A Race Against Time
Ninety-six hours after I witnessed the first of my own patient’s death as a nurse, I lost another one. This time you were CMO, or comfort measures only. You were unresponsive. Your loving family surrounded you on all sides of your bed. As a nurse of just two years, although I was passionate about palliative care and hospice care, it was never easy walking into a room full of family members wondering if the next breath their loved one took was going to be their last. “How long does she have?” Your family asked me. The dreaded question, I thought. It’s the first question anyone would have on their mind when their loved one is imminently dying. You can’t blame them. But the pressure I felt when asked this question was indescribable. There’s no good answer. Everyone is different. There are signs you can look for in general-decreased urine output, agonal breathing, that final, brief burst of energy, etc., but anything can change at any moment. Some people hold on for a while, others don’t hold on for a second. I rehearsed responses in my head, searching for the right answer. I was so afraid to tell your family the wrong thing. I knew their hearts were already hurting, and I didn’t want to contribute to their pain.
When I came onto my shift that night to care for you, I found your Morphine bag nearly empty. Of course, because I needed a new bag right away, the Omnicell on the unit was out of them. I called the pharmacy telling them I needed a new bag ASAP. In the meantime, your family was requesting more pain medication, so I gave you a bolus dose per the doctor’s orders. After that bolus the pump beeped, and it read “bag near empty”. I started to panic. All your loved ones were looking at me, wondering what all the beeping was about. I had to tell them your Morphine bag was just about empty, and that I’d replace it as soon as I had a new one from the pharmacy. I also had to explain that there wasn’t enough volume in the bag to continue the drip. I could see the disappointment and concern in their faces. I was embarrassed and stressed.
I gave you whatever PRNs I had ordered in the meantime. I couldn’t go see another patient until I had a new bag of Morphine for you. What felt like hours later, the pharmacy finally delivered the new bag to me. I went into your room to exchange the bag. I called out for another nurse because the sign off required a second nurse’s signature. Again, more waiting. I could feel the room grow tense. My heart was racing fast. I felt so much pressure to get the new bag going. Once the new bag was signed off, I had to open the lockbox on the IV pole. After opening the lockbox, I used a key to open the pump, but it was stuck. The pump wouldn’t unlock. The other nurse and I were fumbling around with it, and every minute that passed felt like an eternity. My heart was racing even faster now. I felt the weight of the world on my shoulders. When I finally got the new bag up and the pump running, I immediately delivered a bolus dose. You took a big, long gasp, and that was your final breath.
I’ll never stop wondering if you were as comfortable as you could have been during your last moments. I’ll forever feel sorry that your family had to hear from your nurse, who is supposed to keep you comfortable, that your Morphine bag ran empty. I’ll never stop wondering if you could feel the stress of the room in those final moments.
I remained in the room with you, your family still surrounding you. The second your husband turned to me, and I saw tears rolling down his cheeks, my cheeks became saturated too. I offered support to your family, and they returned the support to me. During the worst time of their life, I felt immense guilt that they were taking time to comfort me after what had just happened. I couldn’t help but feel that I worsened their pain. I’ll never stop questioning whether you would forgive me if I had the chance to talk with you again.
After you passed, I had to wipe my tears away. I didn’t have much time to pull myself together. When I left your room, I had three other patients waiting for me, and nine more hours to go.