Alright Alright AlwRIGHT so we’re coming up on a certain number of followers.. and I know I’ve been terrible lately at keeping up on my photoshoots. So when said certain number of followers comes around the corner, I’ll force myself to get both Cheerio and Callisto involved in a photoshoot for you all. I’ve gotten Callisto to eat finally, so I’m not so worried about him. As for my lack of pictures, I’ve just been a bit busy lately and sometimes lacking motivation, I sorries :(
I met you on Sunday, the first day of my work week. It was early afternoon, my preceptor and I were all caught up with tasks and charting when they called the code overhead. “Code Blue ER ETA 5 minutes.” The charge nurse started to head down to help (they are required to go to all codes in the hospital to help).
“Why don’t you go down with her?” My preceptor suggested. “We’re not doing anything.”
I’m always down for a field trip to break up the day. When we got to the ER the charge nurse assigned everyone a job for the code, she had no job for me and decided that I would be in the way. So I was relegated to the hallway until I was needed.
I was standing across from the ambulance bay doors when you were rolled in on the EMS stretcher. Someone was doing chest compressions as you were rolled into the ER. The brief glimpse I got of you was not promising, you didn’t look good. I found out later that you’d been out with friends and started complaining of some heartburn. You got out of the car to get some air and you went down. 911 was called, but you were down over 5 minutes before they got there.
You had no pulse when the paramedics got to you. You were found to be in PEA, they began CPR and you got a couple doses of Epi. Four members of your family came in through the ambulance doors a few minutes after you and they were lead away by the house supervisor to a private room.
Within a minute of getting into our ER room a pulse was detected and we started the hypothermia protocol. This is when I got involved. I was sent for the pads for our temperature management system. This protocol is started in an attempt to preserve brain function in patients that do not regain consciousness after coding. I entered the room and I saw you laying there, tubes had been inserted into your throat, bladder, and veins. You didn’t move at all when we touched you. The ER doc prepared to insert a central line into your neck while we applied the pads and started the cooling process. I looked up and noted out loud that you’d gone into a junctional rhythm. Your heart rate was in the 40s and your blood pressure was dropping too. I helped hang a bolus and get the pressor ready to go.
At that point my charge nurse motioned for me to follow her. Our work with you at this point was done. You’d be coming up to the ICU shortly and would be another nurse’s responsibility.
The rest of the day passed, I took care of my patient and helped reintubate our other patient.
When I came back a day later, we were assigned your room. The news wasn’t good. Your CT yesterday showed a severe anoxic brain injury. The EEG over night showed no seizures, but it also didn’t show any other activity. The doctors ordered an MRI to confirm what the CT showed… which it did.
Your neuro assessment was unchanged since you’d arrived even after you’d been rewarmed. GCS of 3-6. Pupils unequal and sometimes reacting to light. Cough and gag reflexes come and go. No reaction to pain or spontaneous movement. You’re not breathing on your own, the ventilator is doing all the work for you.
Your daughter and one of your siblings arrive later that morning. Your daughter asked me lots of questions and I answered honestly. She apologized for all her questions and I assured her it was ok. The crit care doctor came in and was bluntly honest with her. The chances of you getting better are extremely slim. Your daughter is realistic and understands that this is it. You have a large family and she wants everyone that wants to to have a chance to visit, so the plan is made to withdraw care tomorrow afternoon.
Your family spends the next hour in your room on the phone and crying. I bring them tissues and continue to care for you. As your family looks like they’re getting ready to leave, I approach your daughter and ask her if anything were to happen over night if she would want us to try to bring you back (it seems silly to ask, but I had to just in case). She says no and you are made DNR. We also minimize treatment, discontinuing antibiotics and your insulin gtt. No longer are we in life-saving mode, we are just giving your family a bit more time to say goodbye.
The next morning there’s a blizzard… your favorite kind of weather, I’m told later. We care for you all morning while waiting for your family to arrive. It is late morning before your daughter finally makes it in. She’s pregnant with your second grandchild. You were so excited for your first grandson, she tells me. I give your family some time alone to say goodbye after they confirm with the doctor that we are withdrawing care.
Your family leaves, they’ve decided that they don’t want to be here for the end. It’s ok, I’ll be here. After coordinating with the RT, we begin. I give you large boluses of Fentanyl and Versed, per the doctor’s instruction, and the RT extubates you. Nothing happens. Within a minute your SATs begin to drop. You don’t appear to be breathing at all. I hold your hand and watch the monitor, pausing alarms whenever they go off. It takes several minutes, but your heart rate finally begins to slow. Your SATs are in the 20s and soon so is your heart rate. The SAT no longer registers, so I turn it off so it won’t alarm. Your lips and fingers are grey. I listen. There is no heartbeat, despite the ugly QRSs that continue to blip across the screen. You’re in PEA. My preceptor listens too and confirms. We call time of death.
I’m sorry we had to meet like this. Though, truthfully, I’m not sure I ever met you. I think you were probably gone before you were even rolled into the ER. I’m sorry you’ll never get to meet your grandson and that your family is going to be without you. It’s an awful situation. I am grateful you have such a loving family that did not make us torture your body with modern medicine for way longer than necessary hoping for a miracle.
This was my first patient death in the ICU, but it will not be the last. It is the nature of the ICU beast.
Warnings: language, serious injury to major character, mention of surgery, intubation, etc., fluff.
A/N: I got this idea while I was working the other night. Let me know if you guys want a part two!
“TRAUMA ALERT. EMERGENCY DEPARTMENT. ETA 5 MINUTES. TRAUMA ALERT. EMERGENCY DEPARTMENT. ETA 5 MINUTES.”
“Shit,” you mumble under your breath as you scarf down what little you can of the cold chinese food you had ordered 3 hours ago. You toss the container back into the fridge, and dash back out into the main room. It’s organized chaos, as per usual. Nurses and doctors are pulling on gloves and yellow disposable gowns, yelling for this cart or that tray. You join the bedlam, asking the nearest doc about what’s coming.
“Male, late 20’s or early 30’s. BP was 80/60 when the paramedic called in the report. He said it looks like trauma to the head, abdomen, and lower extremeties,” the doctor says in a rush as she ties her gown. She looks over you and yells for someone to call the blood bank and respiratory department before returning to you. “They found him on the side of some back road by a barn. That’s all we got so far.”
You nod your understanding and snap into auto-pilot, going through and making sure the correct kits are out and everyone is where they need to be. When it comes to major trauma patient, time is of the essence. Your small ER isn’t equipped to handle anything really serious, so the faster you can get the patient stabilized and the helicopter, the better. The doors to the ambluance bay open, and the EMTs rush in with a gurney in tow. The person they’re carrying on it is covered in blood and hooked up to two IVs, both of which are pouring saline into his veins. One EMT has a mask pressed to his face as he pumps oxygen into him. The gurney is lined up next to the stretcher, and you along with four other nurses transfer the patient over so you can begin to work. The moment the mask is removed, though, your heart drops.
No. No, no, no, not him. Please not him, you think as you back slowly out of the room. Your entire body begins to tremble, and you grab the EMT nearest you. You yank him to the side none too gently, your voice shaking.
“Was there anyone with him?” you ask. Your voice is a quavering mess.
“Huh?” The EMT looks at you like you have ten heads, but it’s mostly because he didn’t understand you.
“Was there anyone with him when you picked him up?!” you all but scream at him. With the madness going on all around, no one even spares a blink at your outburst.
“Yeah, tall guy. Longish hair. He looked pretty beat up, too, but denied being transported. He should be out registering this one here- Hey! Where are you goin’?” he called. You didn’t turn to answer. Your feet were already carrying you as fast they could as you fled towards Admissions. Seeing Sam hunched over the desk there almost made you collapse in relief as you flung yourself at him. He jumped slightly at the contact, but once he realized who had latched on to him, his shoulders eased slightly and he returned your embrace.
“What the hell happened?” you demanded after you had stepped away. “I didn’t even know you two were in town and now Dean’s… Dean’s…” you couldn’t force yourself to finish the sentence. Thank God for Sam, he didn’t need you to.
“I know, I know. We were on a hunt. Nasty demon. He got Dean alone, and did a number on him. Dean kept telling me not to call 9-1-1, but he was losing so much blood. What else was I supposed to do, _______? This is out of ‘slap on a bandaid and a few stitches’ territory,” Sam choked out. He was trying to so hard to keep it together that it was plainly visible. Tension tightened every muscle in his body as the clerk typed away in front of you.
The sudden erratic beeping sent you back to Dean after a squeeze of Sam’s arm. In the time you were gone, Dean had been intubated and another IV had been inserted. You waited for the radiology techs to leave before slowly entering the room. He was a mess. His clothes had been cut away, revealing lacerations deep into his torso. His legs were covered by a thin sheet that already had red blooms blossoming through it. You made your way to the head of the bed, looking down at Dean’s face. One of your hands gropes for his, and though its still warm, its completely lifeless. You hope its from the sedation and not something more severe. Blood cakes his forehead and cheeks - fresh and shiny in some spots, already dried and flaking in others. His eyes, those green eyes you love so much, are closed. You glance up at the monitor showing his vital signs, and that calms you somewhat. His blood pressure has already started to rise, and everything else looks to be okay, all things considered.
“You know him?” another nurse asks as she gathers up the various wrappers, caps, and rolls of tape from the bed. All you can do is nod. A yell from just outside of the department makes you turn.
“He’s my brother! I don’t give a crap about your policies! I’m going to see him!” Sam shouts from the other side of the closed doors. You run over to let him in.
“It’s alright,” you say to the clerk who is clearly flustered, and you feel a pang of pity for her. You wouldn’t want to be the one standing between him and Dean now, either. You take Sam by the hand, gently guiding him over to where the ventilator whirs its steady rhythm. Sam takes one look at his brother before collapsing to his knees beside the bed.
“I should’ve been there,” he croaks. “He insisted we split up, but I still should’ve been there. We knew there was more than one in that house. Goddamnit,” he says through clenched teeth. He stands, grasping the hand you had let go of as he surveys his brother. “You gotta wake up, Dean. Please. You have to pull through this. You’ve been through worse. You can do it.”
“Sam, he can’t hear you.” The pleading in Sam’s voice nearly breaks you, but you have to stay strong. “Look,” you point to the bags hanging next to Dean’s bed. “They’re already transfusing blood. He might need surgery, but in a few weeks, he’ll as good as new in no time.” You’re trying to reassure yourself as well as Sam as you speak.
The helicopter crew arrives, pulling their own stretcher and monitors with their helmets tucked under their arms. One flight nurse stops to talk to the doctor as the others start prepping Dean for the trip. You back Sam out of the room, knowing they need the space to work. Soon, he’s strapped in and ready to roll. They’re about to wheel him out when you step forward.
“Wait!” you call out. “I’m coming with you!” You turn to Sam and start giving him directions to the trauma hospital Dean’s being taken to, but one of the flight crew stops you short.
“_______,” he says, “we got this. I appreciate the extra help, but we’ll be fine.” You realize you don’t know him. He must be just rotating through.
“I’m not asking as his nurse,” you reply. You pull out the chain you normally keep hidden under your scrubs, giving a good pull to snap it apart. Sliding off the single ring, you slip it onto your left hand and hold it in front the flight nurses face. “I’m telling you as his fiancée. I’m coming with you.” He still looks uncertain, so you look past him to the other flight nurse. This one you do know, and well. “Brenda,” you say to get her attention. She looks up the folder in her hand. “Bren, please,” your voice cracks on the last word.
Seeing the look in your eyes, she nods once before handing you her helmet. “Let’s move, people!” she calls. You turn to Sam, and he looks so lost standing next to the now empty room. You rush over, pulling him into a bone crushing hug.
“I’ll stay with him as long as I can,” you say into his ear. “I promise.” You call one of your coworkers over, instructing her to finish giving Sam the directions he needs before turning back to him. “I’ll see you there, alright?”
“Don’t leave him,” Sam says, his face set in a hard expression to hold back the wave emotions you know is building inside of him.
You rush out after the crew, the blades from the chopper whipping your hair around your face as you pull on the helmet and climb into the back of the aircraft. You feel a small sense of relief when you see Brenda is nearest to you, and she gives your knee a friendly pat. The craft shudders as it leaves the platform, and though you had always wanted to do a run with the flight crew, you had never wanted this. You lean down, the noise of the wind drowning out your words to the others in the cabin as you talk into Dean’s ear.
“Don’t you do this to me, Dean. Not now.” Your fingers brush through his hair as you finally let the tears fall. “I found my dress. I can’t remember if I told you yet or not. The damn thing is going to cost me at least three paychecks, and I mean to wear it, you hear me? So you fight. For me, for Sam, for Cas, hell just for yourself, you fight. Because I swear to God, if you die on me, I’m gonna kill you.” You press a soft kiss to the part of his forehead that is clear of blood and pull back to find Dean’s emerald eyes locked on your face. The faraway look in them tells you that the sedative hasn’t fully worn off, but he’s starting to fight the steady in and out of the ventilator, trying to breathe on his own. Brenda is already drawing more medication up into a syringe as you choke out a sob. “Hi baby. I love you.” Brenda pushes the med into one of his IVs and he’s out again.
You lose track of time as you gaze down at Dean, and in what seems like minutes and days all at once, you finally land. Another team is waiting on the pad to retrieve the love of your life as soon as the doors are opened. You run after them, but are forced to stop mere yards into the doors at the red line that is laid down on the floor that indicates only necessary personnel are allowed past that point. You watch as Dean is wheeled off, his life now in the hands of doctors and nurses you don’t know, but now have to trust with the most precious thing in your world.
Your arms tighten about your chest as you wander off to find the waiting room and look for Sam. You slink down into one of the few chairs left in the crowded space. Anxious faces are everywhere, everyone either nervous about their own health or the health of a loved one. Its so strange for you to be on this side of the process, and you want to scream. Your whole body is shaking with spent adrenaline and worry, your mind sifting through every possible outcome of the next few hours. The one you dread most is the one that constantly finds its way to the forefront: you being ushered into some small room where your cries will be muffled but still audible to others as a doctor tells you in a sad tone that despite their best efforts, they lost him. You refuse to give in to that, though. Dean’s eyes had only been open a few seconds and he had still been drugged, but you had seen the spark of life that lived behind them. He had to pull through this. He had to.
Sam comes running through the doors, his head whipping around to find you. You give a small wave to show where you are and he comes to sit beside you. Neither of you speaks. There’s no need to. At some point, Sam reaches down to clench your hand, whether to share his own strength or borrow some of your own, you don’t know. It grows dark outside while people come and go from the waiting room. After what seems like years, the doors open and a tired looking doctor still in OR scrubs walks out.
“Family for Dean Winchester?” he calls. You give Sam’s hand a squeeze as you stand and take a shaky breath in. The time has come: small room or Dean’s bedside. You’re heading for one or the other, no turning back.
Here we go, you think as you follow him inside with Sam at your shoulder. For better or for worse.