Sunday, December 2, 2012

A good days work?

He stood at the back of the room, just on our side of the privacy curtain, his eyes followed all the activity in the room but they always returned to his wife, laying on the stretcher, fighting for life.

She had a long history of breathing issues and recently had been hospitalized with pneumonia.  They took this opportunity to visit the casino.  While walking she had become sort of breath and collapsed.  Medics arrived quickly.  They inserted a breathing tube and an "IO", (an IV line directly into the leg bone because it is the quickest to achieve), they administered oxygen and medications and began CPR.
She arrived in the emergency room in asystole, no pulse, flat line.
We continued CPR and administered our many meds, epinephrine, atropine, sodium bicarb, iv fluid.
Twice we got a pulse back, only to lose it again. We were about to call it when we got a pulse again, weak and with a very low blood pressure.  We struggled to keep her pulse and improve her blood pressure.  We started not one but two vasopressors, medication to improve blood pressure.  She stabilized, still no breathing, but a pulse and a decent blood pressure.

When she first arrived the medics told us the husband would be there soon.  We asked that he be taken to the family room so that we could speak with him. 
Somehow he found his way into his wife's room on his own, and there he stood near the privacy curtain.  One of the nurses briefly went to his side to explain that his wife's chances were not good but that we were doing everything we could.  At a time like this someone should have stayed with the husband, but the patient needed all of us.
When time allowed, our doctor went to him and asked about her wishes and whether she had an advanced directive, she did not.

When she stabilized it was just about change of shift.  I had spent the last 2 hours helping her fight for life.  I reported off to the oncoming nurse and went to the husband. 
I had spoken to him briefly a few times in the past 2 hours.  I now explained the situation the best I could and told him that a very qualified nurse was assuming care.  I asked if he had any questions or if there was anything I could do for him.

He thanked me.

Walking to the break room on my way out, I ran into our doctor.  I told him "good job".  He said he couldn't feel good about it because he felt she had been without a pulse too long and felt the husband would face very tough decisions in the next few days. 
On the ride home I ran the events of the afternoon though my head.  Had we done the right thing?  Had we set the husband up for more heartache?  Would we have tried for so long had the husband not been in the room?  Maybe we had given him the opportunity to see that everything possible had been done.
We had run a good code, we had done our job, but had we given him his wife back?