Watching over you and me,
Wild Angels, Wild Angels,
Baby what else could it be?
I swear I hear the sound of beating wings...
("Wild Angels", Martina McBride) *
("Wild Angels", Martina McBride)
Lew didn't look good when I got to his ranch.
His wife had called me this morning, since I was the on-call nurse, begging me to come out and "check on Lew", who, she told me, had been agitated all night, throwing off his oxygen tubing, acting very confused---in fact, she described him as acting "out of his head".
She told me that he had finally fallen asleep about 4:30 am. But then she called me at 9:00 am because she got frightened when she couldn't wake him up for his morning meds and breakfast. She said he "looked funny" and was "snoring weird."
"And I ain't gonna let you call the ambulance, Bo," she stated, before I could open my mouth. "I promised Lew that I wouldn't send him to the hospital again. You know that he just got out of the hospital recently--- and he swore up and down that he didn't want to go back. Just please come, nurse. Just please come...."
Of course I would come.
I threw on a pair of sweat pants and a t-shirt, grabbed a car-cup of coffee, and took off in the Jeep. I quickly stopped by the office for the little gadget that you stick on someone's finger that reads their oxygen saturation.
And I tore out to the ranch of my patient, speeding and careening my way down the highway just as fast as I could down the highway, and then finally turning off the main road into ranch country, where the roads turn into dangerous thin, dirt-covered, rocky lanes--- and don't even have identification signs to tell you where you are. Ranch country is like that.
On the way, I prayed to The Lord, like I always do when I go out on an "emergency call".
I asked the Lord to help me "do the right thing and make the right decisions."
I asked him to "show me the way---or else show me some kind of 'sign' of what He wanted me to do."
About 10 miles further, I saw a little country church with a sign which read: "What if God is asking YOU for a sign?"
I kept on driving, wondering how to understand that sign.
When I finally arrived at their isolated ranch, which is way off the beaten path, Lew looked terrible. He looked much worse than his wife had described on the phone. And he wasn't "sleeping"---he was actually unconscious. And his breathing sounded ominously like the dreaded "death rattle" which usually heralds death.
He was lying there completely unresponsive. And I began my assessment, relying on my ER days to help me do it quickly and efficiently.
His oxygen tubing was delivering the correct amount of oxygen that he was prescribed. There was yellow urine in his "foley catheter" collection bag. I quickly calculated in my head his urine output amount from the last time his wife stated that she had emptied the bag (and noted hopefully that the amount of his "output" was normal.)
But his skin was cold and pale--and he didn't respond to any of the painful stimuli I tried on him to arouse him from his unconscious state. I quickly took his vital signs and they weren't good ----in fact, to my mortification, he was in shock.
His wife and adult son stood by helplessly as I worked. I tried to get an "oxygen saturation" reading on his finger with my little meter---but the meter wouldn't give me a reading because there simply wasn't enough "perfusion" of blood delivery to his fingers and extremities to give me a reading. I even tried his toes, hoping to get a reading which would tell me the status of the oxygenation of his body----even though I could see with my eyes and ears that even without such a reading, that things were very bad....
This was all bad.....very, very bad.
"He doesn't want to die in the hospital!" his wife declared again. "I promised him I wouldn't let him die there!"
As gently and compassionately as I could, I explained to her that I needed to call the EMS medics. And I also explained to her that I was bound by the law to do everything I could to help him---which in this case meant calling the medics for transport to the hospital. Now, although there does exist in Texas a legal document, which would be signed by a doctor, called an "Out-of-Hospital Do Not Rescusitate", which allows patients to choose to allow themselves to die at home without resuscitation measures, Lew had not generated one--- and so I was bound by the law to call the medics.
And I also explained to her that even though things looked very grim at the moment, that we should still, at this point, hope for the best---and that maybe something could be done in the ER to help him once he arrived there.
And so she allowed me to call the medics---but I had to give them directions to the isolated ranch on the phone. That particular county is serviced by a different EMS system than that which services Podunk's Hospital. And that particular EMS company is less familiar with that part of ranch country. In fact, the medics stated honestly stated that they had no idea where Lew's ranch area was.
Worse still, that particular ambulance system only employs "EMT" medics instead of full-fledged paramedics. I knew that the EMT medics' level of training would not allow them to perform some types of advanced critical care life support functions which paramedics are certified to do. (And it's not that I have anything against EMT level medics, but I was worried that we might get into a serious and complicated Code Blue situation with Lew and might need the advanced skills of paramedics---and Lew's ranch is pretty far away from the hospital, which would mean a fairly long transport time--- and there was the possibility that he might need desperate, life-saving measures performed during that long transport time to the ER.)
Since the medics weren't familiar with the area of Lew's ranch, the 911 operator patched me through to the medics truck radio so that I could give them the best directions I could for the isolated spot we were in--- and "talk them in".
But it still took them awhile to find the place. Several times as we anxiously awaited their arrival, I could periodically hear sirens in the distance---but then the sounds would fade. I knew the medics were getting lost and probably making wrong turns and back-tracking up and down the dirt roads to find the markers I'd instructed them over the radio. It's easy to get lost in that particular area as the roads fork frequently and don't have identification markers.
Whenever I would again exclaim hopefully to Lew's panicking wife the phrase: "I can hear the sirens again--they must be getting closer!" , Lew's wife would respond: "How can you hear the sirens? I can't hear any sirens. All I can hear is all those birds flapping their wings outside..."
It is rather weird how I can hear sirens before anybody else can. But I have finally come to the conclusion that due to all those years in the Emergency Rooms, my ears just got "trained" to hear sirens pretty well. I can usually hear them about 3 minutes before anybody else can. I don't know why I can do that---it just must be an odd idiosyncrosy of mine that I've developed over the years.
Sometimes I even dream that I hear sirens in the distance....
I asked Lew's son to go out into the road to wave the medics in when they finally found the right road, which thankfully happened a few minutes later. The medic truck pulled into the driveway and two big EMT's came barrelling out of the truck, guerney in tow. They barged into the house and headed towards the bedroom.
At the time, I had thrown my shoes off and was lying up in the bed with Lew, trying to hear a blood pressure in his right arm since I had gotten such a crappy, shocky reading on the left one---and I was also trying to measure another pulse rate on him.
And all of a sudden I lost his pulse completely----and then I wasn't able to hear a blood pressure reading at all....NOTHING.
Horrified, I realized that Lew was dying, right in my arms.....
"Lew!" I hollered at him desperately, shaking him by his shoulders in a vain attempt to arouse him.
"DON'T YOU DIE, LEW! DON'T YOU DO IT! HELP IS HERE! JUST HANG ON FOR A LITTLE LONGER, LEW!"
The patient's son, a large, "good ole" prideful Texan man, suddenly got a terrible, pinched look on his face and quickly left the room. I knew that he didn't want us to see him lose it and start crying. I knew that he was like all strong Texan men--- and wanted to keep a strengthful countenance for his desparing mother. Lew's wife got on her knees beside her husband's bed, near his head, and started praying to the Lord. She begged the Lord to do His Will---but yet she also begged the Lord to help her husband.
And when she finished her quick prayer she leaned over and began yelling into Lew's ear:
"Lew! Mama's here, sugar! And The Lord's here, too! And Bo and the ambulance men are here to help you---just hang on, hon! Please just hang on!"
As the medics swarmed into the room, we moved out of their way and I handed one of them the patient's medication list which the patient's son had just printed out from his computer. (I had constructed that list for Lew on the computer just last week, in order that he would have a handy copy of the complicated list to take with him to his various doctors' appointments.)
I quickly gave to the medics a complete report of the patient's medical history and current status as they began hooking him up to their equipment and then began loading him onto a guerney. I helped them transfer him from the bed to the guerney because Lew is a big man and it was quite a task to get him out of a low-to-the-floor home bed and onto a thin medic's guerney.
Being loaded up and slung onto a guerney by medics is never a dignified process---and so I made sure that Lew's genitals were covered and that he was handled as gently as possibly.
My heart began breaking further as I watched the medics attempting to find Lew's blood pressure and pulse----and weren't having any luck getting any readings, just as I hadn't been able to a few minutes before......
The medics quickly loaded Lew into their truck. But they again admitted that they didn't know the area very well and asked me if I would lead them back to the main highway---they admitted that they indeed HAD gotten lost on the way to the ranch and didn't want that to happen again on the way to the hospital.
So first I instructed the patient's son to take Lew's wife to the hospital in their own car--and admonished them to drive safely and NOT speed the vehicle. And then I jumped into my Jeep and pulled in front of the paramedics' truck to get ready to lead them.
And now that I had left the inside of the house, I could hear the faint sound of the beating of the bird wings the patient's wife had been talking about---but, curiously, I couldn't see any birds.
I anxiously watched through the ambulance truck window as the medics got Lew's guerney strapped in securely for the trip. And then they gave me the "thumbs up" sign to go on ahead and lead them to the main highway.
I led them out of the ranch country, up and down the crazy, curvy, rocky, dirt country roads. They couldn't drive very fast because of all the curves. But finally we made it to the main highway and I swerved out of their way so that they could now head for the hospital without me in front of them.
At that point, the medic truck's "emergency lights" switched on and came alive with a blazing array of flashing lights and a subsequent cacaphony of sirens which looked and sounded like a burst of glorious red and white-colored fireworks in a synchronized beat to the sirens' wailings. And then the truck suddenly speeded up and took off down that highway so fast that it was like watching a rocket-fueled race-car take off.
And I was worried.....very worried.
I was thinking about how I hadn't been able to feel a pulse or hear a blood pressure on Lew there at the end when he was in my arms at the house......
In fact, I was so worried that I didn't pay attention to my driving and almost drove my car into a guardrail on a bridge. And all during that drive I kept trying to do things to get my mind off my worries during the long trek back to Podunk's hospital (30 miles)---and I concentrated hard on doing those things so that I could stay calm and not become so distracted by my thoughts that I would stop paying attention to the road and kill myself in an accident. I know it sounds strange, but doing those things while driving is what I'm used to---and it helps me drive calmly. So I did all those "usual" things of mine, singing songs and crazily snapping aimless pictures out the window with my camera. I was sort of like in an "autopilot" mode, just like I always am whenever I'm on long drives on the road. But it was still the most miserable ride I've ever had in my road nurse career....
I just did anything I could not in order to NOT think about the worst case scenario..... I wouldn't let myself think it. No, not Lew. Not one of our company's most beloved, favorite patients....
I kept thinking about how wonderful a man Lew is. Despite his serious illnesses, Lew has always been a jovial, cheerful man---always ready with a joke. And I desperately wanted Lew to get well soon so that he could tell us road nurses funny jokes again and do his favorite thing----which is to roll his wheelchair up to the kitchen counter and make "whomp" biscuits.
Lew can make the best whomp biscuits I have ever tasted---and he always gives us road nurses some when we visit him--- big fat whomp biscuits slathered with creamery butter and Smucker's Strawberry or Peach Preserves....
The medic truck beat me to the ER, of course, but finally I reached the ER myself. I hurriedly parked, jumped out the Jeep, and then ran like hell through the hospital's front door, down the halls (startling bystanders), and into the ER waiting room. One of the nurses at the triage desk recognized me and let me through, into the back area where the patients were.
At the ER nurses' station I asked: "Which room is Lew in?"
The nurse replied: "Uh...Bo, he didn't make it."
"Do what?" I exclaimed, almost choking on my words in my bewilderment.
"He didn't make it," she repeated gently.
I stood there in shock.
Unable to speak.
The other nurses stopped what they were doing, a sudden look of sympathy coming over their faces as they realized that I didn't know that Lew had actually, truly died.
"You didn't know?" the first nurse asked. "Bo, he was dead in the truck. There was nothing they could do...."
And then, as the truth finally dawned, I broke down and started bawling like a baby, right there in the nurse's station, bawling so hard that I couldn't even talk or figure out what to do. So one of the nurses led me into a nearby room where Lew's wife was---and I found her again down on her knees praying to The Lord. And so I joined her there on the floor, on my knees, and we had ourselves a tearful talk with The Lord, Who we knew was there with us.
When we finished, I asked her if the preacher had been called. Just at that precise moment, the preacher walked in wearing a baseball cap with the words "Jesus" embroideried on it. His wife was with him, followed by the patient's son, who had been the one to go out and lead the preacher to the right room.
I simply cannot tell you how comforting it is when a preacher arrives at a hospital room. To me, there is no greater comforting human presence. Podunk's preachers are the foundation of our lives---and they are always there for us whenever we need them.
* * *
Later, after I left the ER and was walking out in the parking lot to my Jeep--- to go home and cry some more--- it happened again that I thought that I could hear the faint beating sound of bird wings flapping, this time beating right over my Jeep. But again, I didn't see any dang birds. And I wondered why in the heck I had been hearing the sound of flapping bird wings all day long....
And then I got to thinking. Ok, I thought, maybe it WAS birds---but it was weird that I hadn't seen any birds. And then I thought, maybe it wasn't birds. Maybe I'm just going crazy. I just don't know. But I DO know that I DID hear something---something like the beating sound of wings. And they sounded like BIG wings....
Maybe you'll think I'm crazy for even thinking I heard that sound---and also for what I'm about to say next....
But....just maybe....just maybe... it was the sound of the Wild Angels' wings....
I came home and cried a lot more. In fact, I'm still crying, every time I think about it. But as I sit here in my home crying for Lew, one comforting thought just occurred to me....
His wife had promised him that he wouldn't have to "die in the hospital". And you know what? I don't think that he did!! Because I had felt his blood pressure and pulse STOP while I was still up there on the bed with him, holding him in my arms while his wife was kneeling beside him talking about The Lord.
And so I don't think that he died in that medic truck. I think that he died right there in his home---just like he wanted to.