Another night with no room in the Inn. We currently have some patients who act as if its a hotel. They make us want to kick them out or open a big can of Whoop-Ass...
It is so full that we snuck an extra bed into a single room. Luckily the patient on the secret bed is the husband of the woman occupying the room. It is so full that we parked a stretcher with a drunken teenager in a cubbyhole near the dietary office and all the policeofficers squished in there to charge the patient with all kinds of illegal hooliganism.
I had a feeling it was going to be a long night. As the night wore on, more and more facts came to light that supported this hunch.
Early in the night i was down at the end of the ward with another nurse getting a patient ready for bed. Now, i have learned that there is two types of Not Looking So Good. There's the first case, where you show up at work or school and a peer says "you dont look so good" but its the kind where you just need to go home and drink lots of juice and take some gravol or tylenol and many many naps and a hot shower and brush your hair and you will look better. And then there's the other type. The kind where your collegues tell you someone doesnt look so good and you go down to see them and you think you are prepared but then you actually see them and all you can think is holy fuck! they dont look so good. That was my patient. I'd seen him almost a month ago and he was sickly then, but now. Oh my. As the nurse and i prepared him for bed, i noticed this smell. Can you smell that? Yes, she could. It seemed to linger in the hallway. It was unpleasent. I asked her what she thought it was. At the other end of the hallway was a palliative patient who had a tube draining her liver. She thought it was that. I thought about it for awhile as the other nurse and i made rounds together (there's safety in numbers). Finally i realized what it was. "C", i said. "i think its... i think its" and then as the full realization sunk it, i timidly whispered "i think its the smell of death".
I spent the night surrounded by death. I have had patients die in the past (but never while i was present) but there are many different faces of Death. The ones i saw last night were not the same as the ones i've seen before or even each other. One patient we were all amazed was still hanging on. She was so shrunken in on herself that (forgive me if this is disrespectful to say so) she looked mummified. But she would make unintelligible sounds from time to time and if you looked closely, you could still see her chest rise and fall like that of a fragile bird.
I had a new patient tonight. He arrived yesterday when i was home sick. He was admitted with a stroke and i originally thought that he was quite stable. But as i cared for him through the night i began to see more and more signs that i had only read about in school. And it was interesting to be able to pick them out myself but sad when i realized they added up to a very poor prognosis for the patient. At one point i went to see the doctor on call about this patient because his blood pressure was getting dangerously high and the doctor confirmed my suspicions that there wasnt really any point in further interventions. The man had a bleed into his basal ganlia. He was not going to get better.
I had a patient in isolation. She seemed sick in the way that old people are sick. Not soon to die sick, but old sick. During the night she became very anxious and accused another nurse of keeping things from her. What arent we telling her? she raged. And that's when i learned that the doctor felt she was basically palliative.
I was sad for the patients who were wasting away in a hospital bed. It is sad to realize death is near. But for them, i wished it Godspeed for they didnt need to go on any longer in the state they were in. For the anxious lady, i knew she had more time and yet I was still surprised to make it to this morning without anyone dying.
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