Monday, April 28, 2008

The Death of My Patient

I actually didn't know how to feel when my patient died. It was a sort of mixed emotions that were so strong that I wanted to run away somewhere far. I was so helpless as I watched my patient die. Like I know that sooner or later he was going to die. He had the classic clinical signs of shock like cold clammy skin, he was diaphoretic, his pupils were dilated, and he had consistently low blood pressure. Imagine, I had to re-check if I had the right BP taking because his BP was 40/20 mmHg and this was the first time I've ever encountered this low BP. I was at first excited and happy even that I was experiencing so many new procedures that a normal student nurse could encounter in a medical ward. I was able to assist in inserting a catheter, a nasogastric tube, and I was able to insert an IV fluid as a side-drip. On that same day I was able to observe the insertion of an endotracheal tube and I was able to compress an ambu bag (bag-valve-mask). I have also observed suctioning procedures and even nasogastric tube feeding. My patient was transferred from the medical ward into an (intensive care unit) ICU and of course my partner and I had to go with him. If I didn't have a partner at that time I wonder if I would have survived. we monitored his vital signs every hour, we monitored his O2 Saturation, his ECG, his infusion pump, and he even had a ventilation machine since he was already in coma.

I had a gut feeling that he would die. I just knew it. He had 3 consecutive cardiac arrests and the ward would constantly have to call a cold blue. It was just like in the movies where nurses would inject epinephrine or atropine so that his heart would start beating again. But I just wondered why they never used the defibrilator to revive the patient, they just used the standard CPR. On the third arrest the doctor finally announced the patient dead. I was still deflating and inflating the ambu bag valve mask like crazy because I didn't know whether to continue or just stop. The family of the patient already started crying and their mother called her other children saying that their father had died.

It was weird, I was at first doing procedures to save his life... and then a few hours later I had to remove the tubes and connections that where keeping him alive...

But somehow I don't feel pity for him. Death may be scary and all but he saw it coming. My patient was an alcoholic, drinking too much everyday. I can already imagine him going home late at night drunk and very violent. When you're drunk you become to do stupid things and this has been proven by so many people already. He drun k himslelf to death. That is all that I can say. He had drank so much alcohol that the veins in his liver grew larger until they finally bursted. He had an upper GI bleeding and he literally vomited blood (hematemesis). He went into coma and I guess he died from the bleeding.

Here is a lesson to all alcoholics out there. You just don't kill yourself from drinking. You destroy your family and you become a menace to society when alcohol reaches your brain and you start being stupid. Domestic violence and some crimes happen when people are drunk. Stop drinking!

I don't know why people love to kill themselves. I also had another patient who said that he will stop smoking for a while because he has difficulty breathing and he has blood tinged phlegm. Stop for a while? Why not stop totally? He has been smoking for 30 years (started at age 12) and he hasn't learned that it does nothing good? He's not only killing himself too. His family and the people around him are the ones who are twice affected by his smoking.

Bad vices gets you no where. They may at least make you feel good (as some people say - I wonder how and why) but the outcomes aren't that good. My point? Nothing is gained from smoking and drinking. So too our dragons and drunkards out there have pity on your loved ones. They suffer more than you do.
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