Brush with Death . . . and Prejudice

Today, for my Critical Care clinical, I spent the day in an ICU. One of my two patients was covered in white supremacist tattoos, including swastikas. I wondered how he would feel if he knew that one of his caregivers (yours truly) is Jewish. Lucky for me, he's been unconscious for some time.

And during the night, his nurse noticed that his pupils were fixed and dilated. Never a good sign. This morning, his nurse and I took him downstairs for a CT scan of his head. The radiology tech and a radiology nurse showed me a big white blob in one side of his brain (on the computer screen) and explained that this was an intracerebral hemorrhage (i.e., bleeding in the brain). Later, a radiologist read the scan and saw, in addition to the bleed, some herniation. This is when part of your brain moves to a place in the skull where it doesn't belong, usually because of increased pressure in its original location. Brain herniation is usually followed by death.

In other words, our patient would likely be already dead if not for his ventilator. The docs and a social worker set about contacting his family to get their permission to "wean" him from the vent. Word on the floor is that the patient is estranged from his wife and kids, so nobody expects them to disagree with the plan. I left before they were reached.

I've previously cared for patients who were not going to live much longer, but today's was the most immediately impending death I've encountered. It's weird, but I don't feel the overwhelming sadness I've felt with past patients. This probably has something to do with the fact that two of the prior patients with fatal diagnoses were newborn babies. It probably also has something to do with this guy's white supremacist tattoos. Does that make me a terrible nurse (in training), if I don't get that upset when an asshole dies?