As a student nurse, it was drummed into us how important it was to regularly reflect on things that happened during our times on placements. The following was a reflection that I wrote when I was 19. This happened during the lead-up to my mental breakdown.
(Names have been changed to protect identities).
During my fourth placement, on my alternative branch (adult) I had been taking the same men’s bay of 6 patients for about 3 weeks. I had become familiar with all patients, and their conditions. Four of the six patients were bed bound. These patients were either confused or unable to speak. One of the other patients, James, was a stroke patient, with a right sided weakness and expressive dysphasia. The remaining patient was the only one who could move around independently, and communicate well.
Eddie was an 85 year old man who was being treated for a urinary tract infection (UTI). He was also known to have a 7.5cm aortic aneurysm. He was slightly confused, and had been having hallucinations for some time. Due to being confused, Eddie often tried to get out of bed as he was fed up with being on bed rest.
On one shift, I had spent most of my time in this bay, watching the patient’s who were known for trying to get up, and doing hourly observations on a very poorly patient. Eddie had tried to get out of bed again, as he wanted to look for his sons who were due to visit. After confirming with the nurse earlier in the shift, I had told Eddie he would be able to go out in a wheelchair with his sons. After putting him back to bed, I left the bay for a few minutes and heard James shouting for me. This was extremely unusual as James did not like to speak unless he had to and he also struggled to say what he wanted to say due to the expressive dysphasia. I went back in, to find Eddie shaking, and clearly having difficulty breathing. As there was no response when I spoke to him, and no pulse I pulled the emergency buzzer and shouted to one of the health care assistants to get the sister, Jane.
Jane checked for a blood pressure, and immediately shouted for somebody to bleep the crash team and bring the resuscitation trolley. Within seconds, there were doctors around the bed, trying to get a line in and take blood. They had quickly started bagging and compressions.
As I stood watching, I could feel myself shaking. Everything was happening really fast and I was so shocked that a minute earlier, Eddie had been completely fine. I stood with one of the health care assistants, and said to her that his feet were already white. That was when it became clear that he would probably not survive. Though he was making some respiratory effort himself, there was no output, and after a few cycles the anaesthetist asked me if I would take over doing compressions. With their help, I managed to do a few cycles, until I became tired, and then stood back to let somebody take over. After many cycles, there was still no output, and so the doctor’s agreed to attempt to shock Eddie.
After one shock, an output was found, however it was still too weak and his respiratory effort seemed to be failing more and more.
Potassium levels in Eddie’s blood were checked, and it was agreed that if they were within normal limits, resuscitation should be stopped (normal levels indicated that it was likely that the aneurysm had ruptured). After another few cycles of compressions, and blood results which were normal, it was agreed that they should abandon resuscitation.
The doctor asked if anybody had any strong objections, and I wanted to tell them to carry on. They had got an output after shocking him, so I had thought he was going to be alright, and so my instinct was to tell them to keep going and to shock him again. However, Eddie had an aneurysm and even if he had survived, he would most likely be brain damaged. After stopping resuscitation, Eddie carried on making some respiratory effort for a few minutes.
I went in with the Doctor and another nurse to break the news to Eddie’s sons. They were really strong, and both agreed to go and sit with him while he took his last breaths. Eddie passed away with both his sons holding his hands. When they had left, I helped Jane lay out Eddie’s body and clean him up. I found this to be a very peaceful thing to do, and was pleased that I had been given the chance to do it.
Afterwards, I went to see how the other 5 patient’s were doing, including those who may not have been aware of what was happening. James was crying. He was obviously distressed, as he was the only one who saw Eddie during the first few seconds of what was happening. I explained to James that he had done really well in shouting me. Though he had difficulty in communicating, he still managed to speak a little and he felt the need to reassure both himself and me, by saying that Eddie had lived his life, and that this was his time. After a chat with James, and after calming him down and settling him to bed, I went off to carry on helping the health care assistants. Walking past the office, Jane shouted me in, to ask if I was alright. At this point, it hit me and I realised what had just happened. I was in shock and in a way blamed myself for not being fast enough or noticing something was going to happen. Jane reassured me that I had done well in raising the alarm so quickly, as well as participating in the resuscitation. She also claimed that Eddie would not have felt anything, and that it was comforting that he died with his sons there. After telling me I had handled the situation really well, she also told me that she had seen me check the other patients were ok and said that this was a nice thing for me to do.
I talked through my feelings with her, telling her that I had felt a small sense of relief when they had got an output after shocking him, only to be devastated when they gave up. The main thing that was upsetting me at this point was that it had all happened so quickly. Within minutes, he had gone from laughing at me after putting him in bed again, to being unconscious, and eventually passing away.
I was amazed at how well Eddie’s sons had taken in the news, however I realise that they knew the aneurysm could kill him at any time.
Though I felt guilty for not being able to help him in the way I wanted, I had to realise that Eddie had “lived a long and happy life”, as his son put it, and that even though it was what I wanted, it may not have been what he wanted. It is important to think about the quality of life for the patient after something like this happens, if they survive.
I was upset that this had happened so quickly, however Eddie would not have felt it and would most likely have been unaware of everything.
Laying out the body was a special thing to do. It was the last thing I could do for him, and I felt honoured to be doing it. However it was still a difficult thing to do, as he looked like he was peacefully sleeping and that he would wake up any second to tell me a joke. Even though I knew he wasn’t alive, I still explained everything I was doing, as did Jane. I felt it was important and though he physically wasn’t there, it was still important to treat his body with respect and dignity.
Looking back, I realise that the crash team, the ward team and myself did everything possible to keep Eddie alive, but it is important to know when to stop and accept what is happening. The staff on the ward, especially Jane, were supportive which I think was a lot of help to me. They understood how it feels to be in the situation I was in and they were all a great support. One of the health care assistants told me that I had done a brilliant job with Eddie that day as she had seen me chatting to him while feeding him dinner.
Eddie was happy on the day he died and had spent most of the day laughing at me when I put him back to bed. Knowing he was happy brings some comfort. Though he was confused and having hallucinations, he was still aware of everybody and everything going on around him.
I would not change anything about this situation if it happened again. I acted rapidly, raising the alarm and getting help. I took part in the resuscitation and stayed strong and calm throughout, even though I wanted to cry. I was there while the doctor told Eddie’s sons, who I also knew from looking after him so much and again, managed to stay strong as they had done. I had laid out Eddie’s body, which I felt privileged in doing. I also took into account my other patient’s in the bay and checked they were feeling alright. I managed to calm James down as well as reassuring him that he did well to shout for me. Most importantly, I spoke to Jane about how I was feeling which was a big help. If I had not spoken to Jane, I would probably have carried on until the end of the shift and then would have got upset when there was nobody to talk things through with. The most important thing is that I learned a lot from this experience and that I can take all this away with me for future experiences.