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Remembering Victoria

Remembering Victoria REMEMBERING VICTORIA Life may deal us some unexpected blows, sometimes, which completely blindside us. The day can begin absolutely normal for us. Granted, each person's definition of normal' will vary from one individual to another. When we get up in the morning our minds are clear and all the thoughts from the previous day are, for the most part, abolished. We get up with a new attitude, hope and outlook for the day. We expect this day to be, somehow, better than the last; if in fact the previous day was harsh. But we don't give up hope. There is always hope. I remember one particular day so vividly in my mind. It's a day I will never forget. Even if I tried too, my co-workers won't let me. Someone needs to remember; and I may be the only one who does. Besides, I don't think I would want to forget. It keeps me grounded. It reminds me that I am human, that I have a heart, and that I am not the stone-hearted bitch I thought I had become. I reported for my shift in the Emergency Room as usual and on time. Since I didn't have any assignment yet that day, I proceeded to do all of my daily checks of the equipment in the Trauma room. I am so anal about my work environment. Everything should be in the right place and proper working condition and at my fingertips, should I need it. Once I was satisfied and felt like I was ready for anything that came through the doors, I left my assigned area and went to offer help to the other nurses, or anyone who might need it. The morning was slow and I had made my rounds to the other areas and had done as much as I could offer to my co-workers, just short of doing their work for them. I finally returned to my assigned area and decided to complete some on-line assignments that I had been putting off for way to long. My Charge Nurse sent word to me and my partner that EMS was bringing in a female with a low blood pressure and decreased level of consciousness. So I began to prepare and anticipate what I might need to care for this sick woman. Prior to her arrival, another patient was brought in who was probably having a heart attack. I double teamed with my partner that day on this patient to get them lined out as quickly as possible. Before I could finish helping her, the EMS rolled through the door with my sick patient. I could see they had an Ambu-bag and were providing oxygen to her by that means. But they weren't doing compressions. So I looked at my partner and told her I had to go. She understood. The closer I got to the bedside, the more pungent the stink. It was so overpowering and nauseating. It smelled of feces, urine, and soured milk. It was horrendous. I got a very quick report from the EMS and began to work on her. The Paramedic was unable to establish an intravenous access, so I asked them to stay and help me line her out. I sent one of them to go get the Doc, while the other helped me do a quick assessment and get her on the monitoring system. She was unresponsive to any stimuli that I had tried. Her heart rate was too fast as well as her respiratory rate. Her blood pressure was registering, but it was extremely low. And she was hot to the touch. I put her on 100% oxygen, as she was breathing on her own. By the grace of God, I was able to access an IV site, and put some IV fluids up to run in. By this time the Doc had entered the room and was spouting off orders which, knowing him, I had already anticipated and was already acting on. I gave him the report I had received from the EMS. He wanted to know where the family was so that he might speak with them and get some kind of history, but to also let them know how gravely ill she was. He wanted to prepare them for the worst which might be inevitable. I told him there was no family with this patient, but I had a name. Her name was Victoria. He left the room to go see if maybe she had been a patient here once before, and might possibly be in our computer logs. He said he would try to get some history there, and he would be back shortly. After a half of a liter of fluid was infused I saw a slight improvement in Victoria's breathing and heart rate. Her lung sounds were still clear so I continued to infuse the rest of the liter at a fast rate. One of my Techs heard we had a very sick patient and she came in to offer me some help, and I was so thankful for it. The way things are today, we are always shorthanded, so it is not unusual for one person to have to deal with a crisis alone. God loves us, because he always gets us through it. That, and there is a lot to be said for experience and level headedness. This was not my first time in the rodeo arena. By the time the other half of the liter of fluid had infused, Victoria's blood pressure was a little better, as well as her heart rate and respiratory rate. I already had the prescribed antibiotic infusing as well. All her lab work and x-rays were also in the works. I was just waiting for the results. I told my Tech I thought it was safe now to clean her up and get her comfortable. We collected all the supplies we thought we might need before beginning our task. Once set up, I pulled the covers back off of her and it was only then that I truly got a good look at this gravely ill woman, and I was absolutely shocked. My heart immediately went into spasm and was breaking for this woman. I almost could not believe what I was seeing. Neither could my Tech. And the stench was so over-powering. Regaining my composure, I took a temperature on her and treated her fever appropriately. She was but just a skeleton of a human being. She appeared as if she had not been bathed for quite some time. The linens she was lying on had stain upon stain. She had a feeding tube in place which was unclasped and leaking everywhere. The insertion site on her abdomen for this tube had a dressing which desperately needed changing. She had bedsores that were left untreated, and undressed. So they were exposed to any and all kinds of contamination which was breeding within the bed linens. All four of her extremities were in full contracture and drawn up which made it a challenge to just reposition her. Her fingernails and toenails were long, dirty, and ragged. There were unidentifiable dried secretions on her body everywhere. Even though she could not speak to me I knew she had to be in great pain. I began to take extra care with each touch and movement of her. The Doc came back into the room to check on her progress and was able to see the horror which I had just discovered. He was able to locate her in our computer logs and he began to give me some history on her. She had a multitude of illnesses; illnesses which we would never rid her of, or make better for her; illnesses which at this point were probably her doom. My Tech and I began about our challenge. I say challenge because I am a fighter for life itself. My patients may not be strong enough to do it, but I can have the strength of many when my constitution drives me to do so. And it was driving me with a ferocious anger on this day, and at this time. We first removed all the dirty linen and replaced them with clean ones. We then gently bathed her. We talked to her, as we now noticed her eyes were open. Each time we moved an extremity I could see a grimace in her facial expression. My God the pain she must be in. After some doing, we finally got her clean and the smell dissipated. I changed the dressing around the feeding tube site and re-secured the tube. We again changed the linens and put new fresh linens on her. I cleaned the bed sores and placed clean dry dressings on them. We got pillows and placed them strategically so that we might give her some padding and make her more comfortable. Then we let her be. How could this happen to someone? Who would do such a thing? Why did this happen? In all my years, never have I come across something as appalling as this. I was numb and angry. I didn't know this woman. We had only just been introduced. And what a shocking introduction it was. But it was tearing my heart to pieces. And before I could stop it, out of my mouth I heard myself say, "God, why? Why have you let this happen? Help me please." My Tech just looked at me. Once we got her clean and comfortable, she appeared to be resting better. I didn't know her level of understanding, or if she could understand, but I kept reassessing her so that I might be alerted to any changes that might be presenting themselves, because she was no where near out of the woods. As I expected, the changes were coming about. Her heart rate began to rise again, and her blood pressure was dropping. Her respiratory rate was becoming shallow, rapid and almost labored. Her breath sounds were clear, though. I hung another liter of fluid and sent the Tech to go get the Doc. As she exited the room Victoria's respirations were becoming more of a gasp now. She was fighting for each and every breath. I looked at the monitor and I noticed her oxygen saturation was decreasing. I took the oxygen mask off of her and exchanged it for the Ambu-bag and began to assist her with her breathing. It only took a few squeezes of the bag, and her respirations were restored. So I exchanged the bag for the mask again. Only this time, I didn't secure it with the elastic strap. I held it there for her. I don't know why I did that. I just did. We have a saying in the medical profession: The angels are circling. Which means death is near, and God won't even stop it. On any other day I would have stated loudly, in my thoughts, "Not today! This one is not for you! You cannot have this one! This one is mine! Go away!" And the battle for life would be on, and I would fight fiercely. But this day was different. With tears in my eyes, I looked up at the angel's only to be greeted by their tears. I had no more hope for life for Victoria. For what kind of life was she pressured into enduring by a selfish family? Who by the way, never showed up! Was it because they loved her so much that they couldn't let go? My anger compelled me to think, was it because they would lose a source of finance each month? Why? What good reason could they give me that would allow someone do this to a loved one? This was no life. This was a tragedy and blatant torture. I silently prayed to God for her. And I asked him if it was time for me to let her go. And about that time, my Tech put her hand on my shoulder and softly told me, "Oh my God, I have never seen you like this. You were always the strong one. What can I do?" I looked silently over my right shoulder at her and never offered a word. She reached up and dried my eyes with a tissue, for I still had my hands over Victoria's face holding the oxygen mask. I took my left hand and gently stroked Victoria's forehead. And as she began to again gasp with each breath, I leaned closer to her ear and whispered, "Its okay, its okay. You can let go now. Be at peace. They're here for you, go with them." I hadn't realized it, but the Doc and my Charge Nurse were standing at the foot of the stretcher. The Doc was teary-eyed and wanted to know what I wanted him to do, because she was now a DNR, which meant do not resuscitate. Apparently, there was legal documentation which was brought to the hospital stating her Do Not Resuscitate wishes. He said whatever I wanted, he would provide within reason. I only asked him to please let me allow Victoria to go in comfort. If she was going to go and there was nothing more we could do, at least do that. DNR does not mean to not provide comfort or to treat. I asked him to give me that, and he complied. I stayed at her bedside talking to her and lightly stroking her forehead. I knew the end was near, and I knew wouldn't take long to come. My Charge Nurse had not assigned me any new patients, and he made frequent checks on me. He didn't know what to say; no one did. No one had ever seen me like this before. And why would it all of a sudden be happening now? I had no answers to give. I have seen death many times before, but none of them touched me like Victoria's impending death did. I looked up one more time to see the Angel's still perched and with their wings spread wide, but only this time I smiled at them. I looked down at Victoria and she seemed to be resting more comfortably now. I lightly stroked her forehead one more time before closing my eyes and saying one more prayer for her. I then softly whispered to God, "I can't have this one can I? Then take her. Give her the love she so richly deserves. Give her the peace she is owed." My Tech remained with me, saying she would not leave me here alone. Another co-worker came in and offered to relieve me, and I accepted without hesitancy because I knew the end was a breath away. I knew Victoria was comfortable, and I had done all I could within my powers to give her that comfort and make her passing easier and with more dignity. She looked at peace for the first time since our introduction on this day. I handed the oxygen mask over to my co-worker and walked away without a word. I never looked back. I wanted to remember the peaceful expression she now had on her face. My Charge Nurse greeted me at the desk and we just stood there looking at each other, until he finally said, "Are you okay?" I told him yeah. He put a hand on my shoulder and pulled me to him and hugged me briefly. Then he ordered me out of the unit for no less than 15 minutes to re-group. I didn't fight him on this. I did just as he had told me and walked away. I was just about to get up and return to the unit when I saw my Tech coming through the door, so I sat back down. I asked her if Victoria was gone, and she said yes. My Tech told me she wanted to be the one to come tell me. She told me Victoria was no longer gasping for air and that she was breathing easily when she took her last breath, and that she went peacefully. So we sat there, her and I, in silence and I cried once more.
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