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Extracting Meat

Imagine this: a very thin elderly woman in a hospital bed. A list of her medical problems would be longer than your forearm in 12 point type. She’s been very ill for months. She can’t eat and is fed through a tube. At one point she couldn’t even breathe on her own and was on life support. Her kidneys are failing and she is on almost-daily dialysis, which she sometimes cannot tolerate without the use of vasopressors. Her circulation is bad. She has a massive bedsore on her tailbone and her foot is starting to turn colors. Bad colors.

Over the last few days, she has grown increasingly unresponsive. Sure, she’ll open her eyes when you say her name, and she’ll barely move her head in response to questions. But for the most part, this woman who would clearly call “Nurse!!! I know I want something, but I don’t know what it is!” last week is no longer even verbal now.

As I go about my day, preparing her medications and changing various dressings, I wonder what the point is. She’s clearly dying. She has tremors, so the pulse ox on her finger sometimes doesn’t read correctly; I have already gone in the room 20 times to adjust it. Usually it shows that her oxygen saturation goes from 98% to 60% in the space of 10 seconds, which is just not altogether possible… hold your breath for 10 seconds. I can guarantee you’d still be in the 90% range.

Except for this time. This time, I’m sitting in front of the monitors charting, and I hear the familiar dong-dong-dong and look up. My patient’s pulse ox is reading 80%. I figure that her tremors are acting up again for the billionth time (and resolve to put the damn thing on her ear next time I go into her room) and continue charting.

Dong-Dong-Dong.

Perhaps 30 seconds have gone by. The monitor now senses that her pulse ox has gone to 60%. (DING! DING!! DING!!!) We’ve been here before, several times. I sigh and look up from my charting just in time to see her heartrate go from 110 to 54.

Crap!!

I run into the room where I see that her pulse ox has a nice, even waveform. Definitely accurate. Although her heartrate has come back up to the 80′s while I was rushing into the room, her pulse ox is definitely in the 60′s, and although her chest is moving, there is no condensation on the inside of her oxygen mask. She isn’t breathing effectively.

I have some choices at this point. It would be entirely appropriate to find an ambu-bag and put the form-fitting mask over her mouth to force air into her lungs while I call for help. But for some reason, my instinct tells me to grab the Yankauer suction and stick it into the back of her throat.

Her eyes are open, but they are staring past me. I watch as the Yankauer fills with copious amounts of pale yellow/tan mucus. Part of me is relieved – this will surely fix her right up. But it just keeps coming and coming – where was all of this crap stored for heaven’s sake??

Then it stops. I’ve lost suction. I look at the suction head on the wall. It’s still set to high. I look up at her sats. They’re firmly in the 80% range. I look at her mask. There’s condensation on the inside. Good. She’s moving air.

I pull out the Yankauer. What was on the end of it may very well haunt me for the rest of my days. It was long and the matter at the end was the size of a large marble. It was black and somewhat solid, not like sputum or mucus. I wiped it off with a paper towel, regained suction and stuck it back in her throat. More mucus, more sputum. Sats up to 92%, definite air movement. Whew.

I didn’t figure sending the product of my suctioning session for culture would quite help us figure out exactly what it was. After showing the doctor, he suggested that we send it to pathology.

After the excitement died down, I wondered just what I did for my patient. Sure, I kept her from suffocating, but if that had happened in a nursing home, where she wasn’t on a monitor… I can’t really say I felt great about “saving” her. Does that sound a bit callous? I’m just not sure what I saved her for. More bedrest? An amputation of her foot? More infection? More dialysis?

Interestingly enough, she became a different person after our little incident. She began speaking again within the hour. She began calling out for the nurse again. Her children came to see her and marvelled at how she was so much more alert and responsive than in days past. She insisted she wasn’t in any pain.

I had a few days off after that. I came back to work to find that she had coded and was reintubated the day after I had taken care of her. She remains that way now.

I also found out that what I pulled out of the back of her throat was described by the pathologist as “meat fibers.”

Meat fibers. In a woman who hadn’t eaten anything in weeks. No wonder it was unrecognizable.

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Comments

what can i say? yer good, but i know what you mean by wondering what you saved her for. seems like she turned right back around :( or :) *shrug*

hi!

Oh geeze! I thought it would wind up being a piece of a tumor or something, but meat fibers. That’s one for the record books.

How sad that they “saved” her for death via another route. Maybe the family wasn’t ready to let go?

It was good she had some more “alert” time with her family, but so sad that she coded.

I always called that nasty buildup that nursing home patients get in their mouth from poor (or no) oral care mouth meat. But you just gave that a whole new meaning.

Yep. Been there, done that…didn’t know that it was meat, though. Who’s meat? Hers?
I’m sorry. That whole ethics-thing is the pits, and very draining on a nursing body.

Good job Geena! By suctioning the meat fiber ball from her throat you bought her some more time to interact with her family. Maybe they just needed that one last chance to say the “five things”.

I think we have all been there. Sometimes I try to take comfort in the fact that no one can out wit God and when her contract is up she will be sent to heven. Perhaps she is still here to teach us all something Like getting a detail advavce directive. I know I need a few more lessons because I still don’t have one. Do you?

You are wonderful. All of the nurses like you are wonderful. You do all the little things we can’t do day to day. My mother spent two years going downhill, experiencing medical error after medical error and ending up back in critical care units again and again. I valued each moment I had with my mother. I am sure the family you helped did the same. In the end I wonder if we should keep patients alive by tubes and respirations and dialysis after it is clear their quaility of life will never return.

Judy
gag@judyanddan.com

I agree, sometimes I wonder why we hate old people so much, since we torture them so. But, you could also look at it like you gave her and her family a few mores days together before she dies. My uncle was a raging alcoholic. When he was in his 80′s he got sick, coded a few time, became septic, had MRSA, the whole tamale. My aunt wouldn’t make him a DNR. I thought she was nuts. But he got better enough to go home. That last year before he died he didn’t drink and was like a new person. They got to spend that year together and end on a good note. Who knows why these things happen?

Nurses are angels of mercy. They are not God. They simply do God’s work.

It is like being a Catholic, much of what you do is based on Faith not understanding. We are unable to understand though we would very much like to it is not within our province.
I practiced medicine and surgery for 30 years and I was always amazed that as scientific and advanced as I thought I was that I could never really predict with 100% accuracy when someone was going to die or the actual outcome of treatment. I learned that most of the time it was really in someone else’s hands, not mine.

Marlou Davis, MD

Your story does not surprise me. Being critical care for 25 years. Meat fibers, left over food allot of elderly who are sick can not get there food down right and end up with pneumonia, choking and getting food stuff stuck.

Being a BSN of 10 years and having all my experience in LTC and Hospice I find your story touching and heartbreaking. I can see and have lived those struggles. I have many residents on my unit whose family just can’t let go of thier loved ones. And I have also heard people talk about “slow codes”.

The main thing all of us as nurses can do is to be the ADVOCATES we all learned to be for our geriatric patients (and ALL patients) and EDUCATE!!!

Educate the families, the patients, & our clients to be prepared for death with their living wills. Don’t be afraid to discuss death up front with everyone. Death, like birth, is a stage in all of our lives. The cricle of live.

We can be heroic nurses by helping people die peacefully as well as by helping them live.

AND….The comment about Nursing homes not doing good oral care…yes it may be true in some instances. BUT I am 100% sure that some hospital nurses are lacking in this area as well. Let’s not belittle eachother’s choice of profession or setting.
Until you walk in my shoes……

A nurse in a nursing home is just as much of an angel as a nurse in the ICU or ER.

Mmmmmmm, meat fibers….

What an amazing story! Your comments about the elderly and the end of life are poignant. It really must be up to the team to educate the patient and family and decide just how far to go to continue life. We are so quick as a society to euthanize a pet who is suffering……It’s a major conundrum to which I have no answer.

All I can say is:
1. Wow.
2. Isn’t suctioning great!
3. Good thing you didn’t bag her and push it in further..

It’s amazing that we insist that elderly eat when they can no longer swallow properly..Families will continue to pracitcally push it down and then get upset when the aspiration pneumonia sets in..
I’m really glad that you were able to help that patient. Makes it worth while doesn’t it??

You have a great gift for writing in a descriptive, compelling manner. I felt as if I were in the room with you.

It is disturbing that we have made such strides medically that we don’t know when enough is enough. There is something to be said about death with dignity.

Hello!

I’ve studied medicine sence I was two or three.

So tell me.

Did she live after that?

You said she coded but how did it go after that?



So, what brought you to the hospital today?

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Alltop. I don't know how I got there either.


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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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