Something occurred the night before last. I hesitate, but feel compelled to write. It'll be necessary that I relate this in as detached a way as possible; you'll understand why. I've never written about something like this before and what I write might disturb some.
As a preamble: I know death - I have seen many, many people die over the last 18 years and it happens quite a bit here. My job is trying to help them dodge it for a while, but that is frequently not possible.
I spent most of Thursday night at the bedside of an older woman in cardiogenic shock - life threatening low blood pressure from a very large heart attack. I'm happy to say she survived the night and was improving by the morning (an RVMI, for you medical types).
While I was caring for her, one of the nurses ran in, rattled off something in high-speed Bangla and ran out. I didn't catch it, but it was easy to hear the urgency. I followed him to the bedside of a young man, NZ, who was in septic shock on pressors (continuous infusion of medicine to raise the blood pressure - a form of life support).
NZ was in agonal respirations. Agonal respirations are the last few, slowing, reflexive breaths of a body in which the heart has previously stopped pumping. They are unmistakeable; the duration varies, but I often note them for a couple of minutes after asystole begins (circulatory death).
He was already on the maximal treatment we could provide (we don't have a ventilator available at this time), so given our very limited abilities and his desperate illness, I had concluded earlier that, should he deteriorate, CPR and 'heroic measures' would be futile. I stood watching at him for a moment, then leaned in to check for a carotid pulse, listen to his chest, and complete my job. There were no heart sounds and there was no pulse. I reported to the staff that he had died and I looked at my phone so I could officially declare the time of death.
As I looked down I saw the nurse who had called me, praying. As I looked up I saw the patient take in an entirely different kind of breath. I quickly reached out and rechecked the carotid - there was a pulse where there had been none. His respirations began rapidly changing in character. I listened for heart sounds then grabbed a blood pressure cuff - 60/30. I looked up in consternation, looked back down and rechecked - now 110/60. After some minutes, he opened his eyes and asked for some water.
Please don't comments on this post: I need a little time to just think about it.
As a preamble: I know death - I have seen many, many people die over the last 18 years and it happens quite a bit here. My job is trying to help them dodge it for a while, but that is frequently not possible.
I spent most of Thursday night at the bedside of an older woman in cardiogenic shock - life threatening low blood pressure from a very large heart attack. I'm happy to say she survived the night and was improving by the morning (an RVMI, for you medical types).
While I was caring for her, one of the nurses ran in, rattled off something in high-speed Bangla and ran out. I didn't catch it, but it was easy to hear the urgency. I followed him to the bedside of a young man, NZ, who was in septic shock on pressors (continuous infusion of medicine to raise the blood pressure - a form of life support).
NZ was in agonal respirations. Agonal respirations are the last few, slowing, reflexive breaths of a body in which the heart has previously stopped pumping. They are unmistakeable; the duration varies, but I often note them for a couple of minutes after asystole begins (circulatory death).
He was already on the maximal treatment we could provide (we don't have a ventilator available at this time), so given our very limited abilities and his desperate illness, I had concluded earlier that, should he deteriorate, CPR and 'heroic measures' would be futile. I stood watching at him for a moment, then leaned in to check for a carotid pulse, listen to his chest, and complete my job. There were no heart sounds and there was no pulse. I reported to the staff that he had died and I looked at my phone so I could officially declare the time of death.
As I looked down I saw the nurse who had called me, praying. As I looked up I saw the patient take in an entirely different kind of breath. I quickly reached out and rechecked the carotid - there was a pulse where there had been none. His respirations began rapidly changing in character. I listened for heart sounds then grabbed a blood pressure cuff - 60/30. I looked up in consternation, looked back down and rechecked - now 110/60. After some minutes, he opened his eyes and asked for some water.
Please don't comments on this post: I need a little time to just think about it.
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