Nursing Story: Oh Don Piano (Homenaje a Borges)

We chatted a little as I did vital signs and my morning bedside assessment. He was telling me that he had no family and lived in an assisted-living arrangement, and added that he had a check coming and he planned to move into his own place in the south side of town.

He had been admitted with some kind of neurological thing but none was apparent now and the neuro team had cleared him. There were other little problems, though. He had been developing urinary incontinence issues and he had a history of obstruction; actually, he said that last spring he'd had a kidney removed because of obstructive disease.

The residents wanted me to do a post-residual catheterization and we got a liter-and-a-half of urine out of him so I left the Foley in and let the docs know.

Later he went for an ultrasound of his remaining kidney and urinary tract. He came back from that at the end of the shift as I was giving a report to the oncoming nurse. I settled him in and returned to the nursing station to continue reporting off after getting him a blanket because he said he was cold all over.

I went in to his room to say good-bye for the night and his eyes rolled up into his head and he didn't answer me. I went to get a vitals machine and brought the charge nurse and her orientee into the room. I had walked by the monitors and he was a little bradycardic but in sinus. They said they couldn't feel a pulse and we called the code.

Soon he was intubated and there were a thousand people in the room.

That's when he began to see himself as if from above his hospital bed.


Next he was on the sidewalk beside a man with a brick in his hand. The man muttered that he thought he was Satan, so Don Piano took him to Starbucks for a caramel macchiato and they talked. Eventually the man settled down and went home peacefully. He'd had a very bad day, apparently.

Don Piano then found himself on a school playground where he noticed that a little girl was crying about her cat who had been struck by a car and killed that morning. He sat with her through her classes all that day, then he went to the animal shelter with the girl and her parents and they found the most wonderful kitty... an adult long-haired mostly black cat who immediately took a liking to the girl. Don Piano paid the adoption fees and helped them get the pet to its new home.

One of the nursing assistants who had answered to the code started doing chest compressions because radial pulses were not evident, but the nurse running the defibrillator stopped him for a moment and said that he saw sinus rhythm. I got a pressure in the 120's over 70's. Respiratory continued to bag him.

Evening had fallen and Don Piano was down by the Arizona Center where he saw a man approaching strangers going to the movie theater, asking them for spare change. The man was dirty and reeked of alcohol. Don Piano spoke to him briefly, telling the man that he was never going to drink again. The man said that he could probably stay with his brother for the night, so he did. He went to meetings after that.

We moved him to Intensive Care and I went along because there was just no way the night-shift nurse could just jump into that; besides, another one of her patients was crashing. Another code was called for that one. Like the Keystone Cops, the team members scrambled back onto the unit and into the other room.



Don Piano was placed in an intensive care bed and while the team "lined him up" with a central venous catheter and an arterial line, I reported off, again, to another nurse who would take over from there. He had a rhythm and a pressure but he wasn't breathing on his own and he never woke up.

Outside the home of the man's brother a car sped by. It seemed to be going awfully fast. It spun around the next corner and ran through a red traffic light. Don Piano was in the passengers seat next to the driver. He admonished the young man to slow down and enjoy life.

There were other rowdy young men in the back seat of the car, and one of them chimed in "Yeah, man, why you act so crazy?" and they too told the driver to ease off.

The bleed in Don Piano's brain continued, his intracranial pressure increased and his blood pressure dropped. Vasopressors were discussed, scans were ordered, the neurology team came back on board, but it was too late. His heart rhythm decayed. The hospital chaplains consulted with the ethics committee and it was decided that he would continue life support.

Don Piano hovered over his limp body, then felt himself drawn into a warm darkness. The monitors ceased their blipping noises, the tell-tale flatline appeared, and before long, Don Piano realized that he no longer needed them.

Oh Don Piano.