Nooney, my dude...

Good Morning.

This entry is a little early.

But I needed to get some things off my chest...and out of my head.

We lost my cousin Stephen "Nooney" Lance yesterday. The funny thing is that when I heard that he had been in a bad accident, it never crossed my mind that it meant he could die. Especially since right after the accident, reports said that he was already dead and I know how fast (fake) bad news travels at home. So when I finally spoke to my Mom to see if she had heard how he was and she said he had been airlifted to MUSC but they thought he was going to be ok, it seemed like it was going to be like the scrapes Nooney has had before. My dude even went "missing" for a few days once. But the reports of his demise have always been greatly exaggerated. I figured this would be the same situation. And when I went home this weekend, I'd look across the trees and see him in the backyard and hear him yell my name and say "What's happenin' cuz?" in that goofy voice of his or see him drive by in the GMC, tucked low and leaning to the side.

I guess you get to a point where life is so full of our daily comings and goings that we don't think about death as a part of everyday life. But it is.

I realized this morning that in my short time as a nurse practitioner, the thought of death and dying, as it relates to my patients, has never really crossed my mind.

It strikes me as a little weird. And I am trying to figure out how I, as a medical provider, that I don't think about it more.

Is it selective amnesia for my own comfort? Indifference? Am I out of touch? Desensitized? Suffering from a god complex?

I just don't have a good explanation. 

When I worked as a floor nurse right out of undergrad, I treated every patient as if they could die at any minute. At the time, I was just that terrified of what I had chosen to do as a profession. Better safe than sorry, right?

I remember the first time a patient died on my watch, I was about 6 months out of nursing school. The shift changed and the report that I got from the day nurse gave every indication that the patient was ok. I remember clearly hearing her say, "He is dehydrated and anxious. Just give him some Ativan and he will be ok."

What I have always had is an internal instinct to cover my @$$ in those situations, so I ALWAYS reviewed each of my patient's charts at the start of my shift for things like new orders, labs and/or test results. So after report, I pulled the patient's chart and noticed he'd had an abdominal CT done. I don't remember the results specifically but the report basically said that the patient's belly was full of "sludge" and his organs "could not be adequately visualized."

All of my other patients were stable for now. And because the off going nurse never mentioned the CT to me, something told me that it meant the doctor did not know about it either.  I brought it to the charge nurse's attention. She paged the doctor while I went to assess my patient.

When I walked into the room, he was sitting on the edge of the bed, on 2 liters of oxygen, but still completely short of breath. He skin was cold and pale. He was sweating non-stop. His pupils were dilated. His pulse was racing. And his belly....

His belly.

That's what let me know something was terribly wrong.

I laid my stethoscope on his stomach and heard absolutely nothing. He was so bloated that I could plainly see the veins dilate and stretch across his swollen belly. I could not palpate his abdomen, because the skin was stretched taut like drum. And the beautiful tympanic sound that you should hear when you tap on someone's belly, was replaced by the dullest "thud" I had ever heard.

I didn't know what was wrong, but I knew we needed to figure it out quick. I yelled for the charge nurse to come in. We didn't have a Rapid Response Team at the time and it wasn't technically a code situation. But we had to do something. She still had the doctor on the phone, so I asked her to get orders to move him to the ICU.

The patient's wife was in the room and we explained to her what was about to happen and she seemed relieved. She said that she'd been asking all day for something to be done, but everyone seemed to think that he was ok where he was. She thanked us and just as the charge nurse and I turned the corner to walk out of the room, it happened.

It sounded like the patient had belched really loudly. Then I heard his wife scream. I turned on my heels and looked back to see the patient projectile vomiting what I could only describe as black bile. Inhuman amounts of black bile. The charge nurse screamed for the secretary to call a code blue and we made it over to him just before he fell forward onto the floor. God gave the us the strength to get him back in bed and on his side so he would not choke on the bile. As we cleared his airway, turned him on his back and started CPR, the code team rushed into the room and took over. This all happened in the matter of about 60 - 90 seconds, but it felt like a lifetime.

His heart had stopped. The monitor showed pulseless electrical activity or PEA, which meant that there was some electrical activity, but no heartbeat. Epinephrine. Vasopressin. Atropine (it was still on ACLS back in 2005). Paddles. No change.

They intubated him and moved him to ICU. The doctors explained to the wife that the patient was brain dead. The vent was breathing for him and once it was removed there was virtually no chance for survival. His wife agreed to have the vent removed, but asked that they allow her children time to come in from out of state before it was removed. They agreed.

I didn't hang around the ICU long enough to know what else happened. My shift had started at 7:15 that night and all of this transpired before 8:30. I had 5 other patients that I had not laid eyes on yet. I had to get my brain to shift gears from the thoughts of the dead, who I could do nothing for, back to the living who needed my care.

I think something happened to me then. I'd never seen anyone die before. To that point, it was enough that I'd seen someone dead in a casket. But to witness them passing from this life to the next? It was almost too much. That night I actually considered not being a nurse anymore.

I struggle with the thought of death. So I try not to think about it. It sends a cold shiver down my spine. I am dismayed by it. Weakened by it. Heartbroken by the fact that it can come and take my most beloved, irreplaceable things away from me. That it could take me away from those same things.

Maybe that is why I don't bother it, until it bothers me. Maybe that's why, I never consider it as an option for my patients because to be effective, I have to always feel like there is something I can do. The thought of death, you see, renders me powerless and sorrow seems to be my only recourse.

I will think about Nooney (and death) constantly for the next little while. I will wonder if this was God's way of saving him from an earthly fate worse than death or if it was really just his time to go. Either way, I applaud the folks that never gave up on my dude, even though there might have been reasons other people thought they should.  Life and hope go hand in hand. No matter what the situation might be.

Its easy to say that in a perfect world, all of our chains would remain unbroken.

But my guess is that world would also be absent of God's will and our promised salvation.
 
And nothing about that could ever be perfect.

Its like my granddaddy, Buh Norman used to say, "Chile, you need to try to live until its time to die."

That's right Granddaddy.

I don't think we should bother death, until death bothers us.

RIP Cousin Nooney. Imma see you again.

Towanna