“My heart doesn’t feel right. I think I’m in a fib.” I had just left him a few minutes prior, chatting with a friend as they ate dinner. His previously healthy vigor replaced with pallor, and that look of quiet desperation patients get in their eyes when they know something is seriously wrong sets off alarms in my mind.
Something always comes over me in moments like this. My voice lowers as my mind races. I ask the CNA to get vitals now as my fingers on his radial pulse, thready, irregular, and too fast. He tells me this isn’t the first time, and he needs a dose of a medicine called diltiazem, a calcium channel blocker that will halt the overwhelming calls of his atria telling his ventricles to contract in the frenetic pace he’s currently experiencing; a frantic pace that doesn’t let his heart fill completely, an engine running low on fuel. Like a gas tank that is only filled with a few ounces at a time between drives. His panicky eyes are telling me his brain needs more oxygen.
His blood pressure is low. 80-something systolic. Shit. He hasn’t had his dinner meds yet–the beta blocker that will tell his heart to behave. If I give that to him, his blood pressure might dive even more. The diltiazem might also dump his blood pressure, but it will tell his heart to slow it’s roll.
I stop overthinking and listen to my intuition. He needs the diltiazem. I give it to him with the glass of water. I have an instinctual sense of peace that everything is going to be okay as I quietly ask the CNA what his POLST says. He’s a full code–meaning if he crashes he’ll need CPR. I know this is the turning point. If he doesn’t turn around in the next 15 minutes, he needs to go to the ER.
As we get him to his room and help him lie down with the hope of getting more blood to his brain, I’m reassessing him. His color is returning. He appears to be in less distress.
Picking up a shift in the retirement community might not be as sexy as the ER, but damn, it forces me to rely on my assessment skills and less on technology. What a random thought.
His blood pressure is increasing and his pulse is steadier and stronger. He takes the rest of his heart medications and we make small talk. I recheck his blood pressure, 120/73, his heart rate much improved at 99. I encourage him to take care with transferring, and he asks me to stay with him as he goes from reclining to sitting, then standing.
He’s doing well and he decides to go for a short walk. He reminisces about working in the medical field as he answers my questions. I ask him if he knew my beloved mentor, Mary Fry, who passed away. “Oh yes…” He tells me stories of working with her as we walk, and with each word I feel her presence, growing stronger, so close I feel like I could practically reach out and touch her walking behind us.
Mary, you’re not gone, and you’re definitely not forgotten. Your sweet spirit lives on in every nurse and doctor you’ve taught and worked with…thank you for teaching me so much, about nursing, and life. 💕