When Death Occurs at an ASC: Thoughts From Anne Dean, RN, BSN, The ADA Group

As healthcare workers, we always know that there is a possibility that one of our patients will die on us. I began my nursing career in surgical intensive care in a very large teaching trauma center in San Antonio, Texas. The patients we got in the SICU were major traumas — thrown under a train by a jealous boyfriend, tied to the tracks by an irate pimp or mutilated by a husband. There was one 14-year-old boy who dove into a "too shallow" pool to retrieve his baseball hat while horsing around with his cronies and would now face a lifetime of quadriplegia.

One day when I came into the unit, I looked around and marched straight into the DON's office, where I put my application in to work charge nurse recovery. Those patients were asleep, and as soon as they woke up, they went to their rooms. There was minimum exposure to sadness and trauma. From there I went to the operating room, where all patients were asleep the whole time I took care of them. After being a trauma junkie, I entered the world of wellness nursing, in the guise of same-day surgery. I fell in love with it.

I have faced death in my beloved world of otherwise healthy patients. There was the patient we lost — a 46-year-old healthy woman who came in for a vein stripping and died because the esophagus was intubated rather than the trachea. There was the 45-year-old woman who came into another center for multiple plastic procedures and, after 11.5 hours of surgery, died upon exiting her car in her driveway of multiple pulmonary emboli.

We had the 86-year-old who was oxygen-dependent and who wasn't given oxygen during his stay in the center, consequently exiting the operating room with no vital signs. Nothing prepares you for such a loss. You are never fully prepared. We live in a world of wellness where our patients are, even with all their underlying health issues, truly class 1 and 2 ASAs who consider themselves otherwise healthy. We see them that way. We admit them, take their histories, take their vital signs, listen to their stories, meet their care persons, laugh with them, get frustrated, give them instructions, put them in the car and wave at them as they leave.

"There," I used to say jokingly as I marked another name off the schedule. "Another one bites the dust!" We had returned another patient to his family — another success. We become conditioned that this is the way it is and should be. We become gradually complacent that it will always be that way. We let down our guard, and we start going on automatic pilot. We become drones addicted to the routine of everyday life in a busy surgery center — and then it happens. It is catastrophic: A child dies on our table, and we work frantically, doing everything we know how to do to save this child. But it doesn't work. We have left with the horrific impact, and the horror of facing a family with now empty arms.

I remember once, when working recovery, having a three-year-old little girl brought to me from the OR wrapped in a pink blanket. Her long, black lashes lay silent on her cold, still body. As I carried her in my arms to the morgue down the back steps, I was faced with her parents coming up the stairs from the cafeteria. I just sat down with them right there and handed them their baby. We held one another and cried. There was nothing else that could be done.

A coworker broke down in tears when she heard of the loss at the surgery center. I tossed and turned all night. We had them bring in a grief counselor for the staff. My coworker reminded me that every time a patient comes to our center, holds out their wrist and we affix a wristband, the patient is now "at risk." We must never forget that and must stay alert and ever-ready.

Learn more about The ADA Group.

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