There was no warning, really, that this weekend was going to be wild, unless you count the number of shifts that had gone smoothly and were *almost* boring of late. Naturally, something had to give.
It gave an hour into the shift when the patient threw me out of their room and called for a hospital administrator. It's the first time I've been accused of giving anyone a snippy answer. Guess they didn't like my looks. Their behavior became so outlandish that I had no idea what they might do next. It turned out to be nothing but a fit of pique. So that was a ridiculous episode; a tempest in a teapot. After half a dozen phone calls and a supervisor visit, we traded patients and things settled down.
The night was going well, despite my several ill patients. One was comatose, with a lot of loose chest congestion and an intermittent cough. Another's vitals deteriorated every time they dozed off. A third, with distention and edema, had just finished 2 units PRBC's. I rounded often and made sure equipment was at the bedside just in case. Then I gave a few meds and talked with the nurse whose patient had died.
"Didn't you hear?" she said. "I must be the angel of death. That's the second patient that's gone out on me in a week." "Well, you know how these things run in cycles," I said.
We haven't had any deaths, or even very sick patients, since New Years. Just now we have a preponderance of very ill patients. One of the many charms of a medical unit.
It was now near morning. The floor was quiet, and at that hour you can hear every sound on the floor from anywhere on the unit. Which is how I was able to clearly hear someone call out my name, in the kind of voice that tells you something is wrong. It wasn't a medical emergency; death is not an emergency for those who anticipate it. The patient was simply gone from this life.
Believe it or not, as many dying patients as I've had, I had never had one die abruptly. This was a shock to the system. Another visit from the supervisor. God bless my co-workers, who prepared the patient to be seen by family, and did it before I could get off the phone with everyone who needed to be called. The ride that night went on until a second pair of undertakers, this time wearing dark suits and overcoats, wheeled the shrouded patient away.
We consoled one another, and stories were recounted. The oncoming nurse, one with long experience on the unit, said she had seen seen many cases of abrupt death. Even the float nurse had a story to tell. I came home and had a stiff drink, and slept fitfully.
I just knew the third night was going to be either a bloody bore or something else bizarre. I put in a foley, assessed four patients, gave two meds and two prn's for pain and then we had a minor staffing crisis. The patient we had been told was coming from the ER did not materialize, and now we were overstaffed. You know what that does to the budget.
*British slang meaning to take the call for an emergency.