Wednesday, January 23, 2008

Life, Death & Everything in Between

Apologies to AD for stealing his subtitle for this post.

Yes folks, I know I'm a bad blogger and I don't post often enough. I need to start getting in the habit of jotting things down that I want to blog about. Anyhow, WhiteCoat put up a post today that reminded me of a call I did a few months back.

Nursing home calls are the bane of my existence. In my EMS career I have gone on one nursing home call that involved a critical patient where the staff was actually helpful, this is not the case. My partner and I were dispatched for an 83 year old female resident of a local nursing home, the patient lives in the residential care wing of the nursing home, not the skilled care wing. We walk in and ask for a history and they just say "she's a DNR." There's the first clue that this is going to be a clusterf*ck. We arrive at the patient to find her taking her on the verge of taking her last breaths and the staff demanding that she be transported because they just don't know what to do. They spoke with the RN working on the skilled wing and given that she is already over worked she told them to call for an ambulance. The patient's son, also her health care POA, had already been contacted and not fully knowing the situation and worried about his mom asked that she be transported to the ER.

This frail old woman was unresponsive, cyanotic (turning blue) with a weak slow pulse and agonal respirations. A check of her paperwork confirmed that she did have a current DNR order signed by her primary care physician. So my partner and I picked her up and placed her on our stretcher and wheeled her out to the ambulance. We both knew there was nothing that we or the ER could do for her and we both knew that the only therapy we could provide would be a smooth ride to the hospital. My partner was tending to the patient while I drove and he gave a report stating what we had found and that we were transporting at the son's request and at the ignorance of the nursing home staff. We delivered her to the ER and shortly after she died. Not in the comfort of the room that had been her home for the past few years but under the bright florescent lights of the trauma & resus room in the ER. Not with dignity and not with her loved ones by her side, but instead surrounded by paramedics and nurses and a doctor all discussing what to do. While everyone else in the room stood around and discussed what to do I pulled up a stool and sat down next to her and held her hand as life escaped her. I sat with her and prayed. I firmly believe that no one should ever die alone. The look of death on a patient's face sometimes reveals peace and sometimes reveals fear. No one should be afraid and no one should be alone. Thankfully the patient's son arrived just moments before she passed and he and I sat there, each on one side of the bed.

In the time that I have spent in EMS I have come to believe that death is neither a beginning nor an end, but rather a transition to something else. What that "something else" is, I suppose is left to each person and their beliefs. I have also learned that every life, regardless of how short it is has a purpose and thus every death serves a purpose as well. I have been witness to a life that lasted only hours. When a coworker's son and daughter-in-law learned that they would be having a child and that it would not survive I was asked to photograph this child's life so that the parents and family could have something to look at and remember the day by. Those few hours were the hardest and most rewarding hours of my life. In the span of just a couple of hours I witnessed the love a parent has for their child; the pride they have in showing off this brand new baby. I also witnessed the pain of a family grieving the loss of a child. Close relatives gathered around this child, each taking a turn to hold her and shortly after her grandmother gave her back to her mother and father the doctor came back in the room to check on the child and told us that she had passed away. I am unable to describe the feeling of that night and so I'm not even going to try, but I know, deep down inside that this child's ever so brief life served a purpose. It may take years for me to learn what that purpose was, perhaps I'll never know until I find myself at my own death, but we all serve a purpose and every human life is precious and that we can learn a lesson from every single person we encounter.

Be well & be safe.


nursemyra said...

this is ever so sad (and well written)

we always try to keep our elderly residents with us until the end, somehow I think the staff cope better when a long term patient dies while still at the 'gimcrack'

it's harder for us when they're transferred to a hospital with an ER. we often don't get to say goodbye.

in australia assisted living hostels have access to palliative care teams who supplement the care we provide. it's a good system and keeps patients comfortable in their own unit.

rookie bebe said...

Found your blog through AD. Beautifully and tragically written.
Thank you for showing our soft side.