#agonal

My favorite patient died - and it was not peaceful or clean or any way anyone should go. The fucked up part for me was I had no idea it was imminent. I’ve been a nurse for 12 years, a medic before that and you can usually tell when shit is about to get real.... but of course, Murphy and his Law had to screw my patient out of my end of life care. I am happy I was his nurse, I am happy he smiled at me that night and told me how glad he was that I was his nurse.... but I sure wish I could have made that death easier than it looked. The only consolation was that it happened sooo fast. I was there literally 10 minutes before he was dead and he was fine -(Other than the underlying shit he had going on that was the reason he was in the hospital) - when I went back to check him he was agonal and a DNR. Hate it when the ‘nurse-sense’ sends you back into the room when you’re not quite sure why...

To top things off - my personal life took a fucking nosedive this week too.

I feel your seizure change shape. Your arms and legs contort, then your jaw drops wide, a long snore rattling out of your throat. Your eyes roll forward but looking nowhere. I can barely feel your pulse now.

Still mounted on you, I let it happen. Like you always tell me to. My own heart thumps inside my chest as I feel the agonal convulsions ripple through your body, slamming into me.

You watch me fall into respiratory arrest and as you press your fingers into the soft skin of my neck you can feel I’m clammy, my weak heart is failing. And your suspicions are immediately confirmed as the seizing becomes posturing, my heart quivering into useless activity and my body spastically flexing into a twisted position. Arms drawn to my chest, hands in fists and wrists tucked in on themselves, my legs extend and rotate inwards, toes pointing. And then my blue lips spasm open mouthing a breath that doesn’t exist, snorting and gasping irregularly over and over.

I’m sitting on the edge of my bed in the emergency room rubbing at my chest. Someone has gone off to chase the doctor up about my discharge papers but all of a sudden I’m not feeling good. It’s like my heart is being forced through intense exercise while I’m just sitting down, racing along in my chest and thudding so strongly I can feel each seperate beat shake my little body.

My breath catches as a wave of intense dizziness comes over me, I’m no longer hooked up to any monitors now because I’m meant to be going home but I know I need to tell someone about this before it gets dangerous. It feels like I haven’t taken my medication for the entire day, but I have, the nurses were delivering it to me every four hours… weren’t they?

I push my trembling body to its feet, feeling my heart rate immediately sky rocket and I gasp in surprise as my entire body begins to go numb. I’m going to faint, I can just feel it but this is all happening so fast for me, usually I have a warning. I manage two steps forward and catch the eye of a nurse across the room who looks instantly concerned and then I just crumple. My legs give out and when I hit the floor of the ER I’m already unconscious.

By the time the nurse has run to my side and pressed her fingers into the soft skin of my neck my muscles are tensed and I’m spasming on the cold hospital floor. She finds my pulse racing almost too fast to count and very gently rolls me onto my side in the recovery position. I’m known here, my heart condition makes me a semi regular and she kindly smooths my long hair off of my face, telling me it’s going to be okay. She’s got me. Around her other staff are running over and closing the curtains around my bed to give me privacy.

My eyes are slightly rolled back in my head and completely unfocused, my breaths are coming in sharp little gasps as I twitch. It’s usually over by now, my heart usually corrects itself and I regain consciousness but this time the nurse can feel my pulse only getting faster. She asks for an oxygen mask, a pulse ox and for someone to fetch a crash cart just in case as my pulse peaks over 194bpm and my twitching arms tuck into my chest. I’m starting to drool a little bit from the corner of my mouth and my breathing is laboured, she’s worried now, she’s never seen my episodes last this long before.

Then, as my heart stumbles and pushes itself to its limits she frantically calls out for a code the exact second I enter vfib, yelling over a loud snoring gasp I produce, my arms contorting and I go into cardiac arrest.

So your first ever asthma attack catches you by surprise and triggers a massive seizure.

... and you're sent into cardiac arrest.

honestly all this time I just thought I was unfit.

which I think, in my defence, was an easy mistake to make. Breathless when exerting myself, a cough at the end of the day that I brushed off as allergies… until it all hit me I thought things were under control. But they weren’t.

I was at the gym, nothing strenuous, just a jog on the treadmill when things started to feel more exhausting than usual. I tried to push through it but in the end I’m forced to step off and head into the changing rooms, plopping myself down on a bench and resting my elbows on my knees, just trying to breathe.

it’s the first time my brain stops to consider if something might be wrong, I try to clear my throat and take a deep breath in and it feels tighter than I remember and when I exhale there’s a wheeze that happens along with it. I frown, rubbing at my chest. I feel so breathless, I don’t understand what could be happening. As I get shakily to my feet I breathe out and trigger a coughing fit, making me have to plant an arm on the wall to keep myself steady as I gasp and wheeze, spluttering all my air out and then having to fight to draw any back in.

panic.

I know I shouldn’t panic but I’m now fighting for air, stumbling and falling to the cold tile floor of the changing room I’m in. My lips are starting to look pale and a little blue and I can feel pins and needles forming in my limbs as I begin to struggle for oxygen. But right at the moment when I'm starting to choke, gagging on my own narrowing airways, I stop struggling. My expression changes from panic and fear to an eery blank detached gaze, my eyes slowly move to my left side and a low groan slips from between my cyanotic lips.

And in the next moment everything goes haywire, my little body contracts and stiffens into it's usual posture that it takes when I have a big seizure. An unconscious groan is forced from me as all the remaining air in my lungs is ejected but this time it's accompanied buy a dreadful whistling wheeze. My hands come up by my head and then my arms stiffen out in front of me, elbow locking, wrists tucking in on themselves. My legs straighten and stretch, toes pointing as I tip over and end up laying on the tiles gagging and gurgling as my entire little body starts to convulse.

I'm alone, there's a chance no one heard me cry out over the music in the gym. The jerking in my body starts fast and tight but the movements soon become bigger, more pronounced. I keep hitting my head on the floor, eyes rolling and all my facial muscles are twitching, I'm drooling all over myself - unable to control any part of my body as I seize violently. After a few minutes my lips are a deep blue colour, there's a dark patch spreading in my tight work out leggings from losing control of my bladder. My arms have pulled spastically into my chest now, hands twisted strangely in on themselves. It looks like I'm mimicking decorticate posturing, this is bad. Each convulsion causes me to make grunting wet sounds, If anyone was around they would make the educated guess that I'm aspirating on my own saliva and secretions. Because I am, liquid ending up in my starving lungs without me having conscious control to be able to swallow while I'm drooling like this.

Inside my little body the lack of oxygen is taking a toll, my heart is starting to stumble and skip in my chest having been working overtime to try and send limited oxygen around my body for almost eight minutes now since the asthma attack first had my lips turning blue.

The convulsions begin to slow down as all of this is happening, leaving me limp face up and jerking in flailing spasms ever second or so. The next noise that happens draws attention, my eyes rolled back and staring and my face pale as my little heart finally begins to give up. I fall into cardiac arrest, so starved of oxygen that my body is shutting down. It causes my arms to extend, posturing stiffly and my blue lips part in a horrible long snoring gasp for air.

Agonal way