Mr. B was a patient with a hematological cancer undergoing blood transfusion. Everything seemed to be going OK until he started to complain of feeling "funny" and seeing a bright light.
Anytime I hear a patient say they see a bright light, I become very concerned. I took his blood pressure: 80/50, but his pressure started out low to begin with. It was thought to be a result of his underlying disease, amyloidosis. He looked very unwell though so I turned off the transfusion and started to run normal saline. I put his head down and his feet up and asked the nurse to call for an MD. By the time the MD arrived, his pressure had declined further and his skin had taken on a greyish hue. The Doctor ordered more saline, wide open through both lumens of his CVAD. However, his pressure continued to drop.
I saw his wife appear out of the corner of my eye and almost at the same time, saw the medical intern ask her to leave. I had recently been to a talk regarding having family present during a code. They said it was helpful, not harmful to the family members and the patients. So, I asked the staff physician if I could go and talk with the wife to see if she wanted to come in because it looked to me like this gentleman was going to crash. He seemed very unsure of my request but stated that if I thought it was a good idea, it was okay with him. I went to speak with her while the medical team was working to reverse the hypotension.
"Your husband's blood pressure has dropped, we are trying to reverse that through the use of fluids and medications but we've had to call the ICU team and I suspect he will be leaving for the unit very soon," I explained. "Would you like to be in the room with your husband until they get here?" I asked.
"Yes, please," she responded, and so I took her into the room and had her come to hold his hand and let him know she was there. He was barely responding by that time and the ICU team was right behind us.
"Who is this?" they demanded when they came into the room.
"This is his wife," I said nervously.
"I'm sorry, you'll have to leave," they said to her curtly. "We'll come and find you when things have stabilized." They then shooed her out of the room and into the visitor lounge.
Things went from bad to worse. His pressure continued to drop. The team attempted to intubate, unsuccessfully the first time. He developed DIC and was soon whisked through the halls to the ICU.
"They've taken him to ICU," I said to his wife as soon as I had a chance.
"I wish they would have let me stay with him," she replied.
I didn't know what to think. While I was glad she had had an opportunity to see him and hold his hand for a brief moment, I was relieved that she had not been there to witness the intubation and the DIC.
When the experts say it's helpful for family to be present during a code, is this what they envision? I'm not so sure they have their facts straight on this one.
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