Within the past 20 years, the span of my nursing career, I have occasionally been privileged to be present for things which the textbooks say don’t happen. To tell them in full detail would be a violation of privacy laws. But with minor artistic license and the withholding of certain identifying details I can find a way to share them. This one brings tears to my eyes and warms my heart every time I think of it.
Back when they got married, penicillin was still an experimental drug, significant portions of rural America had not yet received electricity, and hip replacements were unheard-of except in University hospital experiments. The years had battered a toll on their bodies, but though frail in frame their souls were still deeply in love. He brought her to the ER that day because he was scared and his beloved was in pain. Chest pain. The heart that had beat for more than 90 years was in trouble.
ER nurses and doctors work in a protocol-driven dance when such cases present. Seconds are of the essence, and yet we take the time to tell the patient and the family what we are doing and why, so as to allay fears and bring some calm to their frantic arrival. While he gave basic information to the admission clerk we put his wife on a bed, talking gently while we worked.
It was obvious that she was in critical condition, and the monitors and EKG confirmed it. As multiple persons simultaneously initiated a whole bunch of assessment and intervention, I knew there was no time to access medical records to determine if a resuscitation status was on record for this woman. I just asked her as gently as I could: “Your heart is beating very very slowly. That is why you feel weak and are in such pain. The oxygen and medicine will help, but if your heart stops do you want us to shock your chest to try to start it again?” No. “If your heart stops giving you a pulse, do you want us to manually press on your chest for CPR and try to get your heart to start again?” No. “If your breathing stops or if you go unconscious, do you want us to put a tube down your throat into your lungs and breath for you?” No. “You understand, then, that if we did not restart your heart or did not assist your breathing you would die?” Yes– but please help me stop hurting so bad.
The husband arrived and we made space for him at the head of the bed. Her alertness was fading. Morphine was helping the pain. The doctor told him what his wife had said about any resuscitation attempts. He responded, “If it’s time for her to go, and that’s her wishes, then we let her go”. And as she faded he put his face to her ear on that ER pillow, cradled her head in his arms, and whispered little I-Love-You phrases and other things that we could not hear.
I had the atropine in my right hand, the IV line in my left, in the motions of administering, and the monitor went flat-line. No ventricular fibrillation, no ectopic or escape beats, no agonal cardiac rhythm, just flat. It’s called asystole. The final “rhythm” which we document in two different leads before the final pronouncement and the trip to the morgue.
The husband kept whispering sweet somethings in her ear, through his tears. Her rib cage continued a few agonal reflexive breathing motions. I asked the doctor what to do with the Atropine. He said, “Go ahead and push it even though it won’t do any good. We aren’t going to pump her chest to get it to circulate.” And we all knew that while Atropine is the first-line drug for bradycardia, it is not a treatment for asystole. I pushed the medicine into the still-flowing IV line. The husband kept cradling his beloved and whispering in her ear, while we stood by to helplessly watch this ending of things.
But in a little while the monitor started showing some beats. And then a pulse returned. And then she opened her eyes and knew her spouse was with her. Forty five minutes later as she went to a real bed in a hospital room instead of to the morgue, she was sitting up, holding his hand, talking with him, both of them still deeply in love and knowing it.
Never, never underestimate the power of persistent, present, Love.