By Giuliana Guarna (c2019). Photo from iStock.

“We have a 90-year-old female DNR coming in from nursing home in respiratory distress. ETA is 2 minutes”

I felt the pressure immediately. I hadn’t witnessed the passing of a patient yet, but I had a feeling that I would not be able to end my shift saying the same. She was wheeled in, visibly air hungry. Her eyes were rolling into the back of her head. She was clutching onto the sheets covering the stretcher for dear life. Her blood pressure was well into the 200’s.

“Push 0.5 mg of Ativan. Let’s get something for blood pressure”

Her sats began to drop. First into the 80’s, then into the 70’s.

The nurse was ready to push the BP meds. The doctor stopped him. “Take off her mask. Push another 0.5 mg of Ativan, let’s make her comfortable”

We removed her mask and wheeled her into a private room off to the side. No family was around. We couldn’t get a hold of them, voicemails were left. We gave her a warm blanket.

“Ok,” my staff turned to look at me, “She is your patient for tonight.”

I returned to the room. I held her hand. I checked her pulse – thready, slow, and weak. Her breathing was sharp and shallow, barely 5 times a minute. I brushed her hair to the side. I told her I was there. I stepped out for a moment to ask the nurses what to do. I stepped back in, checking on her again, everything was slower still. I stepped out once more.

I came back. No pulse, no signs of breathing. I placed my stethoscope to her chest. Silence greeted me. My staff walked in. He wheeled the POCUS to her side, checking to make sure that there was no cardiac activity.

“Time of death, 21:21”

The tears spilled out of me. I held her hand and wiped my tears.

“Take all the time you need.”

I wept by her side. I brushed her hair back, I stroked her hand. One of the nurses I was on with walked in – “Do you mind if I pray for her?”

I gave her a nod. She grabbed Mrs. B’s hand and began to pray, honouring the life that she had led. She gave me a hug as she left, leaving me to collect myself before walking back into Zone 1, where the sickest people in the department were waiting for us. I took a deep breath and stepped back into the chaos.