canadianskibum1

Thoughts and Ramblings and a bit about m
2005-11-15 07:31:49 (UTC)

First death

His name was Dave, and he was the first person I ever saw
die. He was a patient at the General, and I was a paramedic
student finishing up my clinical hours in the ER; he was
brought in from an AIDS hospice, because he was too sick
for them to care for, because he was about to die.

I met Dave late one night when the nurse acting as my
supervisor told me that I had a patient to asess, for as
part of my duties as a student I had to asess and take
vitals for every new patient. I confidently walked into his
cubicle, with all the courage that newfound knowlege
brings, and stopped in my tracks; the patient on the bed
looked like something out of a horror movie.

His chart said he was 45; he looked to be at least 70. His
skin hung in folds off his face and arms, the underlying
bones showing through like some twisted anatomy lesson. His
eyes were bloodshot and glassy, his face covered in the red
blotches of Kaposi's sarcoma, a form of cancerous lesion
that often attacks AIDS patients. His fingers were
skeletal, topped with long yellow finger nails, his legs
emaciated and yellowed.

He lay looking up at me past his oxygen mask with a gaze
that was unnerving. I read more of his chart: HIV positive
for 15 years, full blown AIDS for 5. Hepatitis. Liver
falilure. Chronic renal failure. Pnemonia for 1 month.
Sepsis, or infection of the blood, was why he was here
today, his disease wracked body unable to fight off the
infection that raged inside him. Massive doses of
antibiotics had not helped, and he was now suffering from
MODS, a condition where internal organs simply stop working
due to trauma or chronic infection. I look for the
information about next of kin: none listed. He's here alone.

Under the direction of the nurse I begin my asessment: his
heart rate is fast irregular and thready at 140, his
pressure is low at 90 on 40. He is burining hot at 42.0
degrees, and his lungs are crackly due to exces fluid. His
skin is jaundiced and yellow, his abdomen distended from
ascites. He is a very sick man.

We attatch the caridac monitor and it immediately begins to
beep, warning us of a high heart rate.
Hes hypotensive, so the nurse tells me to start an IV. I
double glove, and have no trouble finding a good vein on
the back of his emaciated hand, but the vessel ruptures as
soon as I attempt to advacne the catheter. The nurse
manages to get a line in his AC, and quickly hangs a bag of
saline and starts running it into his veins.
Then we step back and wait. This patient is a DNR, meaning
that he has signed papers saying he is not to be
resussitated if he is to suffer a cardiac or respiratory
arrest. He has also sated that he wants no more medical
treatment other than comfort measures, which is merciful,
his disease ridden body could not take much more.

The nurse tells me to take his pressure every 5 minutes and
goes off to check on another patient. I listen to his
ragged breathing through the mask. He has been in a stupor
most of the time, but now he tries to speak " let me die"
he rasps, "let me die"

I dotn know waht to say. He reaches out a hand, and I take
it. It feels cold and clammy and stiff, as if he is already
a corpse. His pressure continues to fall, despite having
recieved almost a liter of fluid. I call the nurse back,
she calls for the Doctor. Together we sit and look him.
There is little more to be done, he has refused any further
medical treatment. He soon lapses back into
unconsciousness, as his brain no doubt is starving for
oxygen due to his low blood pressure.

His breathing grows more ragged, his pressure continues to
fall, depite the fact that he is now getting fluid from a
pressure infuser as fast as possible. His heart rate
increses, his pulse growing weaker and more irregular at
his wrist, the alarms of the cardiac monitor beeping their
warning. Finally I can no longer feel a pulse, and his
breathing grows more ragged until it is agonal. The Dr
begins to bag him, using a facemask to ventilate him, as
his respiratory rate is no totaly random, an agonal pattern.

We watch the cardiac monitor in silence, watching as his
heart rate becomes riddled with PVC's, or extra beats. He
gasps one last time and the rhythm changes to a
disorganzied squiggle of jumbled lines, as each caridac
muscle cell, starved for oxygen, begins to beat on its own,
no longer under the control of the AV node. Normally the
Nurse and Drt would sprin into action, grabbing the
defibrialltor and intubation kit, but now we only watch, as
the heart rate settles into what appears to be a relativly
normal rhythm, but this does not last long, as it is only
PEA, or electrical impulses being sent from the AV node to
a dying cardiac muscle. We lost his radial pulses a long
time ago, but now he has no pulses in his carotid or even
femoral arteries. The monitor beeps again as his rhythm
changes to its final stage: asystole, or absence of
acivity. The breaks the silence. "time of death: 0030.
Print a strip". The nurse prints of a rhythm strip and
asucultates is chest: she is listening for any activity
from the heart. There is none, and it is over. She puls the
sheet gently up over his head and we walk out of the
cubicle.

I pull off my gloves and wash my hands with hot water for
several minutes, but they still feel cold and clammy. The
Er feels chilly and sterile. I think about what that would
be like, dying a slow death all alone.

The porter comes to remove the body, and hes a freind of
mine so I offer to help him. We wrap the body in a special
bag and life him over to the morgue table. It is an easy
lift as the body is so emaciated. As we wheel itdown the
darkened corridor to the morgue, I think about Dave, and
waht a change it was to go from, him to it, from living to
dead.

I wash my hands again with water so hot it hurts, but still
feel cold and clammy.

That night I go over to my girlfreidns house. It's late but
shes still awake, so I ask her if I can stay for while. We
sit on the couch and I hold her hand and make small talk.
Whats wrong, shes asks. Nothing, I say. I just want to feel
someone alive. I place 2 fingers on her radial pulse,
feeling her heart beat, warm and strong and regular. We sit
like that for almost an hour, but I still feel cold.




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