January: The Intubation and Extubation Month

First of all, let me announce that last January 16 was my 1st year anniversary in the hospital where I am currently working. It's been a year of toxic and demanding work. I've learned a lot of things that I didn't learn in school. I've done little medication errors that fortunately did not jeopardize my patient's health. All in all, I've had more than 10 deaths I improved as a health care professional.

So... let me go back to my entry's title... On the very first day of this year, I had to go to work. I was scheduled to work on graveyard shift. We weren't supposed to be busy but surprisingly, two of our patients were hooked on a mechanical ventilator (a respirator in layman's term). On the second day of 2012, we intubated another patient. On the third day, we intubated another. We have had code blues from time to time. The environment in our ward was so stressful this month. The good thing is that when one is intubated, another patient is being extubated.

Whenever one of my patients is being extubated, it feels like I was able to fulfill my duty as a bedside nurse. It  shows that the patient's prognosis has improved and the medical management (please include the nursing interventions as well!) was effective. Seeing my patients, who were once dependent on a mechanical ventilator, breathing on a room air makes me happy; not only because my responsibilities (and rounds!) would be lessened but it also means that a life has been saved and that a person who was once struggling to live longer was given a chance to breathe independently.

But... The other night we had a different kind of extubation. It wasn't the kind of extubation that makes us happy and fulfilled. It was totally heartbreaking...

Two nights ago, we admitted a 40 year old patient who was announced as brain dead. There's nothing that the doctors could do but to wait for a miracle. The patient had a severe bleeding in the brain that lead her to comatose. She depends on mechanical ventilator to be able to get oxygen for her body and inotropics to increase her blood pressure. Based on our observation, we assumed that she and her husband had a fight before she lost consciousness. The husband kept on asking for forgiveness while crying. On Day 2 of her admission, no response from her was seen yet. In the afternoon, her blood pressure dropped to 60/40 until 40/20. The husband, together with his son and daughter, decided to let go of her. At first, they said that they just want all the medicines to be discontinued. But before our afternoon shift ended, they decided to end her suffering. They asked us if we could extubate her right at that moment. We called our medical resident on duty so that she would be able to explain to them the consequences of their request. At 11:00 pm, the husband said his goodbyes to his wife... Her son and daughter kissed her on the forehead and said, "Mahal na mahal ka namin, mama..." At 11:15 pm, the husband went out of the room because he didn't want to watch the extubation of his wife... I handed a pair of clean gloves to the patient's brother who decided to pull out the endotracheal tube. At 11:18 pm, I turned off the mechanical ventilator and the patient has been extubated.

I went out of the room immediately with teary eyes. It was a painful moment for everyone inside that room. In fact, as I am typing this entry, I still can't help but cry. Losing a loved one really hurts.... Let's not take those people important to us for granted. *wipes tears*