March 2, 2012 will live on forever in my mind as if it were yesterday. That particular Friday had been my third day in a row to work. I had the same patients all three days so I felt that I knew them fairly well. I knew which patients wanted ginger ale with their dinner, what time they wanted to bathe, and how many times I would have to beg a patient to let me give them a Lovenox injection before they would give in. This specific group of four patients were wonderful. As my rule of thumb I try very hard not to pick favorite patients. Sometimes it happens unintentionally but I don’t let that fact be known. Mr. X (as he will be called for the remainder of my story) was one of my unintentional favorites. The day before I sat on his bed as he recalled multiple stories from his time in the war. He also opened up about his one son and how much he loved his grandson. Mr. X had dementia so he quickly forgot that it was his grandson in the room with me or his great grand-daughter playing on the couch. He was always pleasant and so thankful for everything.
That Friday Mr. X had slept most of the morning. This is very common for him as well as many dementia patients. I woke him up for lunch and he ate fairly well. I turned out his lights because he said he was tired. As I was leaving the room he, as always, said “thank you so much,” and I watched him instantly drift off to sleep. I checked on him periodically throughout the day and he always said his usual “thank you” as I left. Around 5:00 that evening a doctor wrote an order to give the patient a now dose of 60 ml Potassium Chloride. For a young patient with a potassium level of 3.4 or even an older patient who was in better condition I would have never questioned the order; but for a 93 year old patient who wasn’t doing well and was in a-fib with a potassium level of 3.8 I questioned it. Everything about the order seemed wrong. I asked the charge nurse what she thought I should do because my gut feeling was don’t give it. She said it was a nursing call that I had to make but that if it was her she would call the manager and the doctor who wrote it to clarify the order. So I did just that. Everyone I spoke with said yes, give him the potassium. I reluctantly poured the potassium over orange juice and woke Mr. X up to give it to him. He swallowed it quickly and drifted back to sleep, but not before saying “thank you.”
I checked on Mr. X quite often after giving that dose of potassium. My gut instinct still told me something was wrong. So I documented everything I had done in his chart. 6:20 PM: I sat at my desk doing chart checks and finalizing some paperwork for the day. I heard the telemetry monitor go off and when I looked at the screen Mr. X’s heart rate was in the 20s. I ran as fast as I could down the hall and saw that he was unresponsive and now asystolic. I immediately began chest compressions and screamed for someone to grab the crash cart and call a code. The only person nearby was a night shift secretary who jumped into action as quickly as she could. We continued CPR until the code team arrived and took over. It was truly heart breaking to watch the nurses push countless medications and do thousands of chest compressions. After about ten minutes the doctor in the room called it. The team left the room and it was just Mr. X and me. I cried. The tears poured out of my eyes and nothing I could do made them stop. I didn’t cry for him because he knew where he was going, but I cried for his family. I cried because I worried that I didn’t make the right decision in giving the potassium the doctor had ordered; but deep down I knew that didn’t cause this. When my rational thinking came back into play I knew it was just his time.
I stayed until 10:00 that night just to make sure the family had everything they needed. The amazing night shift nurses dressed Mr. X in the clothes he brought while I did the paperwork. He looked just as if he was taking a nap. He was peaceful. That night as I was driving home I thought long and hard about the choices I made that day. I know I made the right ones, and I know it was his time to meet our maker. I realized that my gut instinct was telling me something and I now know to always listen to it. That night I went from being an RN to becoming a nurse.