Thursday, July 3, 2014

Final Transfer

My best guesstimate is that I've directly cared for 50,000 patients. Probably more if we count the ones I've triaged - seeing 70-80 a night instead of 20-30. Nothing special there, my co-worker for a good chunk of the last 10 years had been a nurse literally since Eisenhower was president (for you youngsters for whom that rings a bell, look it up.) so she probably saw a number much closer to half a million.

And I certainly haven't kept a tally on this, but I'd say I've personally zipped about 100 people into their last sleeping bag for transfer to the Eternal Care Unit.

I bring it up because I was reading a completely separate story, regarding the grisly task of recovering the victims of an airplane explosion, and unbidden I was simply overwhelmed with the thought of the ones I've dealt with.

I don't care where you are, as much as we try to not let it happen, people die in the E.D. (Dammit. It still generally pisses me off.) For some it was a welcome friend, for many a blessing, and far too many a rude surprise courtesy of physics, ballistics, and man's inhumanity to man. I thank a merciful deity that none of them have been children. As a student I watched a futile but understandably prolonged full code on an 8 or 9 year old girl found at the bottom of a pool, long after there was any hope but the outcome expected, but thankfully, I didn't have to deal with that aftermath. Small mercies are always welcome.

Amidst a full code, there's things to be done, orders to chart, algorithms to run through, so you're busy, and amongst friends. The subject of the exercise isn't in any condition to respond, so you tend ( or at least I do) not to focus on them as much as on the rhythm on the monitor, the presence or absence of a pulse, and doing your part in the multi-person ballet at the bedside.

But one way or another, I seem to end up being the one doing aftercare, obviously on my own patients, but a lot of times on others' as well. Sometimes with the other nurse(s), or a tech, and even a couple of students from time to time. But a lot of the time, just getting it done by myself. Part of it is the amount of time on the job, and wanting to share a colleague's load, and to a certain extent, I'm pretty sure it creeps the youngsters out more than they want to admit, particularly when they're still kind of new to the job.

Of course we aren't perfect, and some nights, it's just that person's time. A number had their time come and go at some abysmally-run convalescent home, warehoused by distant family, or an uncaring system, and we just get to deal with the end result of low wages and minimal/minimally functional staff, taking care of way too many chronically sick patients. Other times it's someone set free from the ravages of metastasized cancer. And on more occasions than I'd like to recall, it's a traumatically rude unhinging of the mechanism of life.

It still doesn't happen a lot, maybe once a month on average. Then there was the night we had six in a shift. As Edmund Blackadder once said, "I'm thinking of a phrase that rhymes with 'clucking bell'..."
But any way I look at it, even as rare as it is, the mileage and the years on the night shift adds up; I just didn't expect to be one of the go-to people for "final prep".

I've just been thinking about it, because it's there now, and it's probably going to rattle around in my head awhile until I get it out, so I'd rather write about it than just mull it over. And it's not like there are a lot of people you can talk this over with one-on-one, at least not if you ever want to hear from them again.

I don't know why it matters to me, but the best way I've found to deal with it at the time is to talk to them as I clean them up, especially if there are family members a few doors down just getting the news. I do it some for them, and the patient, and some for me. It seems like it's the least I can do to acknowledge and maintain a little human dignity for somebody who's getting tags tied to a toe, some of the tubes out, some of them left in, and getting stripped just as naked as the day they were born, before zipping them in for their last ride down the hall to the morgue freezer.

Later on, there'll be time to talk with family members, when they have any. And definitely time to talk to the coroner, the organ donation line, perhaps the local PD, and to try to find a personal physician. I'm not a big fan of waking doctors up, especially for this kind of call, but it always seems to happen between midnight and 4 AM. And no transfer, not even to ECU, is going to happen until all the paperwork is finished, all the boxes checked, and the charting done. At least I don't have to call a floor report first.

But before that, and after the drama ends, I figure the least I can do is think, or say out loud, "Sorry you're here tonight. Hope it doesn't hurt any more, or where you are.", as opposed to thinking of them as so much inanimate hamburger. When you're dealing with what's left behind after their personal train has left the station, it's hard not to wonder about that, right? It's not like I'm doing comedy routines, or expecting any answer. But we take care of people, and when you do that, you talk to them, because it helps them to cope with what's just happened. Or, in this case, it helps me.


  1. I too, like you speak to those whom have left this earth. I do the same to those who have had strokes and can't talk. For both these types I do it because you never know when that will be you. And would you prefer to have someone to talk to you and treat you with dignity and a shred of humanity - or to be completely task oriented and treat you like a slab of meat?! I choose the former! I think those who talk show more compassion. Good on you.

  2. Recently I got caught by a coworker when I was standing there at the head of the bed just staring at a recently dead patient. I didn't realize she was watching me, and I just stood there for a minute or two and then reached over and closed the patients' eyes. I don't know why I was embarrassed at being witnessed, but she told me later that it was one of the most profound things she had seen in the ER. So yeah. I don't think you're strange at all for talking to them.