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The ED tech walked up to me and said the patient she just put in my room was an asthmatic. The tech said the girl told her that she had just been seen at a clinic. The triage nurse had already given her another breathing treatment but she was still wheezing.

I said okay and walked into the room. Right away I knew the patient was in a bad way but I was a bit taken aback when the first thing she said to me was, “There is no way I am going to stay here tonight.”

I shrugged and said, “Okay,” then went on to assess her. I started an IV and ran to call the doctor because she needed immediate attention. I handed the girl’s chart to the doctor and said, “This girl is working pretty hard. She already had a treatment at the clinic before she came here. We gave her another one but she is still wheezing. The doctor sat there without answering me. After what seemed like forever, she got up and said, “Put a line in her.”

“I already did,” I said and followed her in the room.

The girl was speaking in short sentences and using her accessory muscles to pull air into her lungs. She didn’t look good. Another breathing treatment was ordered and medications. She was sick and it was clear this wasn’t her asthma. I started the medications and she asked me what they were and why she was getting them. I explained to her that she had a lung infection.

“None of this is working,” she said. “Just give me magnesium because that always works and I’ll go.”

I explained, “We looked at the paperwork you brought from the clinic. They determined you have a lung infection. It isn’t just an asthma attack. The infection is working against you and that is why you are not responding as quickly as you usually would.”

“I can’t stay here!” she said. “No way. Just give me the mag, I’ll feel better and I will go.”

She was not rude, just emphatic. She said she had to go home to care for her dog. The dog was old, sick, blind and deaf, and he was outside in the yard in the cold. Nobody was at her house to bring him in and she had no one else to call. She could not leave him out like that because he would not do well. She had not planned to stay; just get treated.

She really didn’t look good.

We gave her a couple more breathing treatments. She didn’t get better. After a while, the doctor told her that she needed to be admitted because she was not improving. She refused. The doctor was not pleased. I talked to the girl. She didn’t outright refuse to be hospitalized but made it clear to me that her primary concern was with the dog. She had to go to care for him. The problem was if she left to care for the dog, her breathing could get so bad that she could pass out, die, go into distress, die or just well, DIE! She wanted to take care of herself. I could see that. BUT…she was really more worried about the dog.

As she pleaded with me to let her go her breathing got worse. Finally, she gasped, “I can’t breathe!”

She couldn’t. She was struggling. Her heart rate was off the charts. She was scared.

I won’t say what I told her because it will make me cry. But I tried to reassure her and begged her to let me take care of the dog and take care of her. I explained that her worried state was exacerbating the situation. I tried to get her to understand she couldn’t do anything unless she got better. She could only get better if she stayed in the hospital. She listened but still would not let me take her up to her room.

Her breathing worsened. I was getting scared for her. We had to get that dog taken care of.

She told me she could find no one to go get him. She had called everybody she could think of. Eventually her phone died and since she had not memorized numbers we could not even try to call some of the people she had already called to beg them to reconsider. Meanwhile, I was getting yelled at for not taking her up to her room. She had been officially admitted now for over an hour or so. Other patients were waiting. We needed the room she was in.

I asked my charge nurse to help. I explained the situation and she said she would help. She called security. The two officers on duty were animal lovers too but it would be considered abandonment if they left the hospital. They suggested we call the PD. They said that if somehow we could get the dog to the hospital, they would take it from there. They would take care of him.

I called the Police Department. The dispatcher took the information.

“He is sick, old and outside and the temperature is gonna fall,” I said. “He won’t survive the night and his owner is admitted to the hospital.”

The dispatcher seemed unclear why it was such an emergency. I explained again that the animal was sick and would not survive the cold overnight and the girl had not expected to have to stay in the hospital. We could care for him if they could just go get him and bring him to us. He wanted to understand.

“Is he contagious?”

“No.”

“Is he going to fight the officer?”

“No.”

“Is he bothering somebody now?”

“No.”

He said he would call me back because he had to run it by an official. I went back to the girl. She was fighting for each breath now. I could not force her to go upstairs and could only call respiratory for assistance. She was failing. I held out hope that I could give her good news.

The unit secretary called me into the hall after about 15 minutes to tell me that the police had refused to get the animal because he was not a threat to anyone. They would respond if the dog was a menace but not in this case.

“They said she will just have to try in the morning,” the secretary said.

We all knew that we could not take the chance to wait until morning because it might be too late. It would be cold for him over night. I called them back and begged for them to make an exception in this case. The police still refused.

I could not tell her. The girl’s condition had deteriorated to the point that we were seriously considering intubation. All I could do was reassure her and continue to ask everyone I saw if they had a suggestion; somebody they could call to help. Nobody could do anything. Nobody could help.

I couldn’t tell her. We were three hours into this. I told the doctor who had just come on duty and assumed the case what was going on.

“What do you think?” she asked. “You think we have to tube her?”

“Yes,” I said.

The doctor told the girl what was about to happen and we assembled the team to put in the breathing tube. The girl started to sob uncontrollably. Her heart rate shot up. I begged her to calm down and reassured her that we were not going to let anything bad happen to her. I told her, she had to calm herself down. I held her to my chest as she cried and whispered in her ear. She began to calm and I watched through my own tears that I dared not let anyone else see as the monitor showed her heart rate slowing…165, 160, 155, 150, 148, 147, 145, 143, 139, down to 125 as I hugged her close.

The charge nurse appeared in the doorway. “I’m going to go to your house on my break and I’ll get your dog,” she blurted. “How do I get in?” Another nurse walked up behind her and said, “We will go together, so you can trust us.”

The girl looked worried.

“How will you get him to come to you?” she asked.

“We are nurses! We can figure it out.”

“Are you going to stay?” I asked her.

“It doesn’t seem like I have a choice. I can’t breathe,” she said, deafeted.

“Well, I promised you,” I said. “You let me handle this and we will take care of you.”

“She gave us the keys and security codes. She had not even trusted to give them to the police.

“His medicines are in the refrigerator,” she said.

I said, “The minute he gets here I will take a picture and show it to you.”

I took her up to the ICU.

This is a picture of the dog, in my co-worker’s arms, in the ED back corridor, safe and warm!!

JoJo_cropped

My co-workers said he ran to them as soon as they turned on the light. He may have vision problems but he sure saw them and seemed overwhelmed with joy to see them. When my charge nurse carried him into our department, wrapped in a blanket, snug in her arms I ran to get my phone to snap a picture.

“I can’t hold him anymore,” she yelled. “Are you kidding? Really? A picture?”

She waited for me to snap the picture, despite her feigned protestations. She does not know I fell in love with her right then. The dog kissed me on the cheek when I leaned over to pet him. I fell in love with him too!

You should have been there to see the girl’s face when she saw the picture. Now she could get better.

It was quite a night. I’m exhausted.

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