August 19, 1998

I went to work last night on I.C.U.-it seemed like any other night except "we" were 2 nurses and we had 1 patient. Of course, we would NEVER complain...you never speak the "Q____" word...these kind of nights are rare!! Janet, my co-worker, decided to take the patient, and that left me the telemetry to watch. Our I.C.U. is a bit old fashioned in that the telemetry monitors for the Step-Down telemetry unit are housed on I.C.U. and we look after them, calling them (5C) if there is any questionable rhythms or problems going on. I would be that nurse on "the watch" last night. As I settled in, I checked over what each patient on telemetry had been doing during the previous shift, and I looked to identify the "DNR's" - folks that would not have us do a "code" if they took a worse turn. That is where I found Mrs. Smith (her name is, of course, changed).

I Watched A Dying Heart Last Night.....

Her rhythm didn't initially look much different than it had for the last couple weeks, while she had bounced between I.C.U. and Telemetry. Her ST segments were elevated (indicative of all the damage her old MI's had done). Her problems would get bad and she would be on I.C.U., then she'd improve and be on telemetry...but then she'd get bad again and come back. I'd taken care of her many nights and knew her face well now, even though all I was seeing was a line on a monitor.

At one point, a few days ago, the doctor had talked to the family, explaining to them that she probably would not get better, and asked just how far they "wanted us to go", if she took a bad turn. Her family considered her poor state of health, her cancer, and her age (92) and decided to make her a "DNR"...definately a difficult, but kind and loving decision for this sweet, but confused and very very sick lady.

I Watched A Dying Heart Last Night.....



Suddenly, the alarms rang out on her monitor, letting me know she was having a "problem". Her heart rate was low, her "P" waves were now non-existant, and her QRS had taken on a wide, slow look that I had seen many times before in the course of my being a critical care nurse. But this was Mrs. Smith's moment.....

I Watched A Dying Heart Last Night.....



Some of the changes her heart went into began to make me believe perhaps there was something "medical" we could do for her, if the doctor would allow..but then it became obvious this was the beginning of the final act of the play this tragic pump would move in.

I Watched A Dying Heart Last Night.....





I Watched A Dying Heart Last Night.....



I let Janet know what was going on, and I talked to Debbie, the nursing supervisor, to be sure she was aware of the drama taking place. This was not an unexpected event....basically, we all had felt at one time or another, that it would be a blessing for this little lady to finally have her rest. I contacted 5C to be sure her family had been called in case they wanted to come in.

I Watched A Dying Heart Last Night.....



My job now, would be to document this life event. As I sat down to watch and record, I started to think about this lady and the times I had cared for her in the last couple weeks.

I Watched A Dying Heart Last Night.....

I thought about what she had told me of her life. Working night shift, I often have the unique opportunitity to "chat" with my patients, when they cannot sleep, and at times like this, I really appreciate that. I thought about how she had married young - the one man she ever loved had died almost 20 years ago. Now, it appeared, she was finally joining him. I thought about her children and grandchildren, grateful for those who had been in to see her and had helped the acceptence of her end time to come easy. I began espically thinking about her one son who had not been in...did he know? Quickly, I called 5C to be sure they had called him.

I Watched A Dying Heart Last Night.....



I couldn't help but smile a bit when I wondered what Mrs. Smith must be feeling right then. Her pain, very probably, was gone at this point. I checked and she was in no distress. I looked at the monitor...


.....and I saw a heart that was 92 years tired and had decided it was time to stop. She would be weary no more, she would be lonely for her lost love no more, there would be no more pain.

I watched as this tragic pump slowed down to a crawl. I remembered Mrs. Smith's tired, often pain-engulfed face and her wrinkled hands. I remembered how her hands felt, as I had held them, on occasion, during the bad times. I remembered that this dying heart was MORE than just a line on a piece of graph paper - she was a lady and she had a life and people who loved her and would miss her. I didn't want to forget that for one minute of the time I was privledged to share in this event. I don't ever want to forget.

I Watched A Dying Heart Last Night.....



Finally, it appeared we were getting close, and I felt myself getting just a little anxious about the process. One struggling little beat would appear here and there, but was it really a beat? I talked to Debbie, my supervisor, and we agreed that she was probably in P.E.A. (her heart was giving off electrical energy, but not really beating), but I should leave her on the monitor and try to get an asystolic strip for the chart. Just as I was thinking to myself that this could go on all night, I realized the line had gone flat...

I Watched A Dying Heart Last Night.....



I closed my eyes for a few seconds and remembered Mrs. Smith one last time. Then I wished her well on her journey to find her long lost love. I got up from the desk and went for a short walk to assimulate my thoughts, then returned feeling grateful that it had been a "Quiet" night and I could really involve myself in this passing.

I Watched A Dying Heart Last Night.....

Drop Vee a line with your comments, suggestions, and thoughts
by clicking on the heart below!!!!