Death in the Emergency Room happens quickly. It's often surrounded by adrenaline and guided by protocols and teamwork that step-by-step march out the battle plan against the Grim Reaper. Sometimes we win, sometimes we lose - but we fight for our patients for as long as we possibly can.
Had an assignment in our ED Obs unit last night, a patient whom family had withdrawn care from per patient's advanced directive and there were no ICU beds. We were mostly empty so ... we offered a space.
Patient came over at 0030, and we extubated at 0055. For the next seven hours I stood vigil over them as I titrated drips that would help ease their crossing. The patient was young, so we assumed that they would have a few days fight in them post-extubation ...
The night reminded me that a patient's death isn't always a drop kick battle with the Reaper. Sometimes it's a bedside vigil with the family, listening to the life of the patient before you and trying to present the rather... scary but natural processes that come at end of life.
I've lost many patients. I'm well aquainted with Death - She's a well respected rival of mine ... but I'm used to it being a battle.
This was different. This was a night with a patient and family where there wasn't anything I could do but... just wait until Death showed up. I felt incredibly helpless. Still do. It's not my instinct to stand back and forfeit the fight.
They passed at shift change, right during report - as if Death herself decided to take over.
I still commend the family for doing the most beloved and honored thing you could do for a loved one at the end but ... that was a rough shift.