Until the Last Drop
- Cristine
- Feb 9
- 7 min read
Working in healthcare is not for the faint of heart. From seeing turds of all different consistencies to pukes of various colors, it is quite impressive to see what the human body can produce. If you've ever eaten a meal with a group of healthcare workers, do not be surprised of the not-so-pleasant discussions they may be having at the table. Yet, despite such distasteful visuals, there are a bunch of us still going to work everyday to care for people, with respect and dignity.
One of the popular bodily fluids a health care professional needs to be comfortable with is one that is essential for our very existence: blood. In fact, when doing blood draws, I often have patients or their family members making statements such as: "Oh I couldn't be a nurse, I can't stand the sight of blood", or "Oh I can't look". And I don't blame them. I mean, blood is supposed to stay within your body.
For those that know me, at the workplace, I relatively have a calm demeanor. In emergency situations, I generally intervene silently and let only the necessary members of the team be notified. If I am scurrying back and forth from the equipment or medication room to a patient's room silently, it is because the patient is not doing so well. The adrenaline that rushes through my veins stimulates my "fight" response, enabling to me to do whatever task is necessary to stabilize the patient. Concealing such heightened emotions is a trait of mine I have come to recognize and be thankful for. I would be lying to you if I said I never felt nervous. That is up until this past week ...
Mr. K. was a Syrian man who was admitted to the palliative care home I work at a few months ago. When my colleagues and I first heard about his case, the same sentiment was felt amongst us: fear. You see, according to his medical records, a few weeks prior to his admission, Mr. K. walked himself to the ER with his hands applying tight pressure to the left side of his neck. It was stated that Mr. K. was bleeding profusely under the area, which led to the initiation of a massive transfusion protocol.
But wait Cristine, was he shot? Was he stabbed? Why is this man hemorrhaging from his neck?
Mr. K. had a cancerous mass in the tissues of his neck.
Having malignant tumors around such area poses huge health risks for two reasons:
As we have seen, there is a risk of a fatal massive hemorrhage due to the vasculature of the neck (especially the carotid arteries that supply blood to the brain), and the hyper-permeability and friability of cancerous lesions.
The risk of airway obstruction due to the fast growth of the mass near his trachea (windpipe).
When he first came into the home, Mr. K. had what resembled a tracheostomy. However, it was unlike anything I had seen in the hospital setting. Given the cancer's invasion to the left side of his neck, his windpipe was deviated to the right. He had a bulky dressing that covered most of the affected area, and a cone-like device that attached to his trachea (which was visible to the naked eye). I never asked but assumed it was used to ensure patency of his airway from the tumors and possible fluids that may leak into it.
Despite this clinical presentation, Mr. K. was up and about, wearing black long-sleeves and polo shirts to hide his wound. He mouthed words as he was unable to utter his voice. He was quiet and reserved, doing everything but his dressing changes independently. During the fall, he enjoyed taking his daily walks outside of the home. When he initially expressed the desire to be outside, I remember the staff feeling uncomfortable for his safety. Given the high risk of bleeding, being on unsupervised premises could ultimately lead to his death. He, however, accepted those risks, and signed a waiver.
The first time I truly interacted with him was when a colleague of mine required another set of hands to perform the famous change of dressing. It was the first time I saw his neck unraveled. To be honest, I was not repulsed but quite stunned by how the lesions looked.
Unlike Mr. K.'s tranquil nature, the wound to his neck was a ravaging sight. Cancer ate away at his flesh, causing not only his trachea to be exposed, but also neck muscles, tendons and blood vessels. It also had a smell that clearly indicated presence of an infection. He was not only on oral antibiotics; pills of Flagyl (antifungal) and Cyklokapron (antifibrinolyitc) needed to be crushed and sprinkled on his wound. So, with much delicacy and attention, my colleague and I covered his neck as ordered.
As we finished the dressing, Mr. K. took a mirror and inspected our work. He gave a nod of approval and then proceeded to reattach what appeared to be an obturator. He grabbed specific tools to perform it on himself but struggled as the opening to cover was much smaller than a dime. I offered to do it for him. I followed his instructions and clicked the obturator down to his "trachea". It felt weird, but Mr. K. was pleased. I nervously laughed and gave him a high-five before leaving his room. Mr. K. never failed to show patience and gratitude to us.
This week, during my first night shift out of three, I was assigned Mr. K. Other than administering his regular painkiller at 2 am, Mr. K's nights were usually uneventful. When the clock hit 2, I gathered the Morphine and woke him up gently. As it was given subcutaneously (under fatty tissue) through a catheter on his upper arm, Mr. K. rolled up his black sleeves, giving me access to inject the pain reliever. He mouthed thank you and returned to bed.
At 06:30am, Mr. K.'s call bell went off. The patient attendant stated, "That's weird, he usually doesn't call at this time." Not thinking much of it, I headed towards his room. Mr. K. was sitting at the edge of his bed, clasping at his neck with blood spatter on the floor and the cone-like trach device out of his neck. "Oh shit ..." I thought to myself. Mr. K. was applying pressure with a bunch of red-tainted tissues. I quickly grabbed gloves and a dark colored towel from his closet and applied even more pressure to the site. I attempt to reinsert the device back in place with my blood-soaked gloves. As I look around the room, I noticed the blood on his sheets, the side rails, the night table and his air humidifier. I asked Mr. K. if he was in pain, he gestured no. I asked Mr. K. if he was capable of holding the towel for a bit while I go seek help. He did so.
Although Mr. K.'s call bell was still on, no one was at the nursing station. With my two other colleagues occupied, I sprinted to the medication room fridge and grabbed Mr. K's pre-made distress protocol in case of severe bleeding: Versed 15mg, Morphine 10mg and Scopolamine 0.4mg. A sedative, a pain killer and an agent used to prevent the "death rattle". I ran back to Mr. K. while whisper-shouting the names of my colleagues in the halls. I gave the medications and asked Mr. K. if he had pain. He continued to deny discomfort and looked calm and collected.
After giving the distress protocol, my colleague appeared at the door and without a word, offered us the help needed. We brought Mr. K. to the recliner chair, and cleaned, as best as we could, the surrounding environment. As the medications started to kick in, Mr. K. became more lethargic. With a decreased level of consciousness, my colleague and I took off his black long sleeve. It felt heavier than I initially thought it would. The color of his clothes hid the severity of his bleed. Once his clothes were off, blood dripped nonstop onto his chest and stomach. My colleague offered to apply pressure while I went to retrieve the tools necessary for his dressing change.
Once I returned to the room, my colleague began peeling the old dressing slowly, but quickly put it back into place. She told me that it would be best to have all necessary equipment open and ready to use as the area is fragile. I proceed to do as she suggested and we switch sides. As I began to undo the previous dressing, I saw blood begin to trickle down his back and onto the chair. I rushed to peel off the old bandages in order to place new ones, but coagulated blood made it difficult to do so smoothly. We weren't sure if fibers of the old gauzes or if human tissues were being pulled during the removal. Once off, 3-4 abdominal pads were placed in attempts to contain the bleeding. With pressure still on the site, we tried to wipe away the blood remaining on his body as best as we could.
By the time the wound was covered, the day shift team made their way into the room. My night shift colleague took a moment, stared into my eyes and asked me: "Cristine, are you okay?". There was a brief silence. I looked up at Mr. K., now fully sedated. His skin tone began to lose its color, his lips began to have a blueish tint. I sobbed, uncontrollably. While still applying pressure to the left side of his neck, my eyes filled with my own tears. My colleague then called in the day shift nurse to take over my place.
Once I stepped out of the room, I noticed my hands were frantically quivering. I was in shock. I have seen many individuals pass during my career. But, there is something about seeing someone bleed until the very last drop ...
Sleeping after such a shift was difficult. My mind wandered. My emotions were still processing. I was at a loss of words and thought. The only place I thought of going to reclaim solace was at church. Although Mr. K. was not. a religious man, he had stated that he did not fear death anymore. The only thing he was scared of was the torment that he could feel during his final hours. And so I prayed for his peace and hoped I did him justice.
Mr. K. passed away 63 hours later, in bed with his beloved daughter by his side.
Your kindness and cool composure will never be forgotten.
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