Am I Going to Die Today?

Anyone ever ask you that question?  No?  Well, as an ER nurse, I get asked that question quite a lot.  Most of the time it is someone who is a little overly anxious and with some constant reassuring of resounding “No”, feels better by the time they leave.  Sometimes it is a person who is critical and very frightened and is begging for some assurance that they will live to see another day.  The answer to that question is usually “I don’t know, but I’m going to try my best to help you.  You are very sick and we will work hard to make you get better”.  I’ve literally had to hold someone’s face, look them in the eye, and very firmly say “No…I’m not going to stop what I’m doing and get you a drink (or blanket, or whatever” because YOU ARE DYING RIGHT NOW and I’m working damn hard to save your life!  If I stop what I’m doing right now, YOU ARE GOING TO DIE!”

 

Today was different.  It came out of nowhere.  I wasn’t expecting it, and it threw me for a loop.  I had a 30-something patient come in complaining of “being nervous and I’m all bloated, and I want to lie down on a bed.  And (oh by the way) I used ‘just a little bit of Meth’ 3 hours ago”.  Okay.  Vital signs completely normal, pulse a little fast, but not tachycardic.  Level of consciousness completely normal.  Orientation completely normal.  Answered all questions appropriately.  “Please have a seat in the lobby and we will get you back as quick as possible”.  So here comes the question…”Am I going to die today?”  My response?  “You know, I don’t know when you are going to die.  I don’t think it will be today.  But what I can tell you if you keep using Meth that eventually that drug will kill you.”  “Oh…okay.”  What could go wrong?

 

Fifteen minutes later.  “Can I lie down now?  I’m tired and I don’t feel good”  “No,” I respond, “we don’t have any empty rooms and all our hall beds are full.  If you don’t feel well please make sure you are sitting down in the lobby.  I’m sorry.  I promise I will get you back into a room so you can lay down as quick as possible.”  Okay, problem solved.  Right?

 

Patient appears again in the triage door.  “Can I lay down in here?”  “No.  I have to check in other patients and I can’t let you lay down in here.  Please sit down in the lobby”.  Patient then informs me “I’m going to go outside and smoke.”  I reply “Please stay in the lobby.  You should be sitting down if you are feeling bad.”  “Okay, I will”.  No problem, right?

 

So why then do I get a “someone fell outside in the parking lot” yell about twenty minutes later?  Why then is the patient lying flat on her back, blood pooling behind her head, with fixed pupils?  Why then does the patient have blood foaming out of her nose and mouth?  Why then does the patient have gasping respirations and exhibiting seizure activity?  Why are we securing her neck and back with a c-collar and backboard?  Why are we intubating her?  Why is she now a critical, unconscious patient on a respirator?   And, my most important question of the day?  Why the &$@# didn’t she stay in the lobby like I told her?!

 

So why do I feel bad?  I didn’t do anything wrong.  I adequately assessed my patient.  I visually assessed her every 15-20 minutes.  I strongly advised her not to go outside.  I strongly advised her tohave a seat and stay in the lobby.  So I know in my head I’m not responsible for her current condition.  So why do I feel so bad?  Because…it happened on MY watch.