I've written about being a midwife in reverse, when it comes to the dying. Sometimes it seems that death chooses one nurse in particular to do his work for a period of time, and these last three weeks, that person has been me. We often notice that one nurse or another will have a 'black cloud' that will last weeks to months, a time period where she has an unusual number of patients who either code and don't survive or are transitioned to comfort care before passing. The last three weeks, six out of 12 patients I've taken care of have died, expectedly or unexpectedly, and one co-worker on the job.
My extern is getting pretty good at post-mortem care, people.
Yesterday alone, we lost two patients in one day. The first, a man in his 60s with multiple episodes of severe bacteremia and septic shock, which came from his legs and all of the wounds they had, a result of his advanced peripheral vascular disease. For the last two days, we tried to make his distraught wife understand that he was MAXED on pressors, and the only way to stop the sepsis was to amputate both legs, which we could not do in his condition. Even maxed on pressors, his MAPs were in the 40s. She finally let him go, and he died within ten minutes of turning off pressors, and five minutes of extubation.
After we had done his postmortem care, we picked up another patient who was on innercool following a witnessed cardiac arrest, a middle-aged woman with no significant past medical history. She had just returned from a CT scan which showed severe swelling of the brain, and herniation. We had to stand by as the husband was told, by the neurology team, the resident, and finally the fellow and attending, that her chances of surviving in any way, meaningful or not, were ZERO. We watched this man cry and hold her hand and stroke her face, as we had watched the previous patient's wife do the same with her husband only hours before.
Man, it's been a tough month, and this Midwife in Reverse could use a little break from death.