Inside Intensive Care
by Jayn Cameron
I spent twenty five years as a Registered Nurse. ER was my specialty, but I worked in almost all departments, the last twelve years as house supervisor, Not all of my stories are as serious as these, in fact many of them are quite funny. I will share them as well. It’s not my intention to depress anyone with the following accounts, but I do believe the public should be aware of the painful truth of the situations of many of these critical patients. I saw good outcomes too, but these stories will stay with me until I die. These stories were written about events that occured in 1995 or earlier. That was my last year of nursing. I hope things have changed for the better, but I sincerely doubt they have.
February 2, 2001
The patient is eighty years old. He worked on the railroad for forty years of his life. He has been on a ventilator for almost a month now. He came into the Emergency Department at two a.m. on that first night, having suffered a massive stroke. He had been without oxygen for almost ten minutes at home. No family member knew CPR and that’s how long it took the ambulance to get there. The paramedics were required by law to intubate him and administer emergency cardiac drugs. Unfortunately, for this man, they worked. His heart resumed beating, but his brain was irreparably damaged.
This damage is invisible to his family, however, who judge his condition by the pattern of electronic lines constantly crossing his monitor screen. Every few minutes, he appears to moan, silently though, since the breathing tube threaded through his vocal cords prevents any sound from escaping his throat. After a few days, he was started on a tube feeding, ordered to be administered twenty four hours a day. Two days after the feeding was started, he developed almost constant diarrhea. Since the nursing staff has been cut to three or four registered nurses to care for twelve patients, and all the patients in the unit are critically ill, it isn’t feasible for his diaper to be changed every fifteen minutes , as it should be. His nurse changes him as often as possible, but sometimes he goes for an hour or more without being changed. All the while, the acidic liquid stool he produces burns and eats away at the skin of his buttocks. The nurses try over the counter creams and anything else they are allowed to use without a doctors order. A few nurses try forbidden treatments, ones that physicians are supposed to approve, but don’t. Those few nurses are not on duty every day though, and soon the lesions on his buttocks become infected. Despite conversations between the nurses and his doctors discussing the fact that nobody eats twenty-four hours a day, and that maybe that’s why he has the diarrhea in the first place, the feeding orders are not changed.
His face is now contorted in an expression of pain almost around the clock. His family visits twice a day. Every grimace and involuntary movement is interpreted by them as a sign of recovery, a sign of life. They love him and will never consent to turning off his “life sustaining” machines, as long as he is moving. His pupils are dilated, he has lived his life, but his wife can’t let him go. Seeing him only twice a day, she can’t see the suffering he endures. Really, only the nurses who are with him all day and all night can see it. Even some of them can’t.
On one day, a nurse goes in to perform a urinary catheterization, does it successfully, and in an act of unspeakable negligence, leaves his frail body uncovered when she leaves the room. He is naked, exposed to passersby, cold and bluish. It may be an hour before a more compassionate nurse passes his room and notices. She covers him with a warmed blanket and strokes his thinned hair before charting off, clocking out and going home. He will live, rather exist, in this undignified and cruel state of being for another three months, before finally, blessedly, dying.
She is thirty-four years old and has been comatose for over a month. She came in originally with varicella, simple chicken pox. The herpes virus invaded her system though, and the resulting sepsis brought her to the Intensive Care Unit. She has three small children in foster care, due to her past drug problems.
Her stepfather, a self proclaimed minister, visits her every chance he gets. The nurses notice he frequently seems to touch her inappropriately, in intimate places. Her mother stands by silently, indifferent and perhaps afraid. Her need for this man has long outweighed her concern for her daughter. She loves her daughter, she later admits, but “a good man only comes around every so often.”
The patient is unconscious, yet she feels pain, a fact her nurses are reminded of by the grimace on her face when they turn her, clean her, barely touch her. Her agony is apparent, yet time after time they push that Code Blue button on the wall. Compelled by law and afraid of losing their ability to earn a decent living, they code her every time she tries to escape her tortured existence. They succeed for a full four months, through fifteen cardiac arrests, until a greater power determines that enough is enough.
He is eighteen, and an overdose patient, or O.D. as the emergency room staff calls him. He is the adopted son of a man and woman of good intention, but he never really felt he belonged to anyone, and no matter how he tried, he just couldn’t seem to live up to the expectations everyone in his religious family had of him.
He ached to belong, but believing he never would, he turned to a chemical cure, an anesthesic for his raging emotions. One dark, desperate night, he simply decided it wasn’t worth it anymore, and with a glass of bourbon, swallowed every pill he could find in his parents home. Twenty Halcion prescribed for his mother, sixteen Elavil his father had needed temporarily a year ago, and thirty-two Midol his sister used for her monthly relief.
Society tells us that no decent person uses drugs, but in reality most all of us do. They just happen to be legal, purchased from a pharmacy instead of a dealer. He survives for two weeks on a ventilator. He has no control over his bodily functions, and when his school friends visit, he is often found soiled. If he were conscious, he would be mortified. When his friends aren’t there, his family is at his side, usually discussing their belief that he will burn in hell for killing himself. Can he hear them? Who knows? But why take the chance? Sometimes his nurse falsely tells the family she has to change him or turn him or check his rhythm strips more closely, only to get them and their condescending remarks out of the room for a while; to “give the kid a break,” she says. When this child finally dies, only his seventeen-year-old girlfriend cries.
She looks like an angel, with her blonde hair brushed lovingly on her pillow . Her little chest rises and falls with the forced respiration her machine provides. She had left her home the day before to go on her first vacation with her family. She and her brother and sister were so excited to be going to Disney World. Not even halfway there, a coal truck slammed into the back of the minivan her father had stopped at a red light, forever changing their plans and their world . She is their baby, only six years old, and she will never open her eyes again.
At the hospital, when I see her, her pupils, hidden under white baby lashes, are fixed and dilated, her brain dead. The organ procurement director has already arrived. Her parents have amazingly decided to donate whatever organs can be salvaged. I have to witness her father sign the permission form. It is one of the hardest things I’ve ever had to do. From his hospital bed, I put him in a wheelchair and take him to a conference room. There the cororner, the organ procurement director, and I, the nursing supervisor, have to explain what will now happen to his little girl. He wants to see her electroencephalograph strip one last time. It is flat, there is no brain activity. Just a strong, beating heart, functioning kidneys and liver, and viable corneas remain. Shaking and sobbing, he signs the form.
Discharged from the hospital, he and his wife insist on staying until the surgery is performed. They want to follow the hearse that will carry her back to her hometown. In the hall, as they are leaving, they inadvertently run right into the physician who has removed their child’s heart, and is carrying it now in a red and white cooler. Nobody speaks but everyone knows.
Weeks later, I write a note to the family, expressing my sympathy and applauding their selfless act. Some time later, I receive a letter from the child’s mother. “I’m doing alright,” she writes, “But Bill still has nightmares that our baby wakes up screaming on the operating table.”