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How often do you find yourself pondering the inevitability of life’s end? It's a sobering thought, and in my line of work, it is a daily reality-some patients reach the end of life. I believe that God has shown me his words are truthful through the experiences I have had working in the hospital. I have told others and shared my personal testimony that He has shown me how short life is through my work in the hospital. One of the ways that God's word comes to life for me is the Psalms, “Lord, reveal to me the end of my life and the number of my days. Let me know how transitory I am.” This may not come as a surprise, but it is not meant as amusement. It's a simple truth.
I want to share my first coding experience because it reflects the fragility of life. In the hospital, people get sick. Some we diagnose and treat, and they recover and leave, yet I've seen my share of other patients who come into the hospital and never leave. However, amid the solemnity, there is a quiet grace that often accompanies these end-of-life moments, an unspoken hope that lingers like a gentle whisper. It's a reminder that even in the face of life's end, there is a profound beauty in the time we have, enriching the morbid side of life that becomes very real when you work daily in intensive care units and procedure areas, constantly reminded of life's brevity. What scenes from your own life remind you that time is finite, prompting you to cherish each moment a little more deeply?
My first experience with death was as a new graduate in the unit. This was a cardiac specialized unit. During each shift, we had five nurses caring for ten patients, providing a 2:1 nurse-to-patient ratio, with a relief charge nurse on hand. The unit was overseen by a director, and we had the support of a clinical nurse specialist. The position provided me with an opportunity, directly out of RN school, to practice under an emergency permit with the expectation that I would take my examination and licensing boards within six months of being hired. It was a great opportunity. I was enrolled in a new grad residency program that placed me in direct mentorship with a senior RN for 6 months, and I attended classes taught by nurse educators while working part-time in the unit and earning a salary. The mentorship extended to 12 months beyond the initial program. I thought I knew enough as an RN graduate, but I soon learned and was humbled in my first year caring for sick patients in the unit.
Sadly, the very first time I coded a patient in their middle adult years who recently had heart surgery, I remember when the patient came into the unit and reported not "feeling right." The patient had just recently completed a physical endurance event, and their body weight and frame revealed nothing out of the ordinary. As a new nurse, I had been studying in my off time about our patient population of heart failure, but I did not recognize at the time how sick the patient was. I started electrocardiogram (ECG) monitoring, which continuously monitors the heart’s electrical conduction, and we continuously monitored a waveform on the monitor, along with blood pressure and pulse oximetry, to provide up-to-date vital signs regarding the patient's hemodynamics. Our physician had ordered that the patient receive a SWAN/GANS catheter, a lumen catheter inserted from the right side of the neck through the jugular vein and placed just above the right atrium of the heart in the superior vena cava. You can think of it as a pressure gauge for the heart; it measures pressures in the different chambers and provides real-time data on heart function, specifically cardiac output, which is how much blood the heart pumps in a given amount of time. If the heart is weak and damaged, the cardiac output is not that of a healthy heart. I hope this makes sense. Anyway, my patient’s heart was sick and needed to be optimized.
In the medical sense, optimization for patients with worsening heart failure means the healthcare team starts using medicines to reduce the workload on the heart. This is accomplished in different ways, such as lowering volume through fluid restriction and diuresis with medications, as well as by using medicines that affect the heart directly, such as positive inotropes, beta-blockers, and anti-arrhythmic medications, to assist the heart and improve heart function. For example, some patients who have undergone a heart transplant take other anti-rejection medications and immunosuppressive medications to further optimize the body so that it does not aggressively reject foreign tissue. As I left for the day, a mix of emotions ran through me—anxiety about the precarious balance we had to maintain in optimizing the patient's treatment and a determination to make a difference in their care. My patient was admitted to the unit overnight, and I left that evening and would return the next day. In our unit, we would practice continuity of care, and basically, if you were on shift and were coming back the next day, you would get the same assignment as the previous one because you knew the patient. It makes giving reports a lot easier because you are familiar with the patient.
The next day, when I came into work, I received my patient assignments. I took care of this individual the next day and, after a brief rundown of the night before, assumed care of my patient and began my assessment. As an RN, we start the shift with a thorough patient assessment and chart checks, including reviewing completed physician orders and administering prescribed therapies. I remember doing my physical assessment, talking to the patient, listening to the lungs and heart, and at the time, the lungs were clear. I also listened to the heart sounds; S1 and S2 were faint. Those are the “lub-dub, lub-dub” sounds one hears when auscultating (listening) over the heart. I remember them being faint, and I checked the EKG on the monitor and saw the voltage was low. The EKG showed a dampened or weak rhythm compared to a normal rhythm.
The patient's demeanor began to shift as the morning wore on. They sat slightly hunched, their breathing more labored, and though the monitor still showed a pulse oximetry above 94% on room air, something felt different. Their skin took on a clammy, pallid tone, and a fine sheen of perspiration covered their forehead. When the patient whispered, "I don't feel well," the vulnerability in their voice resonated deeply with me. In that moment, I recognized the importance of not just clinical data but listening closely to what my patients were telling me. This became a turning point in my practice—reminding me that behind every monitor and assessment is a person whose words and instincts can reveal what numbers sometimes cannot. From that day forward, I promised myself to always honor the human experience in my patient assessments, especially in those quiet moments when a patient expresses discomfort or fear.
But I, caught up in my routine, continued to assess my other patient that morning, following the usual process. I began by entering each room, quickly scanning the environment for safety hazards and equipment issues. I checked the monitors for vital signs, greeted my patients to gauge their responsiveness, and examined the intravenous drips—confirming flow rates, dosages, and that all IV sites were intact and free from complications. This was my standard workflow before moving on to the comprehensive, head-to-toe assessment later in the shift.
When it was time for morning medications, I carefully prepared and administered oral medications, including Lasix—a potent diuretic that helps the heart by reducing excess fluid in the body. I helped patients with breakfast, updated my charts, and checked for new physician orders for our unit secretary to process. To put the importance of Lasix into perspective: think about how, every time you drink water and later urinate, your body is quietly working to maintain a delicate internal balance. In healthy individuals, the heart and kidneys work in harmony to maintain fluid levels just right. As nurses, we aim to support and restore that natural equilibrium, especially for those whose hearts can no longer manage on their own.
However, in the presence of heart failure, a diseased heart, or acute rejection by the body, if you are taking in fluid, the heart is unable to compensate for the increased fluid volume, and the patient does not make urine to remove this extra volume because heart function is poor. To assist the body in ridding itself of excess volume and to reduce the workload on the heart, diuretics help the kidneys expel excess fluid. My patient received a dose of Lasix, and I remember leaving the room to continue with my activities of the day.
I remember our unit had a nurse assistant, telling me that my patient had reported feeling 'dizzy.' This time, I immediately entered the room and recorded the blood pressure at 65/30. The patient was lying in bed, and I asked how they were doing; again, the patient reported feeling 'lightheaded.' I rechecked the blood pressure; however, the monitor did not register a sufficient systolic, diastolic, MAP, or mean arterial pressure. More importantly, the blood pressure was less than 50, and I knew this was not good, as I could not feel a radial pulse at all; it was weak and thready. I recall the unsettling sensation of the pulse slipping away beneath my fingertips, the warmth diminishing with each passing moment, leaving a cold imprint of urgency in its absence.
Appropriately, I called one of the senior nurses into the room and reapplied the pressure. This time, the blood pressure was 50/34. The patient was reporting increased dizziness and not feeling well, and we immediately started intravenous dopamine to support the blood pressure. Not long after beginning the dopamine, the patient grabbed my arm and told me, "Brian, tell my family that I love them." I remember telling the patient, "You're going to tell them yourself. You are going to be alright; I am here." Those were the last words the patient ever spoke, and I was the last person to whom they were spoken. Imagine hearing that in your first months as a new graduate nurse, unprepared for this. The following moment I recall is a mega code that lasted at least 3 hours. Trying to resuscitate this patient was difficult and tiresome. We ran the code with CPR and drugs, and even a cardio-thoracic surgeon came to the bedside to put the patient on ECMO (extracorporeal membrane oxygenation). ECMO is a procedure in which a doctor inserts large-bore catheters into one’s femoral artery and vein, which are then connected to a machine that circulates and oxygenates the blood because the heart is unable to do so. It is incredibly invasive and gruesome to do in a chaotic environment.
Walking out of the unit that day, exhausted and emotionally spent, I realized that nursing is as much about compassion and presence as it is about clinical skill. I learned that sometimes, despite doing everything right, the outcome can still be tragic—and that being there for a patient in their final moments is an act of profound humanity. This experience taught me to listen more closely to my patients, to trust my instincts, and to never underestimate the impact of a simple, reassuring word or gesture. Above all, I learned that every life, no matter how brief or fragile, deserves dignity, respect, and care. These lessons continue to shape me, both as a nurse and as a person, reminding me that in the face of loss, there is still space for empathy and growth.
Together in the struggle,
Brian