I remembered the first time little Agnes Maglin* came by ambulance to our emergency room. She was one of our "regulars": nearly every other week she could be counted on to pay us a visit for one thing or another.

Agnes was in her late eighties the first time we met. She had a whole myriad of serious medical problems: problems involving her heart (which was, by the way, enlarged to twice its normal size) and lungs (she had asthma and COPD), congestive heart failure, kidney problems, diabetes, arthritis, poor circulation in her legs, edema (swelling of her ankles), and psoriasis, among other things. She was tethered to a portable oxygen tank; you could hear her wheezy, labored breathing as she was wheeled [by gurney] by paramedics to a cubicle in the E.R.

The lady was really sick, sicker now than we had realized. We knew we had to act fast or else she wouldn't last much longer.

Agnes' worried daughter (who was in her fifties) stood by her sick mother's bedside as she gave me a detailed medical history, which I took down on the sick woman's chart. The daughter said that Agnes had been fine earlier in the day, but by mid-afternoon, her breathing became labored. It eventually got worse, so the worried daughter ended up calling for an ambulance for her mother.

Now Agnes was in our emergency room, gasping for every breath, eyes wild with fear.

Dr. Ram, one of our chief E.R. docs, tried to reassure the old woman while he slipped an oxygen mask over her face and gave her a shot to ease her (labored) breathing. In the meantime, I started an I.V. line in one frail, age-spotted arm, while another nurse (Kerry Weaver) hooked Agnes up to a portable EKG machine.

The woman was not doing well at all, judging from her vital signs. Her heart rate was tachycardic (beating at over 140 beats a minute), her pulse was weak and thready, her blood pressure was through the roof, and her breathing was dyspneic (labored, gasping).

We tried to ease the suffering woman's discomfort when suddenly, without warning, her head flopped over to the one side as she slipped into unconsciousness. The heart monitor began emitting a high, loud, shrill whine, which prompted us into action. The woman was going into a state of ventricular fibrillation, which meant that her heart wasn't beating normally, wasn't pumping enough oxygen to her system. She was going downhill fast.

I apologized to Agnes' daughter as I shoved her out of the room and told her to wait in the waiting area while we tended to her dying mother. We would do all we could for her, I told her. I quickly returned to the table, where we continued to work on the old woman. Dr. Ram was on the bed, doing CPR, pushing on her chest, while Kerry squeezed an Ambu bag to breathe for her, while other nurses injected lifesaving meds into her I.V. tubing--anything to try to revive the dying woman.

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Our efforts were in vain: no matter what we did, we couldn't get her back. She remained asystole: without breath, without pulse, without a discernable blood pressure reading. She was at death's door. She was ready to check on out of here.

We worked on Agnes for over an hour and a half. At eight thirty that night, Dr. Ram and Dr. Brady both pronounced her dead. When we told her daughter that her mother had passed away, her keening cries soon filled the waiting room halls. It was heartbreaking. It was terrible. It was one of the worst experiences we had as doctors and nurses. Oh, we knew we couldn't sae every patient that came to our E.R., that death was a part of life itself, that it was normal, but still, when a patient died, it hit us hard, hit us like a ton of bricks.

Now whenever I see a little old lady come to our E.R., my mind goes back to Agnes Maglin, and I wonder if we are trying to do the right thing in trying to prolong their life when they are already sick or suffering, and whether we are doing it only to relieve worried family members.

This is when nursing becomes a trial; it makes us question our abilities or our beliefs regarding health--or human lives in general.

*not her real name.

~Written by Louisiana M. Sandusky, R.N., Nashville, Tennessee.

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