I am looking back to this event as it was the first time a patient has died while I have been working, the first time I have witnessed an arrest, the first time I have seen the crash team in action and the first time I have been involved in a resuscitation attempt.
In just over a year of working in hospitals, before university and on placement, I had never been present when a patient died. While this event was a particularly dramatic one, and the patient did not survive, I feel it went as well as it could, and I personally coped well.
On Wednesday afternoon I came out of a side room to see another of my patients, who we'll call Mary, on the floor with an OT and a nurse; she had fallen, and while apparently breathing there was some difficulty in finding a pulse. She was given oxygen, and someone called the crash team as we connected the defibrillator.
The defibrillator showed a sinus rhythm, which from the brief glimpse I caught of it did not appear very regular. The crash team turned up in force minutes later, and immediately got to action assessing the patient, inserting airways, setting up the bag-valve-mask and oxygen, injecting adrenaline, and commencing chest compressions.
They needed someone to time them between doses of adrenaline, and as I was free and had a watch, I timed. After two of the team were exhausted with the compressions someone, I can't remember who, asked me to take over and I did so; despite never having done chest compressions on a real person. I felt happy enough with my training - I have been learning CPR for over four years now. I was only doing compressions for about four minutes, I did not feel tired, but after someone took over from me I realised my knees were really hurting - I guess my own adrenaline was keeping me going. After a few more minutes the crash team decided to stop as there was no response from the patient.
Despite the fact that we did not save Mary, I felt I did the best I could for her, so was quite happy.
At the time I was caught up in the action, doing the timing to begin with, handing items from the crash trolley when needed and then concentrating on the compressions.
I remember concentrating on being as accurate in timing as possible, handing over items as timely as possible and finally getting the rhythm, and location, of my compressions correct in accordance with my training, but also being aware of what was going on around me.
I remember moving my knee whilst continuing the compressions to enable someone access to Mary's arm to cannulate it, and pausing to allow the defibrillator to analyse her heart rhythm. I remember being pleased that one of the first things the crash team asked was if Mary's family were there - nice to see they saw her as a person, not just a task.
It was good to see how well the crash team, drawn from different professions, worked together. I was also pleased with the thanks and respect shown to me by the crash team, all experienced professionals who I have never met before, but I felt they appreciated my input.
Afterwards one of the nurses from the crash team asked me if it was my first time, and took me aside for a chat. When he asked me if I was all right I thought, 'no, not really' so we sat down, and we talked about it, saying how we had done the best we could and my CPR technique was good, he said he would not have known I had not done it before.
As Mary was not resuscitated by our efforts, the best that came of the event for her is that she did not die alone, and I feel we can say we did our very best to help her – I know I am happy with my personal performance, and feedback from the crash team backs up my perception that I performed to the best of my abilities.
Personally I feel the event helped develop me as a person and nurse in training – as a first experience of an arrest and attempted resuscitation the only thing that could have been better is if Mary had lived. On the day I felt I did not want to discuss the event very much with colleagues, preferring private contemplation and leaving analysis for later discussion with friends.
I felt happier discussing the event with the nurse from the crash team, most likely because he did not know me. I feel from this discussion that my feelings – not a feeling of failure, but sadness at the loss – were not that different from other's, but possibly more intense as it was my first experience of that situation.
I have been reviewing CPR technique, which has reinforced my feelings that I did the best I could. Having thought about the event over the past few days I would like to discuss it with those present, and perhaps find out precisely what happened with Mary.
Although I have checked the crash trolley a couple of times, this has been at night. I would feel happier if I was more familiar with the layout of the trolley, so I might be able to access items required in future resuscitation attempts. Because one thing is certain: this will happen again. From now on things will never be the same – attempting to save lives is not someone else's job, it is part of my job.