1. Carunchio, Ashley L. BSN, RN, CEN, NREMT-P

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AS IT ALWAYS DOES when I work a day shift, my alarm clock went off at five in the morning. After graduating from nursing school 2 years ago, I'd been working in the ED and had seen a lot, heard a lot, and learned a lot. But none of it had prepared me emotionally to care for Mr. C, my first patient that day.

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I treat all my patients with respect and give them the best care possible. To this day, however, I haven't been able to figure out why caring for Mr. C was especially meaningful. Whatever the reason, Mr. C will always hold a special place in my heart.


Typical morning

My morning began as usual with an assignment to cover the resuscitation rooms. Around 0715, only 15 minutes into my shift, a nurse rushed a patient into room 1. He told me that the patient's name was Mr. C, age 42, who came in complaining of extreme fatigue and shortness of breath. He was a competitive long-distance runner, and he hadn't been feeling like himself for about 3 days. He was pale, diaphoretic, tachypneic, and dyspneic.


A colleague and I obtained vital signs, started supplemental oxygen, placed Mr. C on a cardiac monitor, obtained peripheral venous access, and immediately called for the ED physician. We started a fluid challenge for hypotension, obtained blood specimens for lab work, and obtained a stat ECG.


I could tell that Mr. C was trying to be strong even though he realized something was very wrong. "This isn't good, is it?" he asked. Although I was worried and could see that he was getting worse by the minute, I truly thought we'd be able to quickly identify and appropriately treat his underlying medical problem. I reassured Mr. C that we were doing everything possible for him and that we would keep him informed.


Calm during chaos

Despite the enormous amount of activity in room 1, Mr. C remained calm and involved, asking questions every step of the way. I could tell, though, that he was becoming even more fatigued. I asked him if I could call anyone on his behalf. He replied, "Can you please call my girlfriend? Tell her that things are more serious than we thought and I want her to be with me." He was trying to be brave, but I knew he must've been frightened. My heart went out to him. I hoped his girlfriend would make it to the hospital in time.


His BP didn't stabilize despite all of our efforts and Mr. C was becoming increasingly short of breath. A stat consult was placed to cardiology and one of the cardiologists was at the bedside within 10 minutes. Mr. C's girlfriend arrived around the same time.


Time to move

Following a stat echocardiogram, which revealed an extremely low ejection fraction, we scheduled Mr. C for an immediate cardiac catheterization.


Although Mr. C's clinical status was deteriorating, he still managed to crack a few jokes until his level of consciousness decreased and he required endotracheal intubation. "If we can just get him to the cath lab, maybe he'll be okay," I kept thinking to myself.


Race is over

I was exhausted after Mr. C left for the cath lab. I put all I had into caring for him that day. I received word the next day that Mr. C had coded and died while he was in the cath lab. Had nothing we'd done made a difference?


I felt like that for a while until a colleague and good friend told me that I had made a difference. She told me that I didn't realize the things I'd done because I do them everyday. She went on to ask me, "What would have happened if you never offered to call someone for him? Would he have had that last opportunity to say goodbye to someone he loved? You were kind to him. You were understanding and you calmly reassured him. And, you gave him the best care that could've been offered." I suppose I'd never thought about it in that way. I just viewed it as doing my job.


As a competitive long-distance runner, Mr. C fought long and hard during every race no matter how difficult, and he demonstrated that same mentality all the way through his last race. The race to the end.