*Warning: Not a pleasant post…easily nauseated folk beware.*

It hasn’t been an overly good week, and a quick read through the obituaries proved that thought. I was able to point to the patient we lost this week in an ugly code situation.

It was one of those nights where we were understaffed and spread thin. We all had more patients than we were supposed to, and we had no charge nurse. Things just weren’t flowing the way they were supposed to.

At about 01:00, one of the nurses (who was precepting a student that had just left to buy coffee for everyone) came to ask for help cleaning a patient. Three of us walked in there, and I’m pretty sure you could see all our jaws drop.

The patient was bleeding out. She had just had a large melena stool, which to be honest was much more appropriately described as frank blood. Nobody said a thing, but we all knew this patient wouldn’t last the night.

While we were changing the sheets, the patient, and the floor, a med student walked in, took one look, and immediately left. He was oozing panic. He sheepishly came in a couple minutes later and watched as we parading in front of him all the evidence that this woman was in trouble.

“Exhibit A: Attends saturated with blood”
“Exhibit B: The suction canister full of blood. Someone had set up a yonker to help clean faster”
“Exhibit C: The patient…notice her pale face and laboured breathing?”

Her nurse, by far the most experienced nurse on the unit, demanded that he get the senior resident.

“But he’s in the OR!”

“Get him or we’re calling a code” Was her response.

Apparently, a debate followed in the OR. The senior resident was adamant that they go see her, “It’s my patient, I can’t just ignore her when she’s dying.”

“Whatever, let them call the code so you can finish here and not worry.” Was the attending surgeon’s position.

Fortunately, somehow, the senior resident prevailed and came to care for the patient.

I was on the phone with the blood bank trying to get five units of blood STAT (getting yelled at for not knowing if her type and screen was current) when I heard someone yelling “code blue, code blue.”

I hung up on nasty blood bank lady and called a code blue, amazed as always at how fast the announcement is blared over the loud speakers. Even more amazed at how fast there were thirty people around her bed.

Amongst this, I squeezed my way to the front to check for her type and screen bracelet. I took a glance at her…there was blood pouring from every orifice. I returned to the desk to call the blood bank, only to find out the blood was on the way. They are fully aware of how current the type and screen is thanks to the magic of the computers we all have access to…so she had processed the blood and sent it. Seriously, is an emergency situation the time to verbally abuse someone unnecessarily?

The patient didn’t last long after using the rapid infuser to give her five units of blood practically instantly. The whole time, she just kept mumbling, “I’m sorry, I’m sorry.” She hated being such a bother.

*sigh*

Wrapping the body was unpleasant. She was covered in blood and we needed to use the yonker again and again to clear pools of blood. The code team has even left her airway in since every time they removed it, blood poured out. Not a problem…nothing a yonker couldn’t help.

But still, it was, as usual, the most spiritual and serene part of my job. We removed her Foley, PICC, femoral line, and IV. We washed her body and hair, we positioned her pleasantly…all with more gentleness and care than with a living human. There is always a pure peacefulness in the presence of a body…A sucking void of calmness.

We sent her off with porters on a cold steel stretcher bound for the morgue. She was gone, and our night went back to normal. Our routines carried on as though nothing strange had happened. We filled out our charts, entered data into the computer, emptied urinals, and dispensed morphine.

And twenty minutes later the bed was cleaned and filled with another patient, who will never know the chaos that occurred in her bed only minutes ago.

This is approximately when the student came back with coffee and casually said, “where’s my patient?”