the swing of sunday

i love sunday. i mean that i love sundays at home, but every so often, i love them at work. it's a good thing too since this is were i spend sundays now. it's not like i don't get a sunday, except that everyone else's thursday is my sunday. not quite the same, especially when it comes to social gatherings and such.

sunday on the unit is a coverage day which means i don't have to examine every patient, but i read the sign-outs and the charts, check labs and results and change care accordingly. it's pretty chill, until something happens. that something came early on this morning when mr p. was signed out to me. 'his breathing: you can hear the gurgling from the door' said the pa who was handing him over to me. i examined him before starting the day and thought 'this man is not long for this world' then proceeded to look over this chart. Prostate cancer, renal failure, heart failure, end-stage parkinsons and then the anecdotal bit about him being psychotically depressed and nasty to his family when coherent. he was pasty white, sweaty, erratic breathing that came with a gurgling sound, fluid in the tissue of his arms and legs and really, not there. The family signed a DNR/DNI just the day before (do not resuscitate, do not intubate - basically, no extreme measures to prolong life) and I thought that wise. After all, what kind of life did this man have now? I know it's not mine to say, but quality of life is what i advocate for most in this gig of mine, so whatever you may think of me, i thought him better off dead. Harsh? maybe. real? i think so. As i read through his chart the RN kept notifying me of his plummeting blood pressure. 'He's crapping out' was all I could think and then challenged my own attitude about aggressive treatment vs what? baseline treatment and let the man die if that's what he's doing? Seems a little counter to what we do right? we heal, we save lives. but neither of those phrases really applied. his cancer was killing him slowly and through circuitous routes, like sepsis, and falling blood pressure. was i being aggressive enough with the treatment within the boundaries of the DNR/DNI? I thought long and hard about it as i read his chart and discussed IV fluid with the hospitalist.

not long after the renal attending showed up and we began discussing the case. the main doc had written a note that morning with the first line headed "PT DNR/DNI", which says pretty loud and clear, 'he's dying, no extreme measures, don't forget'.
we both agreed that his life was nearly without any quality and how sad that was for the family who was both loving and supportive despite his year-long aggressive verbally abusive behavior. we looked over his labs and went in to see him together. while the renal guy was checking his oxygen saturation, i noticed the patient looked very still. very, very still. dead in fact. we both shrugged our shoulders in gallows agreement that this wasn't unexpected and casually he walked away while i got an EKG on the patient to confirm death. 10:27 am, i called it, time of death. it's one of the more intense things we do as pa's, even if it feels rote; it's not. not ever really. i didn't feel sad for him, didn't freak or feel nervous. i began the paperwork for 'notification of death' and before i could call the wife, she shuffled down the hall into his room without anyone noticing. that's when the shit hit the fan.

a long wailing sound echoed down the hall. while it only hit my subconscious, as i was going through the steps, it all clicked into place when someone said 'ms p just went into her husbands room'. shit. not like she wouldn't have been just as torn or heartbroken, or in shock, but finding him dead, well shit. the Rn staff took good care of her and i notified the son at her request. the rest went as expected and i went on about tending to the other 20 patients.

but when i did have a quiet moment to myself, the waters calm for the time being, i went to find an vacant on-call room. i needed a moment to myself. i needed time to feel whatever i was going to before i could move on; this much i've learned about myself and what kind of impact my job has on me. as i lay in the dark in that room, i thought about mrs p for a moment, and then my mind raced, mumbo-jumbo through random and personal places. my mother, hospital work, death, how many hours i had left, how tired i was, my sister and her current incapacitation, my hunger, my dirty laundry, my own internal wailing in darker moments past...i found it difficult to just lie still, to quiet my gerbil brain. in a moment of recall, tripping through memories, i recalled being with the engineer in recent days past, the feel of her arms around me and the comfort, the safety, the peace it brought me. like quieting a crying child after a skinned knee, i lie there still, calm and resting. i stayed there a good 15 minutes or so and felt sad, loss even maybe, but ever calm. my pager went off and another question, another need called and i slid my feet back into my clogs, put on my white coat and with a deep breath, entered the unit and tended to the query.

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2 more hours. the sun is setting. how does that happen? how does 10 hours disappear like that?

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the afternoon landslide: where am i? lol. 6:46pm, no matter, i'm OUTA here in t-minus 13? oh shit. where is wingnut? crap. time to unbury the burried.