"She's dying..."

Last night was a brand new low in my career, and got a hair's breadth of being something much worse.

A busy, busy night. Several declining residents, and some making painful-slow steps up from illness and injury (read: stroke, fall, or CHF). No experienced help on the shift but me, and another nurse assistant in charge.

I'm struggling through my work (a particularly heavy assignment), and I hear the charge aide announce that help is needed in a room on another hall. I finish what I'm doing, but it's late and I'm sure that one of the others is long since finished and has gotten to the resident who needed assistance.

But on my way to drop my trash, I look up and see that two call lights are on and silenced... The one that was announced, and another near by. The one near by is my dear Martha. She's got some form of dementia, and will often call out for help, when her problem is simple (ha!) anxiety.

I am quick down the hall, and pause at Martha's door. "Hang on, honey. I'll be right there!" I call... but instead of her little "Help! Help!", it registers that I hear only a rapid tapping...

The other resident needs a window closed. I check to make sure her O2 is on, and that she has water, and tell her "Good night, sweetheart, sleep well".

And back to Martha.

I come in the room and hear the sickening sound of labored, liquid, struggling breath. I flip on a light and Martha is stone white, heavy, frothy phlem pouring out of her mouth and nose.

Leaping on her bed, I grab her to flip her over on her side so I can clear her air way. In my mind a racing dialogue... "Is she choking? On WHAT? Flip the call light!", she is rigid, and will not turn, though I'm strong. Her jaws are clenched and I can not clear her mouth. The emergency phone is far away. I tell Martha "Hang on, sweetie! I'm going for help!" and I sprint, absolutely sprint, to the med room/nurses station. As I fly I see a young aide.. "Mark! Go sit with Martha!". In the med room, out of breath, "Mary! Martha is choking!" and we both sprint back to Martha.

Mark is meandering down the hall. He didn't understand I ment "URGENTLY go see to Martha". Mary and I race past, I say "she's choking" to Mark, and I run to Martha.

Mary looks at me and says "She's dying."

We're struggling to get her upright, and Mary grabs a towel and begins to clear the heavy fluid. Again she looks right in my eyes and says "She's dying." Very simply. Very quietly.

"No", I say, "don't say that. You'll be fine, Martha. I'm here."


Mark arrives and we get Martha sitting up fully, Mary says "Go call 911!". Again, the long sprint to the med room.

Totally out of breath, I tell the 911 operator that we have apparent choking in an approximately 90 year old woman. As I'm finishing the phone is ringing again. Not sure if it could be Mary, calling on her cell with more information, and knowing that I work for this place (not for Martha, but for "the place"), I dutifully answer the phone "Wood Ridge, this is Lynn...". It's the DON and thank heavens. When I say "choking" she says "try the heimlich manuver", and I feel one of many waves of frustration for my panic, because it should have been my first thought.

Back in the room, Mary and Mark are attempting to swab out the thick phlem. I slip onto the bed, supporting Martha as high up as I can get her and say "it's ok... I'm here. You're going to be fine. Now COUGH for me, honey!"

I'm nearly blank, my mind is a white place. I'm trying to remember what I was trained to do.

I tell Mark and Mary that I've told the ambulance that someone will be out front waiting for them.

Suddenly I'm alone with Martha and another aide, white faced, but wonderfully solid. She's a girl nearly my age.

I look into Martha's eyes. "Give me your dentures." Her ashed face shows something besides panic, she's puzzled and objecting. "Give me them!" I remove them quickly with my bare fingers. Kathy then can sweep Martha's mouth more effectively. We get Martha's feet on the floor.

"She was fine when I put her to bed!".

"I know, sweetie.. I just found her like this.."

The ambulance, Mark, Mary arrive. The EMT asks a few questions. I tell them she is 94, no history of COPD or CHF. Some dementia. Fine and normal right up until she was found like this tonight.

They ask her if she wants to go to the hospital. The EMT's and ambulance personel are obviously skeptical. As I listen to the quiet pieces of their conversations that slip in, they are disappointed that there is a motorcycle accident so close, but they're stuck with this old woman with no family. They take a pulse and listen to her lungs quickly but take no other vitals and put her on O2.

"Well, her lungs are clear. This is upper-airway. And.. well," (to Martha) "You want to go to the hospital?"

(A little aside here... the one thing you NEVER do in health care, at least NEVER with geriatrics, is ask a question like that. They'll always say 'no!'. They don't want to be a bother. They don't want to have to leave their bed. They're afraid of the cost.)

I'm exasperated, but silent. Mary tells them "yes, we want her looked at".

"No, no!" Martha is struggling to get that out.

"Martha.. you go up and let the doctors look at you. For me."

Not aware of Martha's peculiar style of ambulation, which is filled with objections and anxiety, the EMT's lift her, and she, manages to get in a few of her "I'm going to fall! I'm going to fall!".

She's always said that. Ever since I met her.

Quietly I say "no.. you're fine. I won't let you fall. You're ok".

At the door of the ambulance I tell her "I'll see you tomorrow. Ok? If you're at the hospital still, I'll see you there. I love you. Be good for the doctors."

"I love you, too" she says.

I do something I've done only once at work. I cry. Hard.

All of us shaken, Mark says he said it looked like a seizure. I wonder at that, because she was so rigid at first, and I could not get her jaws apart to sweep her mouth.



This morning I go and do my weekly housekeeping gig (that I keep in order to feed my ponies and other animals). Afterward, midafternoon, I'm close so I go back to Wood Ridge to get an update.

Martha has just been brought back. The DON tells me that all four lobes where effusing, and that they feel it's bronchitis (but don't back any of this up with x-rays).

I go to her room. She's much like she was the night before, but not so responsive. I look in her eyes. I stroke her hair a moment. Tell her I love her and will see her tomorrow.

Tonight I called for an update. Moments after I saw her this afternoon she was taken back to the ER and this time admitted.


I know she can die. I know that 94 is a good age. I don't have any illusions about death ever having to be pretty. I know she is ready.

Many, many of my beloved residents have died. Friends and family as well. This is not new to me, and I'm usually rock-solid about it.

I just wanted them to ease her pain and suffering. And I was mad at myself for so quickly forgetting all training and panicing. And for loving the funny little lady that she is so much, that it erased all elements of my job.

Truth is, no.. I'm not really ready to let her go. Just please, not like this.