A little, white lie

The evening wasn’t a terrible one, but it was busy. I had five stable patients. When I think about it, Karen, the day’s shift charge nurse always gave me easy patients. Maybe she thought I was a lousy nurse, or just sympathetic towards me, or things were just happening that way. I don’t know. There were a lot of medications to pass, I had to do a dressing change, and then a patient’s peripheral IV infiltrated and I had to put in another one. I was busy but not one of my patients had a really bad day.

Patients in the telemetry unit like the one I work at are always at a significant risk to get sicker fast and that’s why we put them on heart monitors. Any nurse would prefer a busier patient over an unstable one.

My other three colleagues on the unit found time to chit-chat and check their phones, but that didn’t bother me. I knew they would have helped me if I had asked.

Dinner was served at five. The unit filled up with the smell of cooked food. I left my patients to their meals and got on with my charting. Staring at the computer screen, clicking on boxes on tables, is certainly boring. Who reads nursing charts anyway, I thought? I wished I was spending the time with my patients in case someone turns worse. That night at least, patients’ loved ones were allowed to visit due to the Coronavirus cases being on the decline in the town. I could hear people talking and laughing. It was much better than walking down the hallway with the only noise coming from the patient’s rooms that of the TV.

Charting, bored and somewhat relaxed, I heard that a call bell started ringing as if it was unplugged from the wall. The aides were probably busy since the bell kept ringing, so I started for the room. As I got closer to a COVID isolation room, the head of a nurse, Irene, showed up. She saw me and cried, “Help! I need help here! Call a Rapid!”

“Rapid Response in room 32” - I shouted to the charge nurse, then ran after Irene, donning the protective gown and face shield before entering the room.

Irene’s patient was an elderly man, lying prone, with open eyes gazing at the ceiling, taking occasional reflexive breaths. In the corner of the room on a chair was sitting an elderly woman, his wife, I guessed. The tiny, wrinkled old lady with white and disheveled hair seemed to have shrunk on her seat. The patient on the bed seemed to be in dire condition and I asked Irene, “Pulse?”

“No.”

“CPR?”

“No. We can’t. He is a DNR.”

Just in case Irene turned to the wife and asked her, “Does he want CPR?”

“No, he didn’t want to be resuscitated,” answered the elderly woman through sobs.

I went to the man on the bed and checked his pulse, then started fiddling with the blood pressure machine which didn’t make much sense. The man needed CPR and defibrillation. While I was playing my role, the room filled up. The doctor on call came in with a medical resident, the nurse manager followed, and then the cardio-respiratory technician - John. Another floor nurse and the charge nurse also joined. Questions were asked leading to the same inevitable conclusion. What a troupe we were and what a play we played, I thought. The patient was gone. We couldn’t do anything for him if he didn’t want CPR and we all knew it. We did our act for his wife but I reckoned she would hardly feel better because of it.

The same thought seemed to have passed through John’s head and he turned to the elderly woman, sitting in the corner. He said, “Go to him, ma'am.” He nodded at the man on the bed “Talk to him. He can still hear you. Tell him what you want him to know.”

The woman listened to John. She went to her husband and embraced his head. She then whispered a few words in his ear too quietly for us to hear. We, the failed caregivers, totally useless, crowded on the other side of the room. The patient continued with his agonal breaths in and out, the useless attempt of the lungs to supply oxygen to a body where the heart was not beating. Soon those stopped too. The woman stood up from where she had kneeled by her husband’s side. She looked at us strangely and quietly said, “He is gone.”

The doctor went to the patient and again listened to his’s chest, “No pulse. Time of death…”

The rest was a procedure. We would keep the body at the morgue until the family was ready to take it. After arranging some details, the widow started for the door. As she was passing by John, she took his hand in hers and shook it.

“Thank you,” she said, and then slowly walked away. I followed soon after and found myself next to John in the hallway.

“The man is gone,” I said in order to chase away the somber silence.

“Yes. It happens” John said, mechanically.

“It was nice what you did there, that you told her to talk to him. Of course, he couldn’t hear a thing anymore…”

John shrugged his shoulders and said, “We couldn’t do anything to save him if he didn’t want CPR. He was a dead man before I entered the room. Whatever you do for a dead man, he is still a dead man. It didn’t matter whether he heard her as long as she had a chance for closure. The living are the important ones. And we should always try to do something for the living, right?” he said, smiled, and tapped me on the back.

I remained in the halfway, with a dead man in the room behind me and John, walking ahead of me, his white coat floating behind him resembling the wings of an angel, carrying away the soul of the man. I knew that John often witnessed the last breath of the ones who couldn’t be helped. His sympathy and kindness were the only right thing to be done at the moment. He gave the woman at least some solace. Even if that was in the form of a little, white lie.