What The Hell Happened?

It was a horrible night to be charge nurse. Everything was going wrong. Two patients' family members needed to vent and I had to listen and try to appease them. A coworker was upset because she was assigned to a difficult patient. I explained several times that we have to take turns taking care of people like that and it was her turn. She griped all evening. Two patients fell. Two patients were admitted with pressure ulcers, which creates a ton of work. We had two float nurses who didn't know how to do the ortho stuff and needed constant help. Some idiot threw out a box of chocolates because she didn't know there was a second layer on the bottom.

It was just one thing after another and then it happened. A float nurse needed help infusing drain blood into a patient, so I went into the patient's room with her. The first thing that struck me was that the patient was dead. His face was blue, his mouth was gaped completely open, his eyes were half-open, staring at nothing and I couldn't see his chest moving.

This was not someone we were expecting to die. He wasn't that old and had just had elective joint replacement surgery. It puzzled me that his nurse didn't seem to notice anything was wrong. I placed my hand on his chest just to make sure he wasn't breathing before I called a code. The patient jolted awake. I jolted too.

We put him on oxygen and quickly, he turned pink. He was alert and oriented and seemed fine. I figured that he was just one of those people who look like they're dead when they're sleeping. I left him in the care of his nurse and didn't intervene. I think I made a major mistake.

The next morning he was found dead. A code was called and they sort of revived him, but he's in a coma and breathing on a vent. His prognosis is poor. No one knows what happened to him. Maybe he had a stroke or a heart attack, but none of the tests really support either theory.

I think I know what happened to him. He was on a low dose morphine pump and may have had an unusually low drug tolerance. The morphine may have caused him to stop breathing. If a patient gets enough morphine to interfere with breathing, they can't be easily aroused from sleep, but perhaps he was an exception.

My instincts told me there was something terribly wrong. I could have changed the rate of the morphine. I could have called the anesthesiologist. Instead, I decided that I was mistaken about the patient's condition, let his nurse continue to take care of him and continued to fight charge nurse battles. Now, I'm battling my conscience.