Patient Seven (goodbye)- My Account Of My First Patient Death

RUTH STOIA –

Many medical professionals will tell you that you will never forget the first time one of your patients passed away. It is said that without that experience, you will not be able to truly embrace the wholeness of medicine. Where there is life, there is also death, and sometimes medicine cannot save even the strongest. Due to HIPPA laws, I cannot disclose any personal details about the patient, so we will call him Patient Seven. I chose this since the letter “g” is the seventh letter of the alphabet. In the word “goodbye,” there are seven letters. Here is the story of the first time I had to say goodbye in the healthcare world.

It was late December, and I picked up extra shifts after my fall semester. I work as a patient care technician (PCT) back home at a hospital. I woke up as usual for work, 5:30 AM, and was out the door by 6:00 AM. It was especially chilly that day, and I remember having a hint of annoyance because of it. 6:40 AM I had parked in the parking garage, and had just sat there for a moment, honestly just trying to wake up. 6:45 I clocked in and reported to the house coordinators office where I was given my assignment. Being in the float pool requires you to be all over the hospital; if a floor tech called out, or night shift had a particularly hard night on a specific floor, I am to report there, so there really is no “home floor.” Nevertheless, I turned the door handle to the office and checked the report sheet. Scribbled in fresh pen ink were the words “Ruth Stoia – Float Pool PCT – 9T.” I was shocked for a moment, I had never reported to that floor until that day and it had piqued my interest. 9T stands for 9 tower, which is considered our cardiac step down floor. As I was walking over to the elevators my mind was running through different procedures and interventions: what to do during a code, how to suspect a rapid call, different arrhythmias, anything that had come to mind that regarded cardiac knowledge. The elevator bell rang signifying I had reached 9T. I walked over to the unit secretary’s desk and picked up my assignment. That day, I had four hyper-acuity patients—patients that need more attention as they are at higher risk. Immediately as my shift commenced at 7:10, patients were coming off and on the floor. December is one of the busiest months of the year, with back-to-back holidays and end-of-year surgeries or appointments, so I wasn’t completely surprised, but knew I had to double down on Celcius during my lunch break. It reached 9:00 AM out of what seems like nowhere, and I had been occupied with my patients, assisting other nurses with their patients, and preparing patients for procedures. At around 12:00 PM it started to calm down a bit, and I strolled back on the floor from my lunch. So far, all my patients were alive, and I had finally put food in my stomach. I like to sit down and talk with my patients when I can, and when it doesn’t impede my other tasks. So when I had some time, I spoke a few words with my German dementia patient, spoke with my other patient’s wife about Paris Fashion Week, and bonded with one of the nurses on the floor. 1:00 PM hit, and it had started to get intense. I was running back and forth again, and kept up with all of my tasks.  It had reached about 5:00 PM, so I was about ten hours into my twelve-hour shift. I remember being exhausted and ready for the shift to be over. It’s that point in the shift that you are so ready to call it a day and cannot physically comprehend another 2.5 hour stay. A fellow PCT came over and asked me to tend to her patient, as she had been busy with her caseload. “Of course, I don’t mind!” I replied. I adjusted my badge, tied my shoes to fit a little better, and walked over to Patient Seven’s door and knocked.

“Come in.” Inside was an elderly man in his late 80s. I remember walking in and hearing the heparin drip beep in a staccato rhythm, signifying his round of it was done. I had to mind the large bi-pap machine in the corner. All down both of his arms were multiple IV puncture sites, whether they were in use, or were failed sites. The curtains were half closed, with the cold white light from the December atmosphere outside trying to peek through. He was surrounded by four family members, all of which wore expressions of anxiety. “Hello there Patient Seven, my name is Ruth and I’ll be stepping in for your PCT for the moment!” I tried to throw a smile towards the family, with a couple of half smiles being reciprocated. I felt the tension when I stepped into the room, but it had become more evident as I stayed longer. I scanned my badge into the monitor, and the silence of the room had made me a little more aware of my surroundings. On the counter next to me lay a card with a scrawled “Merry Christmas” in green crayon, probably from a grandchild. I had progressed through the vitals as normal: heart rate, blood pressure, blood sugar, temperature, respirations, and oxygen level. I tried to make conversation, but he was quiet, lethargic even. I had asked him how he was feeling, and how his day had been going, and his grey eyes with a twinge of blue looked up at me as his lips uttered a soft response. He had told me he had no pain, and that his day was ok. He had enjoyed the dessert from dinner an hour prior. I knew he was weak, so I didn’t try to press for more conversation than he was willing to engage in. I started to count his respirations, and I realized something about his breathing When I was in school getting my CNA license, we learned about a certain presentation common in patients who are reaching the end. It is called Cheyne Stokes breathing, where the patient presents with an abnormal breathing pattern: there are cycles of heavy, deep breathing followed by shallow breaths, and then are followed by periods of apnea (no breathing at all). I continued to listen for a minute for any kind of consistent respiration, trying to hear something I wanted to hear, but I was faced with a more daunting realization. I had heard Cheyne Stokes before on an audio track, and had recognized the same pattern. I took a good look at him. His eyes looked distant, his white hair wisped on the right, and his hands looked as if they were carved of white marble with crimson streaks running through. I finished charting his vitals, and decided to stay with him a while. His family had already left the room and were headed home to prepare for palliative care, leaving him alone. I was not completely shocked when I was told Patient Seven opted for palliative care, but part of me still rang with dismay. I had spoken to his nurse later who had told me that he had a major heart attack at a different hospital, and had come here for treatment but there was nothing we could do.

“How are you feeling, sir?” “I’m just fine, I’m ok.” 

“It’s a bit cold here. Would you like me to adjust the temperature?” “No, ma’am, I feel fine.”

This was one of the last interactions I had with him. I left the room and told the nurse about the subtle signs I noticed in his breathing, and she confirmed my theory. I went back into the room and stayed with him a little longer until the EMTs came to transport him back to his daughter’s home, where he would be staying. Again, he didn’t speak much, but there was character in his subtlety. I had gone in to help prepare him for discharge, and he was half-heartedly laughing at one point; I think I had made some kind of joke with the nurse. His laugh seemed familiar. That same laugh I had heard from my own grandfather, a deep and loving laugh. I had paused mentally for a minute and realized that this man was a family man. He knew he was loved, and wanted to pass on that love to others. His laugh resounded from ear to ear and I could not help but be reminded of my own family back home. We had dressed him in his clothes from home, taking the process very slowly.

The moment came for the EMT’s to take him away. I heard the wheels rolling through the halls before it had reached the doors. Two men dressed in black with neon vests knocked on the door announcing their arrival. I had this sick feeling in my stomach that something was not right. I pushed aside the feeling and opened the doors, helped secure the transport bed, and right before I stepped aside, Patient Seven uttered softly, “I am cold.”

 Without hesitation I bolted for our clean supply room, and reached for the two backmost blankets in our warmer. I came back and ensured that every part of him was wrapped in warmth. Now, here is the part that I will never forget. He looked me in my eyes, and with the bit of energy he had left, he tried to smile. All sound slowly faded out, and my vision almost went in slow motion. That smile pierced through some kind of spiritual air in that hallway. I felt this extraordinary feeling as the EMTs rolled him down the hallway. I stood in the hallway for a moment, and remembered the squeaking of one of the EMTs shoes, the one discolored wheel on the gurney, and the wisp of my patient’s hair slowly moving away from me. I didn’t want to blink. I watched as he was being taken, and once he turned the corner, a tear I did not know that had formed slowly came down my face. Later that night, Patient Seven passed away. 

This may not be the most enthralling story of how I lost a patient during a messy code, or how I had a patient collapse in front of me, or a dramatic death of some sort, but I consider it to be my first witness of death. The moment the EMTs had stood in the doorway, I had felt that death itself had approached the door and beckoned for the life that lay inside. It was an eerie kind of peace that had seduced the air of the hallway, and made time stop. 7:00 PM approached, I gave my report and clocked out. I stepped outside of the hospital and the cold air sharply stung my face and the wind pushed my welled tears out. I hoped the blankets for Patient Seven were enough. The second my car door closed behind me, I cried. 

My whole life I had heard of cool surgeries and diagnoses from textbooks, conversation, or lecture, but coming face to face with the brutality of medicine was something no textbook or lecture could have taught me to deal with or handle. Human life has a beginning and end. Medicine ensures that we live that time in between to the fullest, to the healthiest, so that even when we pass, a strong and healthy legacy is left behind. Patient Seven grew my love for medicine in a heartbreaking way, but in a way that was needed in order to proceed in solidifying my decision to stay on this healthcare path. 

Thank you Patient Seven. 

Copy Editor – Elizabeth Vaitl

Photography Source – https://www.sermo.com/blog/insights/doctors-dealing-death/