Today I admitted a rapid response patient from the floor. He was struggling for each breath, and decided he wanted to be intubated. He was a cancer patient, age 60, and had previously been a DNI/DNR. When they can't breathe, it's so scary many patients change their mind. As we were preparing to intubate, he told us that he did not want ACLS, compressions, defibrillation, etc if for some reason his heart couldn't take it.
I explained everything in a calm voice while chaos swirled around him. I told him we were going to put him to sleep and he wouldn't feel the breathing tube being put in. That he wouldn't remember it and would wake up later. But he didn't wake up later. Anesthesia intubated, he bradied down, dropped his pressure... we gave fluids, 1 of epi, and 200mcgs of phenyl. He lost his pulsed. We stopped. He was pronounced.
It doesn't usually happen like that in my unit. People usually come to us almost dead, or they slowly slip away throughout their stay with us. They aren't usually talking to us one minute, dead the next.
The daughter almost threw up when she came in, she was crying so hard.
My other patient's daughter said to me later, "I think I saw a dead body being wheeled out of here, oh my god that was horrible." I said, "yes, that was my patient from this morning. He didn't make it." Her jaw dropping, "How do you do this job?!?!?! I'm so glad I'm a teacher!"