So this is my first official entry of 2008. I didn't write on New Year's Day because after an exceptionally long morning of rounds for a non-workday, I decided to take a nap. After waking up just long enough to have dinner, feed the cats and get things organized for another day of work, I just decided to go to bed.
One interesting thing that happened yesterday is that the patient who was brain dead died. I spent another hour with the son the day prior and had finally gotten him to the point of thinking in terms of finding a funeral home and thinking about his parent's last wishes. Then, he suddenly changed his mind again and said that something else could probably be done for his parent, and that as long as they were on the breathing tube, he could still come and see them.
I then told him that if his parent's heart stopped, it was no longer a matter of choice. They would be removed from the ventilator, and he would have to tell the hospital where to send his parent for burial. Again, I am usually very kind and understanding when it comes to talking to families about their loved ones, their conditions, and in talking to families about witholding or removing care. But, this situation called for me to be more brusk and candid than I usually am. I felt bad about this. I really like to be as understanding and patient with families as I can be, but that wasn't going to be the case in this situation.
When I came in yesterday morning for rounds, the patient's temperature had dropped to the low 90's, and the nurses were having a hard time getting a blood pressure. When the patient's heart rate dropped to the 30's, we knew we were close. When the patient went asystole (flat-lined), we ran the code, gently, and then pronounced the patient.
I called the son to let him know his parent had died, and he would now need to make arrangements. At that point, he finally seemed to have an acceptance of what had happened and came to the hospital to say good-bye. The social worker promised to help him out with whatever he needed. So that was the start of his New Year, and too, I guess, of mine.
CCU Countdown:Days until the end of the rotation: 4
Actual number of days I will be working during that time: 3
Days left until the painful attending returns: 0, actually, the painful attending never returned as there was a death in family!
Number of days until my next 24 hours off: 3 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 0 - I finish tonight!
Number of long call shifts remaining: 1
Number of patients: 2
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 2
Tags: CCU, code blue, end of life, health care proxy