Life is Weird

Before reading any further, it’s important that I warn you this post contains sensitive material that you may wish not to read. It involves death and CPR. I won’t necessarily go into graphic details, but it may certainly be enough to make you uncomfortable. I totally understand if you skip out on this post and wait for the next one.

I’m not unfamiliar with death. I have been apart of multiple deaths at this point in my life. My father’s, a few of my residents at the nursing home I work at, and my ex boyfriend. With all of these, I wasn’t present at the *moment* of death, I was simply involved in the care that comes afterward, except for my ex boyfriend, as I wasn’t even aware of his death until about a month after the fact.

I say this to say that I’m not squeamish when it comes to death and dying. I’ve long accepted it as a fact of life. Of course, losing loved ones is difficult no matter what. It’s just that I choose to believe that what comes after life isn’t something to be afraid of. I don’t know what that something may be, I just have a feeling it’s not going to be worse than what we’ve got going on down here in the living world.

All of that being said, most of the deaths I’ve experienced were of older people who had already lived their whole lives. I’d also seen their slow decline, and by the time they passed, it was almost a sense of relief to know that they weren’t suffering anymore. But what about when the person isn’t so old? Or when there was no slow decline, no warning whatsoever?

I have been fortunate this semester to receive a clinical placement at a Level 1 Trauma hospital in my state. Before this placement, I have been in a few smaller hospitals, where the most severe patients we take care of are heart attacks, seizures, strokes. But usually only long enough to stabilize them until they can be sent to a more specialized hospital. So it goes without saying that clinical at a bigger city’s hospital is a completely different world. So far, I’ve already seen more in 3 clinical days than I had seen in all of my clinicals combined.

I quickly fell in love with it. The culture, the atmosphere, the intensity. Everywhere I look, there are nurses who really know their shit. They can quickly glance at a monitor and immediately understand what their patient needs in that moment. Their attitude towards students is also reassuring. They are patient and kind, taking time to explain what is going on, and never assuming that I should already know what they know. I’ve learned a tremendous amount already, and I find myself wanting to work for this hospital once I graduate.

Yet, it’s scary. It’s a completely unknown world to me, especially in the ICU. Though I technically work part time in an ICU now, the patients I care for are nowhere near the patients I see at clinical. For example, at my small town’s ICU, most of our ICU patients are septic or have atrial fibrillation. At clinical, there are traumatic brain injuries, gun shot wounds, motor vehicle accidents, so on and so forth. My very first clinical day, I was able to sit in on an in-service education about the hospital’s new cerebral spinal fluid drainage device. As the woman was talking, it felt like I was listening to a foreign language. Yet, all of the seasoned nurses around me took in the information easily. It dawned on me then, that these people have knowledge beyond what I can even imagine at this juncture in my education. While nursing school teaches a lot of fundamental skills, theories, and ultimately, how to pass the NCLEX, there is so much left to learn. I felt amazed by the idea of some day knowing what those nurses knew.

I recently had my third clinical day at this incredible hospital, and it was this day that I witnessed my first code blue. For those who may not know, code blue is when a patient has no pulse. It wasn’t one of my patients, but everyone is urged to respond to a code because it requires many hands. I ran alongside my nurse to the room, and I positioned myself in a corner out of the way. I first intended to only observe. However, I then saw one of my classmates jump in line for compressions, and I realized I should do that as well.

I was fascinated with the process. The room was filled with adrenaline and anxious energy. There were many types of people there, from doctors, respiratory therapists, medical students, seasoned nurses, to nursing students. There are many roles in a code. One person acts as the leader. They make sure everything is going as it should. A nurse is designated as the one to administer all medications, from epinephrine, to sodium bicarbonate. Of course, one person is doing compressions, but that person rotates out every two minutes. At the two minute mark, we do a pulse check. Depending on what’s found, we have either successfully resuscitated the patient, or we continue compressions. Another job is being the person documenting. This is a full time job, as you must keep track of the time. The documenter is responsible for telling everyone when it’s time for another pulse check, another dose of medication, and charting every thing that happens during the code.

Despite the chaos, I was simply amazed by the organization. Everyone had a role, and they knew what to do. As a student, I was busy taking it all in, but I was also anxiously awaiting my turn to do compressions. I was third or so in line, and as I watched the compressors ahead of me, I couldn’t help my bounce my leg in time with the compressions. I was feeling extremely grateful that I had just done my practice CPR a couple of days before this. Every quarter, my hospital requires we renew our CPR certification. We do this by providing compressions and rescue breaths to a manikin. Having the process fresh in my mind brought me some comfort. I knew what to do. I just had to do it.

My turn to do compressions came. I stepped on the stool that allowed me to properly reach the patient. I put my hands in their place, and began. I had to use the full weight of my upper body to press down far enough. I was keeping count in my head to make sure I was going at a fast enough rate. The rest of the room melted away as I was in the zone. The only thing that existed was myself and the patient. It was physically difficult. Two minutes doesn’t seem like a lot, but I was quickly fatiguing. I noticed my right leg was beginning to cramp up, but all I could do was continue compressions. I was wearing a mask to protect myself from possible blood splatter, and I was grateful that no one could see the expression on my face.

The day previously, I’d been in therapy telling my therapist about my high stress levels and anxiety. In the past 3 weeks, I’ve been close to panic attack at least twice. She gave me a couple of grounding techniques that can be done at any time, without anyone even noticing. As I was giving my all to pump this patient’s heart, I began wiggling my toes in my shoes, connecting myself to reality. I managed to slow my breathing down, and focus. Just as I felt like I couldn’t go any longer, I heard a voice that felt very far away tell me I had 10 seconds of compressions left. I counted the seconds down in my mind, and when the time came, I lifted my hands from the patient’s body, allowing the machine to check their pulse. I stepped down from the stool to allow the next in line to get ready.

“Asystole, resume compressions…”

We repeated this pattern, for what felt like eternity. A doctor left the room to speak to the patient’s family. When she returned, she told us after this round of compressions, if there was still no pulse, we would call it. The next pulse check came, and the patient still had no pulse. Doctors pronounced her dead.

My nurse ushered me out of the room, so that those who needed to be there would have room to do what needed to be done. Still feeling short of breath, I took off my gloves and mask, put them in the trash can, and I walked, numbly, in the direction of the bathroom.

When I got into the bathroom, a wave of emotion rushed over me. I began to cry. I let myself feel it, and I had a moment of prayer for the patient. What I had just experienced was one of the most intense moments of my entire life, and yet many of the people who were alongside me do it on a near daily basis. I was saddened, amazed, and exhausted all at once.

What an incredible experience, to be one of many, fighting to save another human being’s life. Yet, what a sad experience, to do all you are capable of and not save the patient. What a scary experience, for this patient to have been fine one day and dead the next. What an experience.

I am still processing all of the emotions that accompanied me that day. There’s a level of gratitude. Gratitude to have my own life, but also to have been a part of that patient’s, even if it was miniscule. Gratitude to have learned so much from the experience. Each moment is engrained in my mind, as time felt like it had slowed down. The next time I am a part of a code situation, there will be no question. I’ll know exactly what to do.

It can seem morbid, in a way, to be grateful to have witnessed a death. However, it’s an experience that’s extremely important for every future healthcare professional to have. I knew it would some day come. I didn’t know when or where, but I knew one day, I would find myself in the same space as someone who was dying, and I would, in part, be responsible for trying to save them. It was an extremely humbling experience. One that I am glad I got to experience for the first time as a student, where the stakes are relatively low.

The reality of CPR is that many code situations do not end in saving the patient. In fact, it’s more rare than common. Yet, every person in that room, on that day, gave everything they had. We all had hope, until the very end. We worked and worked, until it was clear there was no saving the patient. And then, once the time of death was declared, the team remained, to clean up the patient and allow them to have dignity. They removed any tubes and invasive lines. They allowed the family into the room for as long as they needed. Then, with extremely delicate care, once the family was ready, the nurse and an assistant covered the patient and helped transport them to the morgue.

The entire process has a lot of beauty in it. Beauty within the pain, sadness, adrenaline, and anxiety. The beauty of human beings coming together. The beauty of life in its entirety. Life including death.

Everyone alive today is connected by the simple truth that one day, our lives will come to an end. We all have our own personal feelings on that fact, but we are one in that it cannot be escaped or avoided. I’m not in any rush to meet my ending, but I still choose to believe that there is something good waiting for me. For us.

Until next time~