Finishing a long day in the OR, winding down at the desk with co-workers, trading stories from the day, feeling so glad it is almost over. When the dreaded words walk through the door “I have a add on”. It’s typically the standard appendectomy or cystoscopy with stent, I hear the surgeon say, “it may be a AAA(abdominal aortic aneurysm) he is full of blood, and we don’t know where it is coming from”. I immediately jump up and begin to pull supplies. Thoughts are racing through my head, grab everything for the general surgeon, but also need the vascular supplies as well. The scrub tech that is on this shift with me is panicking, the fear in her eyes of being fresh off of orientation and having to scrub one of the toughest cases with two different surgeons.
As I am roaming through the supplies I am trying to collect my thoughts and strategically pull anything we could need, vessel loops, kitners, vascular clamps. My scrub is pulling instruments, and I got to assist her. We get into the room, and I begin frantically opening supplies, I tell my scrub to scrub in and start setting up, we will not have time to count instruments, we need to get this patient in the OR as fast as possible. As she scrubs in, she frantically asks for things that we have already pulled, I tell her to just grab the instrument pans and setup her mayo, whatever we have in the room is going to have to work, and I will run for anything else.
Anesthesia walks in the door, I discuss the patients labs, the situation and they begin to setup for invasive line monitoring as the patient rolls through the door. Patient George is sitting up in the stretcher due to the intraabdominal pressure rising and causing intense pain. I grab George’s hand and introduce myself as the OR nurse in the room, and we are here to help. George is flailing in pain, he can hardly get a word out as anesthesia begins talking to him. We get the backboard under him as he is screaming in pain as we move him onto the operating room table.
Anesthesia has the A-line kit prepared up top, they are assessing his airway as well as IV access to be able to transfuse rapid blood if necessary. George is now flat on his back, and in excruciating pain. Anesthesia is almost ready to put him to sleep, but the minutes feels like hours to George as his belly feels like it is crushing him from the inside out. Anesthesia says “okay George we are putting you to sleep now, when George grabs my hand and says “If I don’t make it out of here, please tell my wife I love her!”. I quickly reassure George that he can tell her himself when he gets out of here, and off to sleep George went. Propofol pushed and paralytics given, Georges vital signs begin to sag. I assist anesthesia in getting the tube secured that will breathe for him during this case.
In walks the general and vascular surgeon, both prepared to do all they can to save this mans life. Scalpel calls the general surgeon, and off we go. Incision made and the suction applied, massive amounts of blood suctioned out after initial incision. I am intensely watching the suction cannister to see how much blood we have lost. Anticipating what anesthesia will need me to get for them. General surgeon is frantically scouring the abdomen for the location of the bleeder. Vascular opposite side doing the same.
I get relieved this particular shift out of this case and hesitated even leaving. I needed to know what happens, what will happen to George. Will he make it out, will he make it back to his wife that he loves? I gave report to the call nurse and went to the locker room. In the locker room the thoughts of his last words to me hung heavy. How sweet it was that George’s last thoughts were about loving his wife. What kind of love George had created in this life that he wanted to ensure his wife knew this, even if he didn’t make it. The sincerity of his words, the love that he felt was transposed directly on me in that moment.
Coming back into work the next day I desperately searched in the computer for the notes after surgery, what was the cause? Was it a AAA, was it something else? I read in the note, it was not a AAA, it was a mesenteric artery bleed. Follow every note made in the chart from upstairs in the ICU, I am following George’s lifeline to see where it will end, when I see, Time of Death 1400. I immediately cry. Knowing that this man, who I only knew for 10 minutes, did in fact not make it back to his wife. He had surgery, stayed on the ventilator, went back upstairs to die.
For weeks I struggle with this, should I contact George’s wife and tell her his last words? Would that be appropriate, would that be crossing the professional line? I felt like it could be comforting for her in a time of grief, but that is only my perspective, and if it only caused her greater pain hearing that would it be worth it? I still think about George, I still think about the 10 minutes at the end of this man’s life that made me wonder how to find the kind of love that George had found. That in the moments of his greatest pain in this man’s life, biggest fear in his life, his last words were ” Tell my wife I love her”.