As I got off the elevator, I felt queasy. I took a deep breath-today I was the charge nurse for the unit. I'd arrived at 18:00, although my shift did not start until 19:00. As soon as she saw me, the day charge nurse blurted out, "You're going to be short today. Someone called out sick and the nursing office can't find a replacement."
I sat down to review patient charts. The med-surg unit was full; everyone would have an extra one to two patients. Some had been admitted for weeks or months. Others were frequent fliers with AIDS who would come in with one opportunistic infection after another. One of my assigned patients had finally been admitted to die. He was a successful, middle-aged man who was estranged from his family. He knew it would be the last time he would leave this unit and I wanted to make sure he was comfortable throughout the night. I put on my PPE and entered his isolation room. He was having a hard time breathing. I propped him up with another pillow and took his hand; I told him I was going to take care of him that night. He blinked and I asked him if he was in any pain; he tried to say "no" but was only able to mouth the word.
Outside the room, a travel nurse approached me to say he'd been sent by the nursing office. I quickly gave him his assignment and introduced him to the patients. After that, I was summoned to the nursing desk. The ED was calling, trying to give report for the first of our four admissions. When I finished, I went in search of the nurse assigned to receive this patient.
After checking on my other patients, I had a chance to see my dying patient again. He opened his eyes, and I took his hand. He held mine tight and I could tell he was afraid. I told him that what would be perfect right now would be floating in a blue ocean with the sun warming my face. He had told me he had a house in St. Barts that he loved and swimming in the ocean was his favorite thing to do.
I asked, "Can you feel yourself floating in the water? The ocean is so calm, quiet, and warm. Keep thinking of St. Barts and I'll check on you again later."
He held my hand tighter, not wanting to let go. I wanted to stay, but I had other patients waiting. As I left him, I told myself he'd be the first person I'd recheck that night. Then I heard a yell from the room at the end of the hall. The travel nurse was calling out that he had a code blue. The code team arrived and started working on his patient. When I finally left that room, I encountered another commotion around a nurse giving CPR to a patient on a gurney. The ED admit had coded at the nursing station. I took a deep breath but couldn't slow down.
I hurried back to check on my patient in respiratory isolation. He didn't open his eyes. At first, I thought he was finally comfortable and resting, but soon realized he had stopped breathing. Although he was a DNR, I had wanted to help him. Tears started rolling down my cheeks. All I had to do tonight was be with him so he would not die alone, and I had failed. I took his hand and told him I was sorry. After a little while I got up and left, but outside the door I rested against the wall and sank to the floor sobbing. Another nurse saw me and said, "Go wash your face and I'll listen for your patients."
I got up, went into the bathroom, and washed my face. I looked in the mirror long and hard and said to myself, "I don't want to be an RN anymore." I composed myself and walked out and went back into the patient's room and turned off the oxygen and IVs. I gently washed his face and hands and applied lotion. I buttoned his gown and covered him with a clean sheet. I placed a tag on his toe, and in parenthesis wrote, "Ready for St. Barts."
I walked out of the room and heard a call light and walked over to the other room. I took a deep breath before I entered and walked over to the bed. I realized the patient was one of my frequent fliers. He said, "I'm glad you're working tonight. I have a great story to tell you." I smiled, took his hand, and sat next to him on the bed, knowing that I had 101 things still left to do.