Going, Going, Gone by Paul Curran

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Paul head shot 2

“Hi, my name is Paul.”

“Hey Paul, I’m Bernard.”

“I’ve never seen you here before Bernard, are you new?”

“This is my first time. I came in through Emergency. They did some tests and found my kidneys had shut down so they sent me here to dialysis.”

“Well welcome. I’ve been a patient here for 8 years now. You’re safe here. They are excellent.”

I was lying in the dialysis unit in bed #17. Bernard had just arrived by stretcher and was in bed #18 – at the end of the bay of 6 and the closest position to the nursing station – a statement of their concern. 

This large room with smaller open ended rooms called bays attached was not originally designed for dialysis. As a result the positions – each one with a machine hooked into the water supply, the data lines, generator protected electrical supply – were jammed close together, the patients about 36 inches apart. In the center of the large room sat the nursing station – actually 5 computers for nurses, the Lead Nurse position, and two administrative positions with the attending electronics and supplies.

Bernard had just come from Interventional Radiology (IR) where they had spent ½ hour installing a plastic catheter high on his chest that accessed his jugular. This gave them the ability to remove, clean and return large quantities of blood as it had a high flow returning to the heart from the cranium. That access to the circulatory system is one of the key aspects of dialysis.

The nurses flocked around him as they hooked him up to the machine and gave him the short explanation of what they were doing. Typically patient training was a year long process involving modules of learning that were covered by different specialists. But when a patient came in through Emerg it was just a talk as you go process – if the patient was aware and alert, and Bernard was. He seemed to be an otherwise healthy 40 year old. A new patient got a lot of attention.

The dialysis machines are designed to be ultra sensitive to any changes in pressure or conditions of any sort and they alarm with each issue. Typically I get about 10-15 alarms through a regular treatment. Doing a treatment without an alarm was a rare occurrence. The first time his machine began to beep, I explained this to Bernard – trying to alleviate his concerns. 

After about 15 minutes, Bernard’s family arrived – his father, his younger brother, and his wife with their two children, a girl about 13 and a boy about 11. They surrounded his bed and it was evident that they had arrived from a rural Quebec community, speaking in French about the long trip to the hospital. After some discussion, the family announced that they would go down to the cafeteria to get some supper and would come back when they were done – the treatment being 4 hours of normally boring duration.

With the position lights out so we could sleep, we settled in. Bernard’s machine alarmed a few times when he rolled over or coughed but the nurses were watching closely and dealt with it immediately. 

About 30 minutes later I was watching TV and Bernard was lying unmoving with his eyes closed when his machine alarmed. A nurse was there quickly and she felt his neck for his pulse. The machines would sometimes give incorrect readings and I couldn’t see his control screen from my station – I assume it indicated a low heart rate. After a few seconds of immobility the nurse bellowed:

“Help! Help! I need help over here!”

About six nurses came running as the original nurse explained:

“He has no pulse. I’m starting CPR!” and she jumped on the bed and straddled Bernard, starting chest compressions. Another nurse arrived with a ventilator bag and placing it over his face began to simulate breathing.

In a few seconds, with some trigger I didn’t catch, the original nurse yelled:

“Call a Code!”

A few seconds later the hospital PA system echoed with

“CODE BLUE DIALYSIS! CODE BLUE DIALYSIS!”

Then in French:

“CODE BLUE DIALYSE ! CODE BLUE DIALYSE!”

And then repeated :

“CODE BLUE DIALYSIS! CODE BLUE DIALYSIS!”

“CODE BLUE DIALYSE ! CODE BLUE DIALYSE !”

At this point, one nurse pulled the privacy drapes around the bed and I heard the Lead Nurse, who had arrived after the CPR had started, say,”Bruno. You’re the timekeeper –get the book.” 

Bruno ran to the nursing station and returned with a ledger and a pen. He started and through-out the process, he could be heard announcing each entry accompanied by a time, documenting every step they took, who took it, and what happened.

Portable equipment, including the defibrillator, was rolled to the bedside and within a few minutes, the Code Team ran into the Unit. There were six team members – all doctors and residents of different specialties.

I could hear the lead doctor take charge as he spat orders, injecting stimulant into Bernard’s heart, continuing CPR, debating an open heart massage. An abdominal probe discerned that it was distended and hard. 

The doctor had CPR stopped when he detected a heart beat and for a few seconds Bernard’s heart was on its own, beating once more – then it faded to silence and CPR was restarted. This happened three times and each time everyone held their breath waiting to see what his heart would do –and each time his heart faded again. Then it no longer started any more. After about 15 minutes the Lead Doctor said loudly:

« Stop ! »

And all activity ceased. He continued, “We are going to stop all treatment for two minutes. Does anyone have any ideas or suggestions ? I have run out of options to try.”

There was silence except for Bruno, the scribe. “Treatment stopped by Dr. Goshen. Suggestions requested Time : 20 :34.”

Then total silence for another minute and a half.

Once again the lead Doctor spoke, “I’m calling it. Time of death 20 :36. Everyone please stand back from the body. Leave everything exactly as it is, even the garbage on the floor. Just pickup any unused medication for removal. The Medical Examiner will want to see everything along with the record.”

And Bruno’s last entry : “Time of death 20 :36. All materials except unused medication left in place for the Medical Examiner. Code Team exits.Time : 20 :37.”

With the privacy drapes pulled a nurse was put on guard to prevent anyone entering until the Medical Examiner arrived.

Bernard was gone – just his body left surrounded by idle equipment , discarded packaging and the evidence of an heroic attempt to save his life.

I could hear the Code Lead Doctor talking to the Lead Nurse and replying to her question as to what had happened. He thought that the distended abdomen indicated internal bleeding – likely an anurysm that ruptured with the dialysis pressure. The autopsy would tell the story. 

He could not have gotten treatment any better, faster or more efficiently – the cause of death was one that could not be stopped once started. 

No one was to blame.

At that point I heard the guard nurse speaking, “I’m sorry, you can’t go in there.”

“My husband is in there I demand to know what is happening !”

Oh My God, the family. They had returned from supper and in all the urgency, no one had gone to tell them in the cafeteria.

The Lead Nurse hurried over. “Can we talk over here please.”

“No, I want to know what is happening to my husband, I’m going in there.”

“I’m sorry you can’t.”

“Get out of her way,” I heard the father say.

They pushed through the curtains followed by the Lead Nurse.

“Please, let me explain…”

Then the screams « BERNARD ! BERNARD ! OH GOD, BERNARD ! »

With everyone’s confusion, the children were forgotten and they followed the adults through the curtain to where their dead father lay.

Now the father and brother’s voices could be heard.

“He was alive when he came in here.” 

“He was fine until you started treating him.”

“He’d still be alive if we hadn’t come here.”

“We’re suing you and the hospital for killing him.”

And then, with a sob, “We only went for supper and now he’s dead.” More sobbing in multiple voices…

And then the children’s voices – not accepting it : 

“Dad ? Dad ? Say something please Dad . You’re scaring us. Please say something Dad.” Now begging. 

I felt the tears start to roll down my cheeks at the sound of their small pleading voices. Jesus, the kids shouldn’t have to find out this way.

A grief counselor appeared and between her and the nurses, they convinced the family to go to the board room to talk. They disappeared and all was quiet – just the occasional beeping of the dialysis machines and the silent presence of the Bernard’s body just 36 inches away – a man who I had chatted with just a short time ago ; a man who came for treatment and now was leaving in a body bag ; a man who I had told he was safe ; a man with a young family ; a man who had left this world 40 years sooner than most, in the prime of his life.

The thing about this experience that struck me was that the patient got immediate attention, perfect treatment, the full resources of a huge acute care hospital with bedside x-rays, ultrasound, ECG, etc. , and a list of specialists that can only be had at a large hospital. Absolutely no stone was left unturned and all delivered within minutes – treatment started in seconds. The system worked absolutely perfectly – the result of centuries of medical experience and training and betterment. And yet he died. There was no one to blame, no what ifs, no maybe’s, no hindsight – it was all done perfect the first time and in record time.

Even so, the attending nurse who was assigned to the patient had a breakdown and was out for 3 months on psych leave. She believed that something she had done must have caused his demise and she wouldn’t listen to those who told her she had been perfect…

Paul does not really have a blog, or I would direct you to it. He does, however, guest post all over the place including at Willow Dot, Mark Bialczak, and Cordelia’s Mom. He is often seen commenting around here and you should know that typically his comments are often better than my posts…. 😉
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82 thoughts on “Going, Going, Gone by Paul Curran

    • It was eye-opening CM. I’ve seen people die before -in accidents and of illnesses and of old age- but never alive and well one minute and dead the next with no evident cause and despite all efforts. We often labor under the mistaken assumption that we have control over our lives – commonly communicated with phrases like: “You will only be what you make of yourself” The truth is much more complex. Thanks so much for visiting and commenting today.

      Liked by 2 people

      • At one point, my husband was in the ER for tachycardia. A recently hired resident gave him medication to slow his heartbeat down, but gave him way too much. I watched at the EKG became slower and slower – when it got down to about 20 (or maybe it was 18, who can remember?), the crash cart was brought in. One of the nurses realized I was still in the room and suggested I leave, which I did. I went out into the parking lot and cried.

        I eventually went back in, expecting to find my husband’s body covered by a sheet, but he was sitting up in bed doing just fine.

        I never, ever want to go through something like that again. My heart goes out to that poor family in your story.

        Liked by 2 people

    • Thanks Gibber. Yeah, I was still working at the time (dialysis was in the evening) and I was profoundly sad for some time after this occurrence – noticed by my colleagues. When they asked why I was down, it was surreal to explain that a man in his prime had died 3 feet from me with no advanced warning. Just dropped dead. It was hard on me, and I was only an observer. The effect on the medical staff was orders of magnitude greater. As I mentioned, the nurse who was in charge of that patient had a breakdown.

      Liked by 3 people

      • It’s so very sad. I can imagine that nurse would have after something like that. I used to be a care aid and when I had my first client die while I was there. My boss told me to go home after. I thought I was fine until I started driving home and by the time I got home I was a mess. It was nothing I did this client was had terminal cancer and was home to die but like you said, one min. she was talking and walking around and full of energy and the next she just laid on the bed and died. Her Husband kept asking me, “Is she gone?” Over and over and I couldn’t as a care aid make that call. I’m sorry for what you went through. I’m sure Victo has seen her share too, right Victo?

        Liked by 3 people

      • I have. Lots and lots of death. But generally speaking, it is an honor to get to minister to human beings at the end of their life. I would love to do hospice work if I ever decide that I am done with family medicine.

        Liked by 3 people

      • I agree it is an honour but we really have to look after ourselves in it too I believe. I don’t know if you’ve found this but I have noticed that dying people are the kindest people.

        Liked by 2 people

  1. WOW! This is an amazing post. My mom underwent dialysis for twelve years before her death following a kidney transplant. She suffered a pulmonary embolism and was taken off life support. I was not present when she died, and always wondered if something else could have been done, or if my relatives took her off life support too soon. This story helps me accept that she would have died no matter what. It is reassuring, oddly, although I am sorry for Bernard and his family.

    Liked by 4 people

    • Hey Cardamone 5! Thanks so much for dropping by with a comment. Pulmonary Embolisms are a job hazard when you are a dialysis patient. When a blood clot passes through through the lungs, I was told the probability of mortality is about 20% per occurrence. I’ve had this happen twice and I survived -just by luck. And that was after treatment for DVT and a regime of blood thinners. I am sad for your Mom’s passing and you have my condolences. Dialysis s not for the faint of heart (literally and figuratively).

      Liked by 1 person

    • Thank you Bee Happee. That article is a good overview of the process.Thanks for sharing it. Indeed we see life from the perspective of life and define death as simply the absence of life. It is so much more than that.

      Liked by 2 people

  2. Having had my own husband die at 40, alone at the farm – it is can be that quick. It is a strong thing to bear witness to someone’s last moments, and how kind that you took the time Paul, to let us know about Bernard.
    I’m also sorry that you and others have to carry that burden of witness as well.

    Liked by 2 people

    • Hello Sheketechad. Thanks so much for dropping by and leaving a comment. I’m sad abut your husband and extend my condolences. Death often sneaks around and strikes when we are least expecting it.

      Liked by 2 people

  3. Ahhhh, such a sad story, but well told, Paul. We don’t always understand death, it doesn’t make sense. Sometimes even nurses and doctors will falsely believe we can control it, so when it happens it feels as if it’s our fault.

    When I worked in the nursing home, my very first patient needed help putting pressure stockings on. I thought I did a remarkable job…. but she died about 10 minutes later. I was absolutely convinced I put those stockings on wrong and killed her. It took me months to accept that it was just her time to go. I can laugh about it today, but at the time it was pretty traumatic. Never mind that it’s probably not even possible to kill someone with a pair of socks.;)

    Liked by 3 people

    • I’ve never worked in such an environment swo8 = it must be very difficult, my thoughts and prayers go out the medical health professionals that labor tirelessly to help us.

      Liked by 2 people

      • We had a code on a young seven year old boy. They weren’t sure what was going on with him. Maybe he had a brain tumour. We just didn’t know at that time when he coded. There were a lot of “what ifs” after that one. We lost the boy.
        Leslie

        Liked by 2 people

  4. Hi Paul! Wow – I think I just felt every emotion there is with this story! It hit close to home because I’ve been in these situations, but I enjoyed reading this with its intensity and fast pace! What a recollection you have, and very descriptive as well. So sad that it’s non-fiction, however. It’s always so difficult to lose someone at such a young age. Thank you for sharing Bernard’s story – I’m so sorry for your loss.

    Liked by 3 people

    • Thank you so much Kelly. I am pleased that your enjoyed the story – as sad as it is. It seems so odd that a man’s transition from life to death can be described in a blog post of a few thousand words.

      Liked by 4 people

  5. A powerful story, but so sad. I can’t imagine the poor family coming back to find Bernard gone–just like that. How awful for you to have witnessed it, although as commenters above noted, you honored him with your words. I can understand how everyone who was there was affected by this trauma.

    Liked by 2 people

  6. What an incredibly sad story for everyone involved. It must have been such a shock for you to witness this young man’s demise despite everything that was done for him, and at top speed as well. It seems to me that when your time is up, it is up.

    Liked by 2 people

  7. Paul I am so sad you were so closely involved in this tragedy ! So sad but shit happens even when the best of treatment is given… Drs and Nurses are but humans not Gods.
    Thank you Victo for bringing us this post from Paul. xx

    Liked by 2 people

  8. Hope you’re doing OK healthwise yourself. That’s the by-product of regular exposure to the hospital environment – bearing witness to the suffering of others. I’m sure it can’t but make you philosophical about death and its untimely and unpredictable nature. Something for us all to try to bear in mind. Thanks for sharing it so eloquently. The poor kids, as you say…

    Liked by 1 person

    • Absolutely Tenderness, constant exposure does change your philosophy. I am a full time dialysis patient on disability as the treatment has caused a serious nerve condition that interferes with walking and standing. Sometimes I feel sorry for myself. One day I entered the elevator at the hospital on my way dialysis feeling bad for myself and foudn a young man of about 25 who was steering a power wheel chair with his chin as he had no arms or legs. We exchanged pleasantries and when I got out of the elevator I was grateful for what I had.

      Liked by 1 person

  9. Such a heartbreaking, moving account of an experience that has to change you, even as a witness. You told the story so beautifully, Paul. I was holding my breath through each successive line.

    To enter the ER and be taken so young, tragic and horrifying for all concerned. My heart goes out to that family, and the nurse who took it all so personally. Thanks for sharing such a poignant memory.

    Liked by 2 people

  10. hey Paul, Really well done. It is such a helpless feeling as we see, or witness the crossing over to the next place. Tragic in many cases. But you have done justice to his story and honored all that could help him…including you, who was there to guide and reassure him.
    Its nice to see a picture of you, and it is how I see you in my mind. I always enjoy your comments and stories. You are an inspiration.
    Keep writing.
    Jane

    Liked by 2 people

    • Thanks so much Jane. I am honored that you stopped by to read and comment.. That picture is recent but when I was working I had the #2 business cut. Now that I look like a writer with angst I have to do some writing.

      Liked by 1 person

  11. My heart aches reading this. For Bernard, his family, the medical team, and all of you who could only bear witness to the loss and the impact it had on everyone. Including yourselves. Thank you for sharing this Paul. We really have no control over our time do we?

    Liked by 2 people

  12. Thanks so much for this post. You ‘ve done an incredible job of describing a terrible situation. I was a dialysis nurse and dealt with this for thirty years. It is heartbreaking for everyone. I always worried about the other patients helplessly watching as well as the staff left feeling inadequate and grieving as devastated families learned of their loss.

    Liked by 2 people

    • Hi lbeth! Thanks so much for dropping by. The dialysis nurses are amazing and you have my utmost respect. The affect on other patients is rather depressing. Thanks again for dropping by- I am honored.

      Liked by 1 person

  13. I had a really hard time hitting the *like* button … it just felt rather superficial.

    This was a powerful story and I’m sure the shock of it still lingers. There is one thing that will always puzzle me though … I’ve lost people close to me frighteningly fast, I’ve lost people slowly and painfully, but never, never has my first reaction been one of pointing blame and anger.
    I know grief and shock does different things to different people, but this I just don’t understand.

    Liked by 2 people

    • There is some truth to that Joanne. My own experience is that the more self-aware the person is, the less likely they are to blame someone else. Thanks so much for dropping by for a read and a comment – please come by again.

      Liked by 2 people

    • Thank you very much for your read and compliment Noelle ( I love that name ). You nailed what I was striving for – expressing the hard facts and the emotional impact from an observational perspective. I am pleased that you enjoyed the piece. Please drop by again. 😀

      Liked by 1 person

    • I’m not a medical professional but my impression from the conversation was that there really wasn’t a “heart attack” per se – the issue was an aneurysm that caused blood loss into the abdomen and the resultant drop in pressure caused the heart to stop – as they tightened up the circulatory system with shock (defibrillator) and stimulants the heart would start and then run out of pressure and stop again. Each time there was less and less blood until it wouldn’t start any more. Mind you I’m not a medical person – perhaps Victo could comment on what happens to the heart with internal bleeding.

      Thanks so much for dropping by for a read and comment, Please come again.

      Liked by 1 person

      • Ha! Thanks Victo! I actually got that from the hydraulic tailgates we used to run when I was the transportation manager for a large retail organization. We had about 50 trailers with hydraulic tailgates that we used to deliver to our stores in the downtown of rural towns in Ontario and Quebec. They were the cat’s meow for the job and could easily raise or lower up to 4,500 pound skids (3,000 pounds is about all one strong male can maneuver with a hand jigger). When they lost hydraulic pressure we had a couple of tricks to get them to work temporarily – 1)Let them cool down by reducing the temperature of the tank (about the size of a suitcase) with ice in summer or snow in winter and 2) shut down the pressure on one side so the circulation was only 1/2 what it would normally be – this will obviously reduce lifting limits by 1/2 but 2,250 pounds would unload most skids and the rest could be manually split in half for unloading. But if the leak was too bad or was a rupture, there was no recourse – you were out of business. (In that case, if the load was small we would load by hand or if the load was big, we would redirect another trailer in the area to the site and transfer the skids form truck to truck and then unload them – not an option if it is a heart.) 😀

        Liked by 1 person

  14. Pingback: My Article Read (10-25-2015) | My Daily Musing

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