Tuesday, December 13, 2011

The Message

AJN, American Journal of Nursing:
September 1997 - Volume 97 - Issue 9 - p 52
Lindsay, Carol RN

Her abdomen was rigid. Her skin was so pale it was translucent. As I removed her clothes, I saw her skin was covered with various shades of black, blue, green, and yellow. "How did you get all those bruises?" I asked. "Playing baseball," she whispered. "I like to play baseball."
An unlikely story, I thought, knowing that she had been brought to the ED by ambulance after being hit in the abdomen by her husband. She lay quiet, her eyes closed. She spoke only to respond to direct questions. Her blood pressure was low, her pulse rapid, her veins nonexistent, her breathing labored.
Suddenly, her eyes opened, clear and blue. She observed the room full of physicians and nurses standing over her. "I'm going to die. Tell my kids I love them," she said.
"You're not going to die," I quickly responded. "You're going to get better and then you can tell your kids you love them yourself."
Looking directly at me with desperation she repeated her request. "Tell my kids I love them." Solemnly, I nodded. Her eyes closed.
She did not speak again. Her labored respirations stopped. "Intubate!" the respiratory therapist shouted. "Does she have a pulse?" someone else asked. Hands flew reaching for pulse points. Her pulse was gone. Chest compressions were begun. Drugs were given. "I'm going to crack her chest," the ED physician said, just as the surgeon entered the room. "Let's get her to the OR," he said.
Packs of IV fluids and units of blood flapped against the pole as we raced to the OR. One nurse kneeled on the stretcher performing chest compressions.
We turned our patient over to the OR crew and returned to the ED. There was chaos as the police questioned her husband. "Murderer!" her parents yelled at him. Two little boys sat quietly in a corner, their heads hung low.
We received word from the OR that her heart was beating. They had removed her ruptured spleen. They transfused blood and platelets. Still she bled. She was transferred to intensive care.
Nurses stood over her every second. Blood seeped from her incision and from every IV site. Her nose bled. Blood rolled out of her tear ducts and down her cheeks. For hours she bled. Over 30 units of blood products were transfused. And then her heart stopped.
Leukemia, the lab tech said. Undiagnosed leukemia, the physician said. Probable cause, the police said. Assault with intent, the district attorney said. Murder, her parents said.
To the little boys sitting lost in the corner I said what their mother told me to say. I told them their mother's last words. I said, "Your mother loves you very much."
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