. He came in and looked at grandma and looked at the monitor several times and decided to call it. There was nothing more we could do for her. Everyone left the room but me and a nurse. At this point, grandma still had a pulse of 35 and was trying to breath on her own. This is the part that really got to me...here we were trying to "help" save this life, the life of a wife, mom, grandmother, friend and there was nothing more we as humans could do, all of the years the doctors spent in school learning how to save a life was of no use. It was out of our hands and in the hands of the Lord.
The doctor asked us to stay in the room and wait for her to pass so that we could have a time of death on the death certificate. So, we did. It was hard to watch someone slowly die, I felt guilty that I was just standing there watching and not trying to do something to help her live. I felt guilty like I was "taking" her life. As humans it is amazing that we have the ability to create or take away life. I felt like I was taking a life as I stood there and watched her heart rate go to a flatline. However, we had done everything we could as humans. It was out of our hands.
We started cleaning up the room so that things were put together when the family arrived back in the room to say their goodbyes. It was so hard to sit there and watch the monitors, the heartbeat got slower and slower until there was nothing more. Her time here on earth was up. Her job was done. I called the doctor and told him that the time of death was 0434. It was a very humbling thing to stay in the room of someone who was trying so hard to stay alive but it wasn't meant to be. I watched a life end and there was nothing I could do to stop it. Just a little while earlier, I was talking to her telling her that her husband was at the foot of her bed, and that we were going to start an IV and try to make her feel better. Now she was going home. There was nothing more I or we could have done.
The amount of time we have here on earth is out of our hands. We are lucky enough to come and do the things we do, like go to school, and have families, but when it's our time to go, it's our time to go.
Live life like today is your last day!!
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