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If you knew…

2010 August 9
Posted by Nurse Me

….what we knew would you still have a surgery?

Gary was not your typical patient, everybody liked him, which is unusual. He was bright, chipper and charming. He did what we asked him to, even when he was in pain. And even more amazingly he always said “please” and “thank you” despite being in extreme pain. He smiled and waved to everyone. On his required post-op walks he would stop by patients’ rooms to offer support, sympathy and encouragement. He talked openly and honestly about is post-op course which was riddled with complications of effusions, both pleural and pericardial that kept him in the unit 33 days longer than usual and befuddled and beleaguered his surgeon.

He was the mayor of our unit, if mayors were well liked, congenial and sincere.

He NEVER pitied himself even though his crappy heart had 4 vessels (CABG) and 1 valve repaired  (MVR) and the surgery left him languid and short of breath.  He worked hard to get home and we worked hard to get him there. When he was finally discharged home, we rejoiced. Some even shed a tear or two of joy. Finally, a hard fought, befitting outcome.

Or so we thought.

Less than a month at home and Gary was back in the hospital with shortness of breath, a return of his pleural effusion. His surgeon had no idea why. He came by to visit us all smiles, as usual.

“You know, what can I do? You guys gave me my life back. I’ll get better from this too.”

He left the hospital and was back 2 weeks later. This time the news was a little more concerning. Gary would need cardiac stripping. As soon as we heard this, we all had that look on our faces. The look we get when we know that a person isn’t going to wake up from his surgery. Its a rather vacant expression usually accompanied with a sigh. Some even shed a tear or two. This time not of joy. Gary’s incredibly crappy heart in addition to all his post-op complications made this a riskier than usual surgery more than doubling his mortality rate.

I know his surgeon explained the risks to Gary. I know he stressed the risks and that the very surgery needed to save him would likely kill him. Either way Gary was going to die.  It was just a matter of when and how. Every day since Gary’s initial surgery was a struggle for him. A struggle to breath, a struggle to maintain his energy, a struggle to eat. Basically a struggle to live. And I wondered if he remained as happy and upbeat at home as he was in the hospital? So I’m sure the choice to have this surgery was a no brainer for him.

The day of his cardiac stripping arrived and we did our best to remain positive and upbeat, although in my mind all I could think was “dead man rolling”. And as he rolled down the hallway with the OR team, we said things like “see you soon”, “I’ll be here when you get back”, and “you’re in good hands”.

Gary smiled and reached for as many hands as he could. We all knew that would be the last time we saw him smile.

5 hours later Gary rolled back into the ICU, cardiac team, techs, and machines in tow. Lots of machines. There was a ventilator, 2 4-channel IV pumps, each channel filled with a life saving medication of some sort. A Bair Hugger (warming blanket), external pacemaker and oh yeah, the portable bypass machine. This was such a painful sight to see considering the man we had grown to adore. It broke our hearts and his was literally broken. We would give him until the next morning to “recover”. If not, the bypass would be disconnected and we’d let nature take its course.

Dying in the hospital isn’t pleasant. A lot of times you’re connected to tubes and machines, strapped to the bed, unable to speak and who knows if you can think or hear? Your reflexive movements make sense to us but are viewed as “he’s in there” by family members. And speaking of family members, in your hospital death bed you somehow turn into an exotic exhibit of tubed flesh with each family member taking a turn to ogle in wonderment, disbelief, hope, guilt or whatever emotion ties you together.

Don’t get me wrong, plain ole dyin’ isn’t pleasant either and if I were offered a Hail Mary, knowing what I know, I’m not sure I’d take it. I think I prefer to be a hospice kinda girl.

I have no idea if Gary said “goodbyes” to his family or if he remained an eternal optimist. Gary lived in his reality instead of the medical reality I wanted him to. The next morning when we disconnected the bypass machine, I held Gary’s hand and tried to smile as he had always done.

So if you were offered a Hail Mary to save your life would you take it?

4 Responses
  1. August 9, 2010

    Wow, you just described so many patients I have seen in my unit… minus the positive outlook. Those are rare, but I definitely see the hail mary being thrown a lot and it is so hard to watch! I am a hospice girl too… we always joke about it at work. A few of my nursing friends and I have decided to be each others’ DPOA because we know that we will be the only ones to let go when it’s time. My rule… “If I require a trach… it’s time to let me go folks”
    So sad and so hard to face.

  2. Jonathan permalink
    August 9, 2010

    Wow, this is great. There was an amazing “60 Minutes” piece just on TV about this subject- that a “healthy” death is the natural end to a robust life. Denying it can not only be cruel, but it is also bankrupting us as a country due to the huge medicare cost in the last two months of life…

  3. August 9, 2010

    I see a lot of dead people, more than that Haley Joel kid, and most go the “full court press” because they don’t want to disappoint or hurt their families’ feelings. I get that. BUT if they only knew…… I didn’t see the “60 Minutes” piece but I think its an up and coming “hot topic”. I wrote an earlier blog (http://nurseme.blog.com/2010/07/08/beginning-of-the-end/) in which I linked an article about patients being relieved when their doctors approached and explored their feelings about death and the option of hospice. Morphine euphoria, now that’s for me!

  4. November 19, 2010

    Thanks!

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