he was 97 years old and in good spirits for being seen in the ER for abdominal pain. when i asked what his allergies were he said "women" which both gave us a chuckle. but something wasn't right, his breathing was labored and his color was gray. i kept asking if he felt short of breath but he didn't really notice, then i went to catheterize him and he didn't even flinch.
he wasn't my patient, i was covering someone's lunch when he came in. when the nurse came back from eating, i gave report and went to cover the next person. eventually i got my own patients and then at shift change i was put in triage. i tried to keep up with him but things got busy and the last thing i remember was seeing his lab results. curious to find out what the results said, i took a peek. a potassium of 6.1?! so his labs are out of whack, a high potassium can cause lethal heart problems. but triage beckoned so once again i left.
i came back in search of a room for a patient who was probably stable enough to wait. i saw one room was closed off and asked our charge nurse why. she said the man that was supposed to go to the floor coded at some point and they were holding his body in that room. then i saw the name written on the board, the name i labeled the blood with, since i started the iv. the name i labeled his stool samples with since he was complaining of diarrhea. the name i pulled the foley catheter out on and tried to catheterize him with no luck thanks to his large prostate.
wait....what? MY patient? the man i joked with when he arrived? yes, sadly so. no one was freaked out except for me.
here's how i'm guessing it went down. i took care of him and then his nurse came back from lunch, the patient went to CT or Xray. when he returned he wasn't placed back on the monitor, i saw him right when he arrived back from CT/Xray and he was already not as responsive, why didn't i tell the doctor? at change of shift (6:30PM)the oncoming nurse took report, looked at the vitals last taken at 6:15pm and figured he was stable. the patient was to be admitted and had a room assignment so she called report. a question came up she didn't know so she walked in the room and he'd already died. at what point? i have no idea. were those really the last vitals?
the truth is, he was a DNR (do not resuscitate) and the doctor knew. i don't know how much he did for him, why he didn't stress that the patient be on a monitor? how come no one noticed? all i kept thinking was, what would i have done differently? and really, what more could have been done? he wouldn't have wanted heroic measures, no chest compressions or intubation kits. he would have coded and we wouldn't have done anything and that would have been more difficult.
the family came to pick up his belongings. they got his gold watch that i removed so carefully when i started his IV and then ever so carefully placed back on his wrist. they took his gold chain that i put in a biohazard bag before he went to xray. but they left his glasses behind. i was tempted to bring them home since i was more upset that the family left them there for no one, his body was already gone.
we get so used to saving patient's lives that defeat isn't taken easily. it was his time to go, that i understand, i just wish i could have done more.