I. LOVE. YOU.

The way my dying patients wife spoke those words took my breath away. The pause between each word. The emphasis on each word as though willing him to feel the power, the pain, and the emotion.

It was as if it was a plea and a fact at the same time.
It's been weeks for him in our ICU. Weeks of ventilating, making gains and losing ground. Weeks of family updates and he's not doing well today but then a bit better tomorrow. Weeks of slowly failing organs. Weeks of sedation and life support.
We finally approached the wife and told her the terrible news that his lungs just would not recover. It's as though his lungs were made of concrete instead of balloons. And she decided that enough was enough. She would not put him through any more.
The morning that she chose to withdraw life support she was a mess, understandably. "Are you sure we've tried everything?" She knew what the answer was and I understood that what she needed most was to walk away with only her grief and not the weight of feeling like she gave up.
We reassured her that every option had been exhausted and his lungs were just too badly damaged. He was not a candidate for transplant even at his young age. It was time.

I talked her through the dying process and reassured her that I would be available at all times.
I asked her if she wanted me to stay and she eagerly said yes, please don't leave. I pulled up a chair and as I took his hand the little knit heart fell to the floor. I told her there was one for her as well... so they could carry each other's heart.
We started the process of letting go. First stopping the blood support infusions. Next, giving doses of sedation and pain medicine so there would be no distress. Next... Stopping the ventilator.
And then we waited.
She told stories and laughed and cried.
And when she spoke of him being surrounded by angels I told her about a little angel song my mom used to sing to me... Oh please do sing it, she asked.

I immediately regretted saying anything but also knew I would do anything to help connect them in this moment
"I put angels around your bed, one at the foot and one at the head. One at the left side and one at the right, to keep and guard you through the night"

"Oh that's a perfect song!" she said. "I hope there's angels around his bed"
I look up at the monitor and see that it won't be long. The heart rhythm has a process when it's dying and I can see the changes. I used to think it memorizing to watch a dying heart on monitor. The slow beats then the fast pace as it gives its finale before coming to a stop...
I tell her it won't be long.
She starts to cry & speak every thought to him at rapid pace.
"You have been my best friend. My love. The best father. A wonderful friend. You are so brave. I'm so sorry! I can't believe this is happening. I'm going to miss you. I'll be ok...
As his heart comes to its final resting place she cries out the slow exaggerated words from the depths of soul with angst and confusion and betrayal and every imaginable emotion:

I

LOVE

YOU
I tell her that I will give them a moment and turn towards the nurse server. Tears are spilling into my goggles and I believe my nose is doing the same thing inside my layers of masks but I just need to power through a little longer...
And after she cries all her tears she asks what's next. I tell her to call a funeral home & they will guide her through these next steps.

And then I give my heartfelt condolences and hit the button to end the call on her last iPad visit.

I really hate Covid.
I don't really know where to begin replying to your comments on this thread but I want to thank everyone for reading to the gutwrenching end, for sharing it to your followers and for sending words of encouragement.

We're still in this.

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More from @rn_critcare

24 Jan
My pt *Tim was admitted with Covid. A relatively healthy guy. Exercises more than I do if you don't count the steps I put in at work.

It's rare that Covid patients are already intubated before coming to the ICU, which can be both a blessing and a curse... ICU + covid =
Not a great combo.
But it does give us a chance to get to know our patients.

Tim was doing ok with self proning, he watched his oxygen levels and flipped himself over for "tummy time" to get them up again when they were low.

He's been here for weeks so he knows the drill.
I try hard to connect with my patients on some level, either through food, family or music. It helps them relate to me and reminds them that I am human too. I think it's paramount to building trust.

Tonight we talk about food. It's a safe starting topic.
Read 19 tweets
10 Jan
Expect the worst, hope for the best...

It's been many weeks now since we admitted the 'Lords prayer' Covid patient. He came to us awake and talking but deteriorated quickly overnight. After calling his wife and praying with him I held his hand while he was intubated.
Each shift back to work I would casually wander to his bedside to see how he was doing. Each shift a different plan of care to accommodate his failing lungs and subsequently his failing organs.
Sometimes he would be on his stomach with arms positioned like a swimmer.
The bedside nurse asked me, "Do you know him?"

I sheepishly responded with, "No I was with him when he came in. He was very sweet. So scared. I'm just hoping for a win"

Then the nurse & I would lock eyes, and exchange that knowing look, 'this won't end well.'

I know. I know.
Read 12 tweets
24 Dec 20
Our Father, who art in heaven. Hallowed be thy name...

He was admitted for monitoring but we know how it goes. With the high flow nasal oxygen and the mask his oxygen levels were still only in the 80s.

"Try to lay on your stomach for as long as you can tolerate, I'll be back."
He did not tolerate. It's hard with all the things on your face to lay like that. It's hard when your lungs betray you and don't do their job. It's hard when you see the news every day and know that the ventilator is the last resort.

He was tiring. It would soon be time...
All garbed up in PPE I go back in the room to talk to him before the team comes in. He knows it's getting worse. I ask if he wants to call his wife to talk to her before we rest him on the ventilator.
He asks if we can take the mask off to make the call.
Read 12 tweets
19 Dec 20
It started as a normal shift... I mean, whatever normal looks like for us these days. I was extra staff so I busied myself with little projects, helping with turns and baths and dropping off meds. I was present but not really invested in this shift
I check in on the new nurses. They are always my favourite. They have just as much to teach me as I do them. Today they want to know the quickest way to the blood bank in case of MTP (massive transfusion protocol). I take them to show them, it's better than giving directions.
Next I pop over to check on a new admission. It's like a game of Red Rover: people from inside the room are calling out the things they need to the people outside the room. It's a flurry of activity. It usually is with a new admission, especially an unstable bleeding trauma.
Read 16 tweets
7 Dec 20
I just sat down to do my assessment after a busy start to the shift. It's been like that lately, hit the ground running. Staff are dropping like flies, resources thin. We've gone back to 'team nursing' where we travel in packs room to room to do patient care
Anyway, just sat down
The phone rings and it's my coworker in another bay asking me to come help with matted hair if I have time. I don't really but I also love the challenge & satisfaction of getting matted hair fresh and braided.
I grab some supplies and head over.
There's two nurses at the head of the bed working away. They almost seem angry with how they have a fistful of hair and are attacking it with the comb. But I know better, this project is an act of love. I get to work and start braiding.
Read 10 tweets
17 Jul 20
The alarm goes off at 0535. And again at 0545. Can't trust myself to hit snooze when the first one goes off. Since the beginning of COVID I started taking a sleeping pill before dayshift. Otherwise it's just tossing and turning, wondering what the day will bring...
My dayshift routine is always the same: lunch made for upcoming days the night before. Shower in the evening, clothes laid out. Coffee maker ready for go time when my feet hit the floor. These days I leave 15 minutes earlier due to the staff screening line up...
Are you experiencing any fever, cough, diarrhea? Almost always I must sing the Pepto song: nausea heartburn indigestion upset stomach diarrhea. We all have a nervous laugh while they wait for me to answer. No.
In the past two weeks have you travelled outside of the country? No.
Read 21 tweets

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