Tag Archives: death

The Fourth Floor

15 Apr

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About a week and a half ago, I got a phone call from my educator telling me that I was being moved from the ER to a makeshift Covid floor that they had installed on the fourth floor above the emergency room. I knew something like this was likely coming as most of my other nursing friends around New York City have also been shifted around to units that exclusively treat Coronavirus patients, but I was still nevertheless heartbroken. I had been training for 8 months to be an ER nurse, and in the matter of a day, all of my hard work felt like it was pulled from me. I was to be given one day of training into a whole different type of nursing. Oh, and I was being moved to the night shift.

It’s grim. It’s bleak. There are moments of light that I grasp onto and try to repeat over and over to myself in my mind, but the image of watching people struggle for air as they slip closer to death without family or friends by their side is haunting. On my first night, a couple of hours into my shift, I was given a transfer patient who was DNR (do no resuscitate) and was completely unresponsive. Her head was contorted backwards with her mouth open as she gasped for air. As I was instructed to do for a new admission, I took vital signs on her and listened to her lung sounds, roiling with the sounds of fluid as she slowly drowned.

I remember thinking, “How do I process this? How do I deal with this and with all that is still to come?” And I realized I can’t. I just have to do my job, and I’ll work through the trauma at a later date. Neither me nor any of my fellow healthcare workers have the luxury right now to take a mental health day or to see a therapist. It’s the first time that this whole pandemic felt like actual war to me. What it must be like to be on a battlefield, surrounded by death and the only option is to keep going, to keep fighting, because that’s the only way through. No end date. No idea when the resolution will come. Just keep fighting.

I love being a nurse, but right now, I dread my job. I never wanted to be an inpatient nurse (which is what I am now), especially not dealing with hospice care. I have a deep well of respect for those nurses, but I always knew it was not the type of cloth that I was cut from, that my heart was not built to endure or sustain this kind of work. But I’ve been drafted, and I don’t have a choice. I ride the lonely subway to work. I put on layer after layer of protective gear. Masks that make me gasp for air throughout my shift, gowns that trap heat and make me sweat, face shields that cut into my forehead. I try to do the best job I can and offer as much compassion as I have stored within me to each patient, then I go home to my lonely apartment and try to sleep through the daylight until the night comes, and I have to go back again.

Moments of light, though. Brief, beautiful, savory moments of light. My schizophrenic patient who is often confused and disoriented and asks me repeatedly if she can stay in bed (she’s homeless and used to being kicked out of places.)
“I’d be very happy if you stayed in this bed until you feel better,” I told her.
“Oh good,” she replied, relaxing a little. “Then I’m going to go back to sleep, and I wish you luck doing whatever you have to do in all that gear. Good night. I love you.”
“I love you too.”

An elderly dementia patient who asked another exhausted nurse to put on a ballgame for him. She explained there is no baseball and that it was the middle of the night. I got one of our iPads for him and pulled up the 1986 world series games for him on Youtube. I set it up on the table in front of him.
“I just wish I could bring you a hot dog,” I told him.
“Oh, I miss hot dogs so much.” He looked at me. “I know I keep asking you, but I’m waiting for your answer on my marriage proposal.”
I laughed awkwardly, not knowing what to say.
“It’s just that you are the most beautiful woman in the world,” he continued. Remember that I am wearing two masks, goggles, face shield, bouffant, gown, gloves.
“You can’t see me under all this gear!” I remind him.
“But darling, you look beautiful no matter what outfit you’re wearing.”

Moments of light. Moments of light. Long 12-hour night shifts with brief moments of light before I walk out into the early morning sunlight and head home to try and sleep.

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Youth in Asia

10 Feb

It’s peculiar and fascinating what people can get used to, what our minds can adapt to. At my vet clinic, there are about two or three euthanasias a week. Sometimes more, sometimes less. A lot of times pets die naturally at home. It’s a part of the job. People always ask me if it’s hard, if it’s sad. The easy answer is yes.

When I started at the clinic as a receptionist two years ago, I began with a wide-eyed optimism. My new job would surround me with adorable puppies and kitties. Somehow I didn’t factor death into the equation. I remember the first time I saw an appointment for euthanasia. I didn’t even know how to process it. I can vividly recall watching the family in tears carrying the pet into an examination room and leaving the hospital, their arms empty. My heart hurt, and I went home that night and quietly cried in the shower.

I remember the first euthanasia I participated in. It was a very old, incredibly sick Yorkie. Dr. S was hoping he could save it and had me sit vigil with it for about six hours while he monitored it between appointments. The dog lay on its side, breathing heavily. It had what my tech friends and I call “death diarrhea.” It’s black, liquid, the most horrible smell you can imagine, and it slowly seeps out. We call it the death diarrhea, because once a patient starts having it, death is almost always a day or two away. The black liquid (Melena) is actually what happens to blood when it is digested, so the presence of the diarrhea indicates that there is extreme internal bleeding along the intestinal tract.

I sat with the dog for hours, trying to not gag because of the smell, and petting the dog’s head lightly. Finally Dr. S spoke to the owner on the phone, and they opted to put the dog down. It happened so quickly. He drew up the drug’s and injected them. He leaned close to her and quietly said, “You did a good job. You’re a good girl. Your dad loved you very much.” I went home and cried in the shower.

Since then I’ve participated in many more, most of the time in pets that are suffering and death seems to be a blessing. Usually the doctor brings the dog to me, I place an intravenous catheter, the doctor takes the dog back to the owner, euthansizes it, they bring the body back to us and we prepare it for the crematorium, which is done offsite. Rarely, the owner doesn’t want to be present, and we perform the procedure in the treatment area.

And I’ve gotten so used to it. Just another duty at work. Sometimes we even make off-color jokes about it that seem hilarious to us, but when I mention them to friends, I obviously get a look of horror. It’s kind of horrible to feel calloused, inured to death. But it’s psychological survival at its finest. I can’t come home everyday from work and cry in the shower. I would lose my mind. Some people do. Veterinarians have the third highest suicide rate among professions. Physicians are number one.

Yesterday we had a euthanasia where the owner didn’t want to be present. It was a new patient. A 21-year-old dog, which is remarkable in itself, who was having difficulty walking and no longer interested in food. It was an adorable ragamuffin terrier. I held the butterfly catheter in place as the doctor injected the drugs. I pet the dog’s head and watched the lights dim in its eyes. I told him what I tell them all, “You’re a good dog. You did a good job,” because I believe that’s all a dog really wants to hear in its life. And then I felt it, that same heartbreak I felt two years ago when the idea of a euthanasia appointment was enough to upset me. But I also felt relief. Relief that I still have a piece of my heart and am capable of feeling that sadness, that mourning. Because I need that to psychologically survive as well.

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