I held you in my arms at 2:35 am. As soon as the ER nurse called your admission, I began my distress. “For standby intubation,” –these are the words most dreaded by any nurse who knows how to read beyond doctor’s orders. In medical world, that basically translates into “you have a few hours to live.”
Yet I stood there, hoping you were a miracle.
You were breathing heavily, too rapidly, and the oxygen support didn’t seem to be of much sustenance at all. In fact, your O2 Sat was 9 digits low. Again, I began my uneasiness. I laid you under close watch service, on the first bed where I could see you from the nurse’s station.
I’m sorry you had to share a bed with another patient. I couldn’t risk placing you on the farther side of the ward, in case…you know, something bad happens. You need to be attended every hour. You were high-maintenance, and though I had 21 other patients last night, you pretty much consumed my 8-hour shift.
Your chart wasn’t modest of your condition. It read: Pneumonia very severe s/p colostomy 2010, Down Syndrome. You had, not just one, not just two, but three diagnoses. First problem was that your airway was clogged with mucus, which explains the little oxygen circulating in your body. Second, you weren’t blessed with an orifice on your rectum so in 2010, they had attached a “poo-bag” for you. That, by the way, increased your risk for infection. And third, you were born with chromosomal aberration.
Am I now sounding too technical for you? Don’t worry. You don’t have to understand these things at such a young age. All you had to do was fight your battle. You carry a deadweight much heavier than you can endure but you lay there with your eyes closed, looking tranquil in sleep. Were you dreaming of heaven, Rachel? I guess I will never know.
Your mother was kind, and so is your grandmother. They amenably did what I asked them to do and they never left your side. But at around 4 in the morning, your vitals started deteriorating. Your O2 Sat fluctuated from 90 to 64 to 85. Your heart was pounding for the lack of oxygenated blood, and on top of that, you were having a hyperthermia.
Nebulization every two hours began and we suctioned your secretions after that. Did you feel any bettering? Your vitals expressed no, but only you can best judge what you had felt. Just one more hour and you will be surviving my shift. I put away the emergency cart since you didn’t look like you were going to have a cardiac arrest within my duty. But in the midst of the endorsement, 30 minutes passed my shift, your mother came running and said something I could barely understand. But no words needed for that, because as soon as I saw her face, I knew. I jumped on my feet, grabbed the stethoscope and rushed your way.
When I reached you Rachel, you were no longer gasping for air. I placed the stet on your chest and heard nothing. The pulse oximeter now reads 0 0 – negative for oxygen and negative for pulse rate. I immediately called your physician and while on his way, I grabbed the emergency cart that I just put away. I didn’t notice how malnourished you were until we had to stripped you off your clothing and do chest compression. I could do a mental count, not only of your ribs, but as well as your intercoastal spaces. That’s how skeletal you were. I injected Epi in your system to start the heart pumping, but not even a flutter could be heard. Your O2 was now on full blast, but we were the ones doing the breathing for you.
Last try, another dose of Epi was ordered. But you were still a flat line.
At 7:45 am Rachel, your doctor pronounced you dead. I started returning everything that I had put out for you: the pulse oximeter, the nebulizer, the suction machine, the E-cart, and the O2 tank. None of these equipment were strong enough to fight a much bigger force.
You fought a hard battle, Rachel. Now it’s time for you to continue living in your dreams.
Sincerely yours,
Your Pedia Nurse
A Nurse's Note 