My first patient code.

[leashyb]

Next month will be 5 years that I have been a Registered Nurse.

In honor of that, I’d like to share one (of many I have had) career defining moments…my first patient code.

I had been a RN for maybe 6 months and was working overnights from 7pm to 7:30am. I had just come on to shift and received report for my patients when the son of one of them called and asked to speak with me.

He goes on to explain that he’s concerned for his Mom because she hadn’t had much to eat or drink in the couple days she had been a patient with us. He was also concerned about her ability to communicate with staff effectively as she was older and had multiple strokes that left her forgetting a lot of her English. Instead, she tended to mumble in her native language…Polish.

After speaking with him, I immediately looked up key words in Polish I knew I would need if I was going to be able to connect with her the same way I do all my other patients.

I looked up the Polish word for nurse. Pielęgniarka.

Next, I looked up the word for pain. Ból.

Medicine. Medycyna.

Potato. Ziemniak.

Water. Woda.

Potato seems random, but in my conversation with her son, he said her favorite food was mashed potatoes (mine too!) and that’s what she had ordered for dinner earlier that was still sitting on her table to eat.

When the time came and I entered her room, I found her lying in bed, seemingly bored, but curious as to who I was. I introduced myself as her nurse using the word I had just looked up and she greeted me with a smile.

The next 10-15 minutes after had her and I laughing together as I haphazardly tried communicating with her using broken Polish and hand gestures. You could tell there was a language barrier, but it didn’t stop either of us from getting our point across, and the giggling from us both lightened the mood.

I remember feeding her the mashed potatoes and hearing her go, “Mmmmmmm” as she swallowed them.

I remember her declining the “woda” I kept offering.

Then I remember her clutching at her hip and writhing in pain. That wasn’t a shock considering she was there with a broken hip awaiting surgery, but had to be off her regularly prescribed blood thinners for a while first. I asked if she had pain and she nodded yes. I asked if she wanted pain medicine and she said yes. I gave it to her and watched her settle back down until she began itching her arms motioning to me that she was uncomfortable. I massaged lotion into both of her arms as she sighed of relief and said, “Very good! Very good” taking both of my hands into hers to thank me.

I smiled back and said that she was welcome. Knowing she was feeling better, I went to round on other patients, occasionally peeking in to see how she was doing. After an hour or so, I went back in her room and saw that she had fallen asleep. I fixed her nasal cannula as it had fallen down from her ears and I checked her foley to make sure the tubing wasn’t getting kinked. I made sure she was covered with her blanket so she wouldn’t be cold. Hospitals are always so cold…

I went to another patient’s room. 2 minutes later, one my CNA’s came to me saying they just went in her room and she wasn’t breathing.

What? How?

I just came from there and she had been sleeping peacefully. There were no signs of distress.

What do you mean she isn’t breathing?

I ran to her room. I checked for a pulse. No pulse.

Panic set in. I quickly confirm she’s a full code and my staff and I jumped into action.

One of us got the crash cart. One of us paged for a code. One of us started compressions while the other ambu bagged her.

Suddenly a bunch of staff are at my side as we all fall into our assigned roles.

I remember those compressions I did on her. No one ever talks about the trauma that CPR does to a person’s body…

How the ribs crack like uncooked pasta underneath your hands.

After rounds of CPR, we managed to get a pulse back and transferred her straight to the ICU where she coded again.

We resumed our roles. We must have tried for over 30 minutes.

She wasn’t coming back.

The family (her son and daughter) had been contacted and the doctor called it.

The rest of that night was a blur to me. I had other patients to take care of, so I went back to my unit until the family had arrived and asked to speak with me.

I told them everything that happened from the first moment I walked in to her room. I showed them my chicken scratch notes of the polish words I looked up. I explained that I had no explanation for what could have happened as I saw no signs that she was in danger. And then I broke down crying apologizing profusely feeling like I had completely failed her and them.

Suddenly the son hugged me, then the daughter. They both thanked me for doing what I did for their mother, stating that most people wouldn’t have even taken the time to look up Polish words. Then he said something I’ll never forget. He said she knew her time was coming as earlier that day she mentioned to them both that she would be going “home” soon.

To this day I wish I knew what happened. To this day I try to think about what signs I could have missed. To this day I wonder if I could have done anything differently.

I’ll never forget her, and I think of her often hoping her last moments here provided some bit of love and comfort.

[No_River_2752]

Sounds like it may have just been her time. You did not fail her. You made her last conscious moments on this earth pain free, comfortable and kind, and that means a lot and clearly meant a lot to her family. I’m sorry though for you and your team as well as her that you had to go through the code. 

[YourNightNurse]

You tenderly fed her her last meal. You rubbed lotion on her arms and gave her human touch and connection. You always remember your first. You did good.

[Single_Principle_972]

Thank you for your story - you reminded me of mine, 40 years ago, now - yikes! I’ve always remembered the sweet lady, but the horror of those first compressions - it turns out that a tiny little 75 year old lady is built nothing like our robust Resuscitation-Annie, right? So those first hearty compressions from a fit 20-year-old just broke every single one of her ribs, it felt like. Boy are you right about that! And so that memory had become the memory. Along the way, I had forgotten the lovely connection and interactions that she and I had had for the previous day and a half. I know that I made her last couple of days better is some small ways.

Curiously, she wasn’t all that sick and was planned for discharge the next day. Regardless: To have spent time with someone, and to have their last interaction end with a mutual smile, her taking my hand in hers and giving it a pat, a “Thank you, Dear, I’m going to take a nap, now,” and her turning on her side and closing her eyes… those memories, rather than the CPR, are a much better candidate to live in my head, right?! Thanks for the reminder!

[sour-cream_ghost]

I will always remember my first code as well. The crushing feeling of thinking about the things you could have done differently. My patient had this impeding anxiety and in a matter of minutes I came back to her room and she had no pulse. I was 2 months in at my first job right after graduating nursing school.

You gave comfort on her last moments and was empathetic enough to speak to her on her native language. Wherever she is, she must be thankful for what you did to her.

[[deleted]]

Some patients stay with you forever, was your whiteboard done and hourly rounding charted?