I’d been a nurse for about a year working on the medical surgical floor. This was my third day in a row. The good thing about working three days in a row on the floor is that I knew my patients. A nice continuity of care.
The patient I was about to see was going home soon. IV was out. His wife was coming to pick him up in a couple of hours. I knew his history. He was in the hospital for an illness, not surgery. His history included an abdominal aortic aneurysm, AAA, that was stable. I bee-bopped into his room happy to go over his discharge instructions. At first glance I knew something was wrong. His face was pale. He said his stomach suddenly started to hurt “really bad”. I took his blood pressure. It was very high….much higher than it had been in the previous days. Red flags. I tried to hide my concern. I took his blood pressure on the other arm and it was much lower. I knew that when there was a big difference in blood pressures on each arm that it could be a sign of an aortic rupture, dissection or leak. If it was a rupture he could bleed internally very fast and die. I held his hand and told him I would stay with him. His hand was clammy. I hit the help button next to his bed. I said in a calm voice for someone to come into the room.
Things happened very fast. He was scared. Little beads of sweat gathered on his forehead. Several nurses came running. Within minutes an anesthesia doctor came up to the floor. He was extremely calm. I explained to him what was going on and that I knew the patient well and that his pain hit him suddenly. IV put back in and normal saline fluids hung. Another bag in the bed. If he was bleeding fluids and blood would have to be hung immediately. No time to waste. Part of the operating team also came to the floor and they quickly took him to the emergency room. The CT scan showed that the aneurysm was dissecting and leaking. The team worked fast to help him….stabilize him enough that he could be air lifted to a bigger hospital that could operate on him.
In the meantime the patient’s wife and sister came in to visit him. I took them aside and told them what was going on. The wife had recently had open heart surgery. I was concerned that this would be too stressful on her so I stayed with her. I’m trying to hide my stress and fear. A cardiologist came to the door and motioned for me to come into the hallway. He said the patient had died on the table. I told him he had to tell the wife what happened. The wife and sister were upset and wanted to stay in the solarium for a little while. I stayed with them. Then the cardiologist came back to the floor and motioned for me to come into the hallway again. He told me that the patient didn’t die….that it appeared that they had lost him, but he was still alive. They were still working on him, had given him 4 units of blood. We had to get the wife to the ER to see her husband in case he didn’t survive. The cardiologist’s eyes were big as saucers. He didn’t know what to do. I smacked him across the face. GET A GRIP!
Grabbing the doctor’s shoulders and looking him directly in his eyes I said, “escort her to the ER now. Tell her you were wrong. This can happen during a code . He was still alive. They had given him four units of blood. They were working hard to save him.” Off they went.
Of course this last part didn’t happen exactly like that but it was close.
I would like to say that everything turned out great. The patient is alive and well. He and his wife are surrounded by lots of grandchildren telling them the story about he almost died. That is not what happened. After 4 hours from start to finish the docs and nurses were trying to save him. He died. His wife did get a chance to see him before he expired.
None of us get out of this alive. His story was dramatic and sad. I hope he’s in his idea of heaven.
TIDBIT Who knows how long Abdominal Aortic Aneurysms have been around. It could be one of “those things” that came out of the blue leaving people dead as a door nail. Certainly in Florence’s time people must have dropped dead. People still abruptly drop dead, but now we can figure out why.
CT (Computed Tomography) scans were discovered in 1972 by two men. One, Godfrey Hounsfield, an engineer and the other, Allan Comack, a physicist. They won the Nobel Peace Prize for their efforts.
Now AAA’s can be operated on and people’s lives saved. The trick is to diagnosis it and then not wait too long to have it surgically fixed. Of course surgery has risks. It’s a balancing act if surgery will help enough to take a chance. From one source the mortality rate is as low as 3.9%. Seems like pretty good odds to me.