Perspectives..

First thing I noticed when I walked into work this morning was a message on a printed email from a patient's daughter. I had looked after this patient for the last week of his life where his lungs were becoming hardened and slowly decreasing in size, and he so badly craved breath that he was on a mask that pumped pure oxygen and then caught it again in a rebreathing bag so that no air would be inhaled. Just pure oxygen.
He was on a lung transplant list and this was his last chance. His whole family had moved into a house nearby to be near their father and kept a vigil at his bedside all night, sometimes with 4 of them sleeping in the room at a time. They were sleep deprived and they were scared. Their father was getting sicker and sicker every day.

Anxiety was gripping him with every breath and his intake of sedatives and morphine was increasing. Not enough to stop him breathing, but enough to slow him down so he didn't struggle with the fear of not having enough breath to survive. Fans were on and with every attack we - being his entire immediate family and myself - would fan him with a towel because somehow feeling air on his face and body made him feel that air was available, even if he couldn't breathe it in.

The doctor was refusing to inform the family that this man would die before getting the transplant and I was becoming increasingly pissed off seeing the family holding hope, having to encourage them to keep hope that any second those lungs could come in.
"There is a 20 year old girl on a ventilator in ICU in the public hospital who will get lungs before he does, and even if the match came in, he's too ill and far gone now to operate". This is what I was being told. Compared to "Anyday now, you never know. Just keep hope.. " was what the family was hearing.

The Dr and I walked out of the room after I called her in following a particularly nasty attack. "This man is dying", she said to me. I turned to her "Then maybe you need to tell that to the family". Immediately his daughter comes out in a florrent of tears. Almost pleading, begging with the Dr she explains how much her Dad deserves this transplant and how long he has waited. Begging, crying, requesting that he father not be overlooked, the Dr calms her and explains that her father will not be overlooked. In the seconds that follow a psyche patient runs down the hallway and the Dr takes the opportunity of distraction to quickly get into the lift, leaving me with the hysterical daughter who begins asking me if her begging was inappropriate. I sit her down and explain that she needs to prepare herself and her family for the fact that the margin between being operable and too sick to receive a transplant was getting very close and that her father may suddenly deteriorate any day now. Part of me was terrified that my boss would find out and I'd be disciplined for doing something that is only the responsibility of the Dr, but part of me felt I was doing the wrong thing by giving them false hope.

His morphine dose was subsequently increased as the attacks got worse, and I left that day with a heavy heart, and a guilty conscience. He died that night.

To my right, a card on the bench behind the reception desk was an almost identical match to the email. Inside were 2 photographs of the man I cared for, when he was healthy and vibrant.
I stared at this man. This man that I cared for. He looked almost nothing like the man I saw everyday in the hospital bed. Seeing him, as a person, as a healthy, REAL person.. not a sick and dying patient changed my perspective and I suddenly burst into tears. "We wish you could have seen Dad when he was well, he truelly was an amazing man" "I hope one day you all think of dad, and smile".. I'll never ever forget these words. I'll never forget that card, and I'll never forget that family.

The lines blurred today. Between patient and person, and instead of being scared I'd not be able to save someone when I moved over to the ED, I was scared I'd not cope seeing people die. Its a fear I've not ever felt before. Death is death.

When I resigned, I cried. My boss was amazingly sypathetic and she expressed how much they would miss me. Everyone is shocked and everyone is upset. Including me.
But I'm excited about this new journey, and as of January 8th, 2007.. I will be an RN in the ED.