Ren and the art of Motorcycles

Monday, September 04, 2006

The First Time....

Something most nursing students don’t see much of, if you are in a big university program, is death. If there is a code blue on the unit where you are, you are shuffled out of the way so you don’t interfere with the care being provided. In fact, during my nursing school days, I never saw a code when I was in the hospital for clinical.

However, I was fortunate. A big inner-city hospital near my home hired senior nursing students to work in the hospital. As senior students, we were permitted to do everything a nurse did, with the exception of giving medications. Unlike nursing school where I cared for one or maybe two patients, in BIC hospital I carried a 8-10 patient load, responsible for patient care, documentation and reporting to the next shift. It was a very good job and I learned a lot. But it is also where I saw my first death.

It started as a usual day. I had a full patient load of 10 patients. One of them was Mrs. Smith, who was on our unit with pneumonia. Mrs. Smith also had Alzheimer’s disease, and she was very hard to care for. She kicked, bit, scratched, and did anything she could to hurt people. I learned a LOT of four-letter words from this lady. Her husband, who sat by her side continuously, was mortified by her behavior. From him, we learned this lady never raised her voice in their 40 years of marriage, always was immaculately dressed, had her nails done weekly, and never swore. Mr. Smith adored his wife. He made her up daily, made sure her nails were still done weekly, and tried to keep her clean and neat. Unfortunately, Mrs. Smith had some behaviors that made that very difficult for him. We had to put her hands in restraints to keep her IV in place because not only would she pull it.out, but she would dig out feces with her lovely nails and rub them all over herself.

At the start of my shift, I went and checked on Mrs. Smith and the remainder of my patients then returned to the nursing station to chart the vital signs I had taken on my patients. No sooner had I sat down then the Smith’s daughter, who had arrived for a visit, came running down the hall yelling that her mother had stopped breathing. I followed her back to the room, took one look at Mrs. Smith and hit the code button.

As I began CPR, the charge nurse came in, followed by the respiratory therapist. The other nurse brought the crash cart and opened it as the code team entered the room. The charge nurse ordered the intern to take over CPR and instructed me to start keeping notes as she escorted the family out of the room. The Code Team senior physician asked for the medical history, which I gave. He stated, “Pulmonary Embolism” which really impressed me, that a physician could 1) make a diagnosis that fast and 2) that a pulmonary embolism could cause this.

Although they tried for over an hour, they were unable to resuscitate Mrs. Smith. I followed the doctor as he went down to the waiting room to talk to the family and stood in the corner as he spoke to them. The family’s shrieks and wails rang through the room. I didn’t know what to say or do, so I opened the door and left.

I returned to Mrs. Smith’s room, where the nurses were finishing preparing her for the morgue. I stared at this lifeless body, so still after all her activity. I had never seen a dead body before, never encountered death before. Family members had died, but I had been very young and not been taken to the funerals.

Death had a face. Death was someone people had loved. I finished the shift, thinking about Mrs. Smith, her family, and their grief. I learned a lot that day, and I’ve never forgotten it. And yes, the attending physician was correct…she had died of a pulmonary embolism.


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