The Beard Dealing with Failure

Last week on my clinical rotation I was enlisted in removing a breathing tube from a patient. This would be my first "extubation." When I received the order I was excited, as I usually am with a new procedure. I mentally went over the procedure, finished my coffee and headed up to the Critical Care Unit. I was stepping out of the elevator when it dawned on me that none of the intubated patients in the CCU had spontanous respiration. I had been up earlier to do ventilator checks (paperwork) and none of these patients were near being able to breath on their own. As I left the elevator I realized I was about to withdraw "vital therapy" , put bluntly, I was going to nudge someone into eternity. As I walked down the hall I may have said, even aloud "I am going to kill someone." I was not prepared emotionally for the task. As a former radiology tech I know that while everyone in medicine talks about being exposed to death, most medical workers rarely deal with death and fewer than that help facilitate it. When I am emotionally unprepared for something it is usually my way to just do it. This has probably profitted me more than it costs, I think this is compensitory, because I am a sensitive person. By the time I had the order in hand "D/C O2 therapy, per MD request", I was a white coated robot. As I entered the room I realized this was the same patient I had drawn my first real blood gas (a painful procedure used to obtain arterial blood) from a week earlier. Thankfully he was unconcious then and I assumed he had been all week. As his large extended family (tearfully) left the room. I felt better as if they had all given consent and I was helping them do something they could not. I thought about saying goodbye to my own grandfather, which I have yet to do, but have imagined doing. I realized I had to put this out of my mind. I thought what had brought this gentleman and I together, I had poked and prodded him the week before and now here I was to end him. Technically a series of strokes had done the brunt of the work, I reasoned the sin was not taking away his air, but cruelly prolonging his life. Strangely I did feel as if I was his nemesis. I turned on the overhead light and closed the door. My supervisor stood silently in the corner. I put a pad on the old mans chest, I put on some gloves, got a 5mL syringe, I hooked it to the tube and removed the air from the bladder on the distal tube, in one fluid motion I removed his breathing tube and feeding tube. I had forgot to turn off the alarms on the ventilator. They all begin to ring, I quickly muted them, to make up for my forgetting the alarms, I jerked the cord out of the wall. I then put the mucus covered tubings on the pad, bundled it all up and threw it (actually tossed it!) in the red bag a few feet away. Instantly his already low vital signs begin to nose dive. I was surprised at how quicky it had happened. I was glad it was over and felt priviliged for doing the work. My supervisor had told me he was impressed and had considered not letting me do it. So here I am gloating over my kill, when the nurse asks me to put a nasal cannula on the patient (oxygen). I said I didn't think that was a good idea and the nurse (not a big mean one, but a young atheletic one touched my shoulder and said "humor me") I am stupid and because of this quickly set up a nasal cannula and set it to 2 liter per minute. I reasoned since this gentleman was barely breathing he would continue to go, so whats the harm if I put a little Oxygen on him. He continued to nose dive and was probably minutes from death, the family were told they could come back in, most did not, probably thinking it was over. I left and went to another room to suction a another patient, I came back ten minutes later and the guy had good vital signs. The nurse had turned up the oxygen and placed the cannula in his mouth. So a week later he is still not awake and has been moved to medical ward. I have killed no one. He is not going to get better and in the meantime will cause the family emotional and financial distress. I realize my mistake and have learned from it. What I take from this experience is that the process is not more important than the outcome. From this sad episode I got to go to labor and delivery and watch a C-section. The baby was healthy and I got to stand directly over the surgery for open and close. I enjoyed this more than my attempted euthenasia. If you have read all of this please comment to say if you think I am flippant about this, it has troubled me that I feel guilty for not letting someone die.