Our best CNA who takes care of these people like they were his own son points and hits the nurse firmly on the shoulder. We look. What we thought was a benign napping patient enjoying an afternoon snooze in his regular chair under the skylight in the warm sun is now a medical problem.
Seemingly sleeping with eyes open slumped in the chair, staring straight forward unblinking into nothingness, eyeballs wont track, not responding to verbal stimuli or sternal rub…i take his vitals. Oxygen: 97. Heart rate: 56. Nurse calls his blood pressure 110/68. In terms of vitals he is medically “fine”. Nothing abnormal to pounce on. But he is not fine. I tell the nurse…bluish tinted bottom lip, bluish tinted fingers…palms warm and sweaty, fingers clammy and ice cold. He is drooling excessively and i know he is soon to vomit. They want to lay him down so the ems can slide him on the stretcher. I say no. I wont let them lay him down. I tell them that he is going to vomit and if they lay him down he will aspirate on his vomit and death will be a 100 percent certainty. I raise the head of the crank bed to 90 degrees just in case they dont listen to me. They protest that they are listening and he’s no longer going in the bed. I point to his left leg. There is a blotch of purple tinted skin the size of my hand where his pants leg has ridden up. The rest of it is pale white. He is very pale and still unblinking. They are all rubbing him and calling his name. I move some of the wanderers over to the activities department where they are doing crafts in the dining room so that the nurses can focus on our unconscious patient without worrying the wanderers are escaping. The activities director catches my plan and thanks me for bringing extra participants. He incorporates them into his activity and helps them sit down. I go back to the room where they are holding a trash can to the patient’s face. He is drooling excessively, a flood of liquid coming down in long strings from his mouth. No one is wearing gloves. Everything has happened too fast. Possibly two minutes have passed since we found him and the CNAs dead-weight lifted him from the chair and jogged him into the room, borrowing a w/c to put him in. I hold the trash can and provide everyone medium gloves from my scrub pocket. Now that they are gloved up they take the trash can again. We are disagreeing. They say he hasnt thrown up he’s just drooling and we should put the trash can away and lay him down. I tell them that i know for a fact he is going to throw up, the drooling is a precursor and there is no way they should lay him down or remove the trash can. They believe me. When he first begins talking the words dont make sense and his lip is drooping a bit on one side. After a few seconds the murmurs turn to words. They ask him if he has a wife or children. He answers no. They ask him who we are. He doesnt know. They ask him how old he is. He doesnt know. They ask him his name. He doesnt know. They ask him if he has a ranch. He says no. The director states immediately and sternly, “He needs to go.” The wooden sign from his ranch hangs on the wall in his room. Across from it on the other wall are cameos of his favorite cow and calf pair and his old bull. EMS has been called. They run their vehicle over from across the street. Someone hollers, “now he’s throwing up.” 4 and a half minutes from discovery the EMS vehicle is parked outside. I meet them at the door, “i can take you to the patient.” I hold the door open for them and in comes their stretcher. I lead them to the room and while im walking they ask me how the patient is. I tell them he’s drooling a lot, just vomited, very confused, doesnt know who we are, oxygen is 97, heart rate is 56, blood pressure is 110/68. They enter the room, ask him two questions he doesnt answer, hoist him onto the stretcher, take the packet the nurse has printed while all this is going on, buckle him in, and they’re headed out the door. Doors to the ambulance close. 45 seconds later they’re pulling away to the hospital across the street. There goes my little buddy. May God watch over his soul. The nurse goes to call the family. The CNA begins cleaning up the vomit. I go across to the other building to tell my boss what has happened because he needs to document reason therapy was withheld. The nurse thanks me for my help, as always. Here, we are a team, and when a patient is in distress a therapist can answer the door, assist in a transfer, or relay vitals just as easily as a nurse. It frees the nurse up to print the packet and call the EMS if you help. I want my patient to get the best chance at living. I would never not help. Especially with a patient i see regularly and feel responsible for because i know him. This patient in particular has a very involved and loving family and multiple members visit him daily for a few hours at a time. They trust us to take care of him as they would if he were in their home. I could see on the nurse and director’s faces that this phone call was going to be painful because they too knew he had a family that loved him dearly and they were going to be relaying bad news. His sweet family members were going to be terrified and they were going to cry. I did not envy this job of making that phone call. Reasons i cannot be a nurse…
Dazed and numb i returned to the other building and relayed the last ten minutes’ events to my director. I went over in my head all the times id seen him napping there before and tried to see if there was anything different i could have noticed that would have tipped us off sooner. I settled on the drooling and decided that both the nurse and i should have picked up on the drooling and known this was different than his regular every ten minute kind of naps in the chair in the sun with his ranching hat pulled down over his face. My director tried to pull me out of my perseveration and stated that there was no way we could have known this nap was different from any other nap with his hat blocking his face and a history of drooling minimally during upright sleeping in the chair. He pointed out that as soon as we noted something was wrong we got him the speedy intervention he deserved and now it was in the hands of the EMS crew and they would take good care of him. I repeated over and over, “we should have seen it before ******. We work with him every day. Why did it take ****** to note the excessive drooling.” My director stopped trying to reason with me and pulled me into a hug. He patted my shoulder and said, “He’s going to be okay.” I dont love that he has to deal with this side of me at times because i know he has plenty on his plate but i know he prefers managing this type to the unethical ones that would harm patients or commit medicare fraud, and i know this because he gave me a job where he landed and not them. He is a good boss and puts up with all of us. He is the glue that holds our team together. ***** reads scripture to all the patients and nurses. ***** pushes the ornery patients’ buttons until they want to deck him and then tells them they can kick or punch him if they get out of bed to do so (and a lot of them do). ***** feeds everybody, and finally i watch over them like a helicopter parent. I am the gait belt police, the locked brake police, the uti police, and the sitting up during meals police. I will keep you alive. My boss is the provider of good coffee that keeps the patients willing to come down and visit us. He also takes several patients on afternoon trips to the garden outside because they cant open the door themselves and need supervision. We have a good harmonious team and we take care of the patients to the best of our abilities.
Several staff members called the hospital on and off duty to check on the patient. The hospital would only say one thing: awaiting tests. It was frustrating. Take him to san antonio man. If i have a possible stroke i want you to at least start on the tests when i arrive, not a day later. But it wasnt my call. We did our part. Now we could only wait. It was at this moment that the nurse who had made the call for EMS decided to share with us that the EMS crew member had responded when she stated he was a full code, “of course he is. He’s gonna live for ******* ever.” And rolled his eyes as they took him to the ambulance. I was so spitting mad i wanted to deck the guy. Several staff members asked for a physical description of the man and i paid close attention when she described a facial feature that was unique to him. If i ever end up in a position to give him a piece of my mind i will. You dont say **** like that! You dont say it because its not your place to do so and you dont say it because the patient is two feet from your head and can hear you. Imagine if God decides its your time and you have that moment of clarity before you leave this realm and instead of seeing two young men trying their best to save your life you see a guy rolling his eyes and basically wishing you dead. If he had been standing in the lobby without a patient at the moment i would have decked him. I was spitting mad. We gave him our little buddy and that was the way he received him. **** him. If your heart is not in this job anymore ******* quit. Dont you ever put on an EMS uniform and come to do anything other than save people you ******* piece of ****. EMS are the last to see those patients who pass in the back of the ambulance. Those are the last faces and voices and spirits they will interact with before they go to the afterlife. When i go i want to know the person is doing their level best and respects my wishes written on paper whether they be full code or dnr. I dont want to know that somebody selfish whose heart is not in it is just waiting for me to die so they can go home. People like that shouldnt have a healthcare license. If your heart’s no longer in it, go.
Update from the hospital: ran tests. If we cant find out whats wrong with him we’re sending him back. I dont know how he’ll be when he comes back to us. I don’t know if he’ll ever remember us or his ranch or the cows. I know that this is his home and we will all take care of him just the same regardless of what condition he returns to us in. I would give anything to see the recognition light up his face as he points to me and says, “you…” every day, remembering that i see him for exercise but not my name or why i come. I would give anything to hear the words, “well do you have the time to set and visit for a bit?” Then see him reach a shaky hand out to draw an adjacent chair nearer.
My coworker that reads scripture to me and to the patients sat down with me and said, “you know God will take him whenever it is his time to go, no sooner and no later. You know its in his hands right?” I hung my head, “i know.” Ive decided its my job to keep them alive until God makes it known that its over. Right up until the last moment i will do everything in my power to keep them thriving, because that is my job. As for the EMS individual, i still dont think he should be part of this operation and i hope God either opens his eyes to the damage he could be doing or just moves his heart to retire and try something else. If you are in a profession that saves lives, there is not room to wish death upon someone. There’s a special kind of karma for that and its not good.