The Cat Named Jackie

You had advanced stage lymphoma. I remember when you were first admitted because you were so sick. You had a large mass in your neck, which forced us to feed you via a feeding tube. You had several large masses in your abdomen as well. I remember this clearly because as we gave you your first cycle of chemotherapy your doctor warned us that you were at high risk for perforation of your bowel. The thought of this terrified me. I knew that a bowel perforation was often fatal in the average healthy patient, without immediate surgical intervention. However, oncology patients are rarely surgical candidates, making your chances of survival extremely slim, if your tumors were to perforate your bowel.

You received multiple rounds of chemotherapy, but your lymphoma was relentless. You had recurrent admissions to the hospital because you were having trouble breathing at home. Imaging revealed pleural effusions, or a buildup of fluid in the lungs. I can’t imagine how it feels when the organs that are supposed to provide you with the means to breathe become flooded. I supported you through multiple thoracentesis procedures. You were such a trooper as that huge needle pierced your pleural cavity through your upper back. Despite how uncomfortable this procedure was for you, you told me over and over how much relief you felt immediately. Once the fluid was removed from your lungs, you were able to breathe again instantly. Unfortunately, this wasn’t long lived. The pleural effusions recurred. In fact, they got so bad you eventually had a pleurx catheter placed. This type of catheter allows for removal of fluid from the lungs at home. When the pathology results came back from your thoracentesis, it was confirmed that the pleural effusions were malignant. When I heard these results, I knew this would affect your prognosis significantly.

You went to the clinic on a Friday. Your doctor informed you that your current treatment wasn’t working. That evening you were admitted to the hospital to start salvage chemotherapy. This was your last chance.

When I came onto my shift Saturday night, I was so glad to have you as one of my patients. We got along so well, and you were always so kind to me, often insisting on giving up your recliner so I could take a break. You had a pet cat at home, who you loved deeply. His name was Jake, but you later changed his name to Jackie. I was truly honored to hear that.

The first time I entered your room that night, I knew something was off. It was clear that you weren’t feeling well. Your chemotherapy finished around nine. I went in to take the chemotherapy down, and I was about to head out of your room to go see my other four patients. I didn’t know it at the time, but it was going to be another three hours until I saw the rest of my patients for the first time.  

You became air hungry. You had a sense of impending doom. I couldn’t tell what was causing this, all I knew was that something was terribly wrong. I paged the doctor several times. She came to see you but couldn’t explain why you were feeling the way you were either. Your oxygen level was near perfect, but you continued to gasp for air, telling me you couldn’t breathe. You were so fearful you grabbed for my hand, begging me not to leave your room. I was panicking. You were suffering, and I had no idea how to help you. I paged the ICU float resource, and she came to see you as well. She didn’t like how you looked either, but the cause of your symptoms remained a mystery. I tried to drain your pleurx catheter, but nothing came out. I drew some labs, but the results were pending.

You told me that you had to use the bathroom, so I helped you to the bedside commode. As you got back to edge of the bed, I watched your eyes roll back. Your whole body went limp. It looked like a syncopal episode. I wish that was all it had been. I called out for help. One of the other nurses was attempting to check your vital signs, but she couldn’t get a blood pressure reading. When we checked for a pulse, we couldn’t find one. I started compressions immediately. I was trying not to look at your face as I pounded on your chest, hearing the crack of your ribs. In the moment there was no time to feel anything. I went completely numb. I hope you were also numb at that point. When another nurse took over compressions, I had a moment to catch my breath. When I stepped back from your bed and caught a glimpse of the scene, I couldn’t believe my eyes. I couldn’t believe this was really happening to you.

We continued compressions for an hour. The code team tried everything, but we couldn’t get you back. Just like that, you were gone…forever.

I had performed compressions on two patients prior to you, but on those two occasions I didn’t know the patient. It wasn’t any easier being in a code for the patients who I didn’t know, but there was a big difference in the pain I felt after the fact. When you’re the nurse of the patient who codes and doesn’t make it, you can’t help but feel partially responsible. You start questioning everything you did, and wondering if there was anything you didn’t do. The “what-ifs” start consuming you immediately. You wonder how you’re going to face the family of the deceased patient when they come in to say their goodbyes.

In less than three hours, you went from sitting in a chair telling me about your cat, to a corpse in a body bag. The thing that kills me to this day is that you and I both knew something was wrong. You were telling me this, and I believe you, but I failed in saving you. I’m forever sorry that your life’s last moments were filled with nothing but panic and fear. 

Despite the pain that your passing caused, I try my best to remember you by your big smile, your oversized shoes, briefcase in hand, and Hawaiian button up shirt, always taking about your cat Jake, who was later re-named Jackie.