Speaker 1: It took me about a half hour to drive to
missus Crabtree's house. I'm fine, just get there, since I've
technically finished both for the supervised visits I'm required to do.
I was voluntold to spearhead of solo shift. I can
handle it. I look through the binder. Natalie gave me
irregular breathing, glassy eyes, modeled discoloration on the feet and knees.
The last few times Natalie and I worked missus Crabtree's house,
nothing of note ever happened. I just doom scrolled on
my phone for most of the twelve hours that I
was there. Half the time. She's not looseid enough to
acknowledge anyone in the room. For the most part, Natalie
handles all the family stuff. I'm just there to be
a sponge, take notes, get through the steps. Natalie called
out today, you're already so understaffed as it is. She's
my lifeline. As embarrassing as that is to admit. Minutes
away now, I had to get gas on the way there.
This always passes. I just have to ride it out
and do my job. I skimmed that binder. I know
I did every single page. I flipped through is sitting
in my bag right now, and I can feel all
of them five minutes away. Now. I met at the
door by a disheveled woman, her eyes bloodshot, her nose running.
She's wearing the same pair of pajamas she was wearing
a week ago. She managed to eat today. That's better signs, right,
I mean it was only a bit of jello and
chicken broth. But yeah, that's a very good sign. I
tell the woman. She thanks me anyway. Inside the house
looks so different than the last time I was here.
Before I even start doing anything, I have to go
through my notes and do some pre charting. Diagnosis already
filled in Louis body dementia, brain degenerates, the body does
what at once? Code status do not resuscitate, already document
it oral intake one jellow cup, some chicken broth. Cognition
status dis oriented times three, mobility status that bound. The
woman told me that she asked for food on her
own today, first time since coming home from the hospital.
I asked her if she'd managed any full sentences since
our last visit. She thought about it for a second,
not exactly, she said her mother would start talking, but
it was like she was picking up a conversation from
somewhere else, days ago, months, maybe years, by coming back
to a video and it's playing where you left off.
In the living room, A man sits in a chair,
eyes locked on the screen, not really watching it. But
my grandfather was passing. I locked myself in my room,
didn't come out until it was time. I asked the
woman if there's a specific pattern she noticed, maybe a word,
a particular subject she can't let go of. She says
her mother has been narrating things out loud, step by step,
like she's teaching someone. Only her hands don't match what
she's doing. She's talking about folding towels, but her fingers
just keep doing the same thing, opening and closing, opening
and closing, same motion every time that she's grabbing something
that isn't there. Hour is it a time, yeah, only
stopping when she finally falls asleep again. Lbed patients do
weird things with their hands. It's in the binder somewhere,
So how long, the man asks me. I tell him
I won't no specifics until I get up there and
check her vitals. I checked her this morning. She kind
of recognized me, at least seem more aware of her surroundings.
He says. I tell him that's a good sign, that
any deviation from her dull, confused state is a small victory.
This tone only barely shifts. What are we celebrating? She's
one step closer to knowing what's about to happen. I
continue up the stairs. I don't have a response. The
last time I checked on her she was sound asleep,
he says. We make it to a room. I lightly
knock and make my way in. At the edge of
the bed, missus Crabtree is sitting upright, eyes fixated forward,
completely still. I open my bag, take blood pressure, then pulse,
go to the list. She isn't moving no matter what
I do to react to anything. The man and the
woman look worse than they did downstairs. The woman comes over,
places a hand on her mother's shoulder, frantically trying to
get her to react anyway. Hey, it's me. Where do
you think you're going? Can you hear me? Hey? Mom,
tell me what's going on? You're supposed to be laying down?
Still nothing. I managed to slip the cuff in the
gap between her shoulder and upper body and secure it
to her arm. The man stole the doorway, just standing
still and watching his grip on the door handle getting tighter.
As the scene unfolds, the woman turns to me. Why
isn't she moving? Why isn't she reacting? What's happening to her?
Blood pressure is done? When eighteen seventy six? This can't
be right. Her charts showing a SETI downward trend consistent
with decline. Last time I took her reading, it was
hovering about eighty over fifty four before that ninety four
or sixty. The cuff must not be calibrated correctly. I
take it off, hit the reset button, and then I
try again. No change. The woman looks to me for answers.
The cuff titans when eighteen were seventy six, same reading.
I tell the woman to step back a bit. She's
still angry visibly, so I tell her it's okay, it's
not I've seen this before. I haven't that. Her blood
pressure is about the same as it was last time.
The woman moves aside as the man finally steps into
the room. He convinces her to calm down, that I'm
doing my job. To give me space. They leave the room,
and I hear their muffled conversation outside the door. Paull's
socks is next. Remember the steps. Make sure you actually
turn it on. Hold on the button, light flashes. I
hear the beep. It's working. Oh two at ninety eight
pulse rate. Eighty numbers wrong. I take it again. No change,
only because I got this one from the clearance aisle
at CVS. Natalie gave me the one from the facility.
Same numbers as before. No decrease or increase. I note
it in the chart. When the next nurse gets here,
I'll use theirs. It'll be fine. I begin the neurological assessment.
Touching her shoulder yields nothing. Saying her name doesn't work either,
still not moving. I take up my pen light to
check her pupils and see if she can track my movements.
Eyes are still forward, pupils are severely dilated. No constriction
after shining the light either. If i'd the urge to
call Natalie, no, not on my first solo shift. It's fine.
Autonomic dysfunction is common with LBED patients. Pupil abnormities can
happen it. I waved the light back and forth again,
no visual tracking. It's too risky to try to reposition
her fall risk patient found seated at the inter bed
and assisted, unable to move without risk of injury. We'll
continue to monitor. A few pillows behind her and to
the side, and some to the front should suffice outside
the door. The muffled conversation is barely audible, but still
carries some urgency it did when it first began. Heading downstairs,
the woman was mid sentence. Attention immediately focused on me.
How did she move? Did she did she say anything?
The answers came almost word for word from the chart,
albeit a bit nicer and less clinical. She isn't having
it before anything else is said. She's halfway up the stairs.
My pace matches her urgency. At her room now the
door is wide open. The pillows are back in their
original place. Missus Crabtree laying on her back, deep into sleep.
The woman lets out a sigh of relief. She thanks
God that her mother is okay, sleeping in bed as
if the last ten minutes never happened. She lowers her voice.
Distant sounds of the TV make the quiet a bit
more bearable. I stare at the pillows. I can't dwell
on what we saw fall risk patients resting in bed
no signs of injury. Will continue monitoring the next few hours.
Drag on. Missus Crabtree has been sleeping since the last assessment.
Her breathing patterns have become a bit more laborious. Not
the exact kind of watch out for, but worth a
mental note. The anxiety has calmed down a bit ever
since the man and the woman also took it upon themselves.
The map back to phone scrolling and occasional staring contests
with the window. Nothing really interesting WITHO. Looking at rural
Texas has trees, grass, and more trees, with the occasional
bobcat or coyote making their way through both. The cell
service is decent, at least one of the few small
towns that actually has a five G tower, which is
about as close to a compliment it's going to get
feeling restless. I go downstairs to get a cup of
coffee and find the TV on, but the man absent,
still asleep somewhere. Can't blame him. On my way back up,
the unmistakable sound of an eas warning Blair's this is
not a test shelter in place, avoid windows. There's more
warnings here than actual emergencies, you kind of get used
to tuning it out. Back in the room now, missus
Crabtree is still sleeping, same routine as before, scrolling, listening
for changes, rinse, and repeat. Her breathing is noticeably different now,
not the labored rhythm noticed a few hours ago, the slower,
the gaps between breaths are stretching. Exhale silence. The stopwatch
reads fifteen seconds. Downstairs, the muffled conversation between the man
and the woman is getting louder, and they're awake again.
Exhale twenty seconds. Murge to go tell them slowly building,
I have to make sure it's actually happening. Exhale silence,
thirty seconds. Only Natalie were here to keep counting. Exhale
silence forty five seconds. I think about my own loss
years ago in the similarities. Exhale silence. Once you hear
the death rattle, they go from days to hours. It's
a checklist, she'd tell me, fifteen years of watching people
die the same way, anything becomes clockwork. Staring at missus
Crabtree for any signs of life, I go from actively
counting breaths to feeling for when the pulse finally stops,
two fingers on her wrist. Still there, slowing down now,
the conversation downstairs getting louder. In my head pulses, growing weaker.
It's harder to place. I call Natalie. No, I can't.
I don't have it in me. I could be wrong
about it anyway. One more beat, silence, nothing. I just
sit in the room. The time reads three twenty eight pm,
looking at the door I need to open. Feels paralyzing.
Natalie is usually here to handle any in all family stuff.
I'm just here to be the sponge, to write everything down,
administer Med's help in any way I can without having
to worry about saying the wrong thing. There's a man
and a woman down there dreading the news. I'm about
to bring them at Times, says four thirty pm. This
crabtree has been laying in the same position since I
noticed her last heartbeat. Walking over to her for one
last check before I ripped the band head off, I
noticed that her eyes are completely open, not partially closed,
not closed at all, wide open, not terribly uncommon with
death and paarimmortal muscle relaxation. It's one of the binder sections.
I'm sure I grabbed my pen light and shine it
in them. The pupils immediately contract. The time now reads
four forty five pm. Grabbing my binder, I flipped tough
this section in ocular nerves. Nothing's helping me. I have
no frame of reference for this. Did I miscalculate the
breaths the pulse? What possible reason could there be for
her eyes to be responsive? Now? I placed my fingers
on her wrist again, it's cold. Nothing beats under my fingers.
Maybe a bad area of circulation. I try the other wrist, nothing,
same temperature her neck. Next. My final test is putting
my head against her chest. Still nothing, not one single heartbeat. Yet,
her pupils contract every time I shine a light on them.
If there's any time for my pulse socks to actually
work now would be great. I get it out, reset it,
place it on my finger, working normally one ten bpm
ninety five percent. Taking it off, I reset it once
more and pry missus Crabtree's finger off the side of
the bed. Clipping it on and gives a flat line
for the bpm. But an oxygen level of thirty five percent.
Something can't have oxygen saturation without a heart to pump it.
No rise and fall of the chest either. Taking the
temperature now I get a reading of ninety four point
eight fahrenheit. There was that by the door reads seventy two.
I have to be wrong. Peripheral Shutdown, page thirty two
A section D twelve. As the body declines, the veins
on the arm get more visible, pulse slows down, body
temperature fades, consistent with my notes, a sudden knock on
the door. The man and the woman must have heard,
the rapid shuffling of feet, and the time I thought
I had to rationalize everything happening in their absence has
come to an abrupt end. In front of me is
a patient that defies explanation. Behind me is a family
waiting for one. As the door opens, the old woman
lay motionless in her bed, eyes now closed once again,
no pulse to account for, no signs of life. I
tell the woman in the doorway that her mother's vitals
are about the same as when she took her nap earlier.
She asked me if her mother said anything. I tell
her no, that she's been quiet. The woman pauses and
stares into me. I've seen that exact look from Natalie
without saying anything. She makes a beeline for her mother.
She grabs her hand. It's cold, but she's always cold.
Now stiff, but her arthritic hands haven't been any different.
She looks over to me, teary eyed, asking how much
longer she has I don't answer. The woman doesn't wait
for one. She steps out, the sound of her feet
descending the stairs. Once more alone in the room again,
her chest is rising and falling, agonal breathing. Seen this
many times in the er, especially with cardiac arrest patients.
The body hasn't caught up yet. Doesn't mean that she's alive.
But that happens when someone drops suddenly, not gradually. The
heart attack trauma, not someone who's been declining for months.
Her heart didn't stop without warning and wound down. That
the same thing. I have to get back to charting
hand patient rests and comfortably vitals obtain, blood pressure unable
to obtain due to patient positioning science, strokes, respiration noted,
respiration shallow and irregular. Will continue monitoring. Just as I
finish writing, one of her fingers is moving, tensing and
flexing back and forth. Only one, the index finger on
her right hand, same one that gave me a flat
line with an oxygen level of thirty five percent. It
happens on the other hand, index finger flexing back and forth.
Her eyes are still closed. The chest to stop moving again.
The movement of her fingers on her right hand is
now fluttering emotion perfectly in sync with her left. Ten
minutes pass the fingers haven't stopped. Every time I glanced
at her motion, It's still there, steady and synchronized. Can't
dwell on it. Chart needs finishing. Fine motor tremors noticed
in bilateral index finger consistent with LBED symptomatology. Fine motor tremor.
No other change is noticed. We'll continue to monitor time
for another neurological assessment. I grab my pen light to
check the pupils again, expecting to have to lift her eyelids. Nope,
open constricting pupils just like before, but no other movement
to note. Moving the light back and forth horizontally yields nothing.
Still looking ahead, moving the pen vertically is when the
eyes lock onto the light. The time now reads five
two PM. I don't know how long I've been standing here,
when exactly I put the penlight away, but it's now
in the pocket of my bind there. My first instinct
is to open it, flip to the page that has
all the answers, and the hum of the air condition
is louder. Now looking down at the old woman again,
her eyes are still open, fixated on the area where
the pen light was shining from. Is not moving. Checking
her pupils again with a pen light, the vertical track
from earlier is gone, not tracking vertically or horizontally now,
eyes still in the same general direction they were. Pupils
are contracting again when the light hits, this time at
the exact same rate, both pupils returning to the exact
same size, like watching two camera apertures sink together. Her
fingers start back up, moving faster with both sets of
flexing and twitching in a choppy, glitch like rhythm. Arms
are motionless at her sides, the wrists turned towards me.
I take a step back, eyes watching her hands. I
nearly trip on the chair behind me. She stops everything
does My phone vibrating cuts to the silence. Natalie, Hey,
just checking in my bad about today. Can't stop throwing
up last night and I woke up with like a
fever of one of the three throat's killing me too.
How's Crabtree doing? Is she doing okay? No, you're fine.
It's been all right. She's been very quiet and a
whole lot of changed since last time had all Oh,
thank god, good to hear. How's Jake and Allison? Jake
and Allison, I type it back. They're coping in their
own way. I think Jake's been glued to the TV
most of the day. Allison's come up to check a
few times, but she's been sleeping, so not a whole
lot of back and forth conversation going on. She mentioned
any changes before you got there, or was she awake yet,
just that she's been moving irregularly, muscle spasms, repeated hand motions,
that sort of thing consistent with lbed symptoms. So far.
Do you notice anything weird about her breathing yet? Her
heart rate only slightly When I took vitals earlier, everything
was pretty normal. Heart rate a bit lower from time
to time, about as normal as it can be. From
what's happening. I guess that fits. If you need anything,
let me know. I'm gonna try and get more sleep,
but don't feel bad for waking me up if you
have any questions. Also, be careful when you leave. The
roads are backed up really bad right now, thanks a lot,
I will do you know what's happening? Huge pile up
on I thirty five ambulance just swerved into oncoming traffic
going like ninety Holy shit, right, I'm wondering if the
dude had like a medical episode or something Caesar maybe.
I don't know. I just saw a clip show up
at my feet and instantly recognize the exit. Anyway, talk
to you later, Good luck, you got this, text me
before you leave or call We'll do. Thanks. I put
my phone down. Nothing, well, not exactly nothing. Her head
shifted in the direction where I was standing. The time
is now five fifteen PM. I can see small muscle
flexes in our cheek, the faint sound from her mouth
almost too to hear, teeth on teeth, I come to
think of it, she's the only geriatric I've met that
actually still has them, has had at this point. The
specifics betray everything I've ever known. I'm way too restless
to deal with it right now. Being sedimentary for this
long as making my legs fall asleep, and I can
hear the sounds of someone washing dishes and the faint
beeps of a microwave keep hat downstairs seems weird if
I don't make an attempt to at least try and
socialize with them. Downstairs, the man is in front of
the sink, scraping grease off of a very expensive looking
cast iron skillet. The woman is on face time with
someone sitting curling up on the couch, surrounded by empty
water bottles and crumpled up balls of tissue. I make
my way into the kitchen. My dad has one just
like that. I said to the man. Nearly took my
head off, and I told him I'd put it in
the dishwasher. Oh I who would be livid? He says,
half laughing. What's the deal with that? Does it render
it completely unusable or something? Oh? No, But the way
cast iron works is you have to season it. So
it's like you spread a thin layer of oil on
it and then put it in the oven so it
forms this like nonstick coating bakes onto the metal, helps
it not rust and shit. So the soap do? So
what does soap do? Removes the coating makes it a
pain in the ass to deal with. Not very versed
on cookwar, and the subject isn't particularly that interesting, but
it's a good break from everything happening today. Yeah, that
makes sense. Yeah, and it usually takes like multiple times
in the oven before it's done. Right anyway, Right, where's
your uh? Where's y'all's bathroom? Matt? Keeping a conversation going
has also not been a strong suit for mine either.
Through living room. Right as you get to the front
door on the left, the woman phone in hand is
now up from the couch, pacing back and forth in
the living room. I could hear her talking about her mother,
about how she's been that her favorite hobbies are currently
sleeping and staring at the wall. Her voice trails off
as I shut the door. I'm halfway up the stairs,
getting closer to the door. Hey, you going somewhere again.
The old woman is standing next to the bed, face
in the doorway. Gay's fixed in place. You can hear me, right, Mom,
I'm right here, missus crabtree, what you're doing? Huh? Can
you tell me what's going on? And now she can't.
But it helps keep up appearances if I at least
entertain the idea. She keeps turning her head every time
I move around. Has it moved a muscle otherwise? Was
she doing anything like this earlier? Where were you? I
don't have a response. Will you looking at hey? Mom?
The old woman's head snaps to look at her daughter,
tracking her hand movement. Hey, look at me. Okay, you're okay?
Can you hear me? As soon as the woman's hand
pulls away from her mother's cheek, the old woman grabs
her wrist with both hands. Mom, Hey, you're okay. What's
before she can finish? The old woman's teeth dig into
her daughter's wrist. She's frantic, swearing at the pain, trying
to process what's happening. Get her off, Get her off,
Get her off. I need to call someone now, I
have to. She won't let go. Right now is when
i'd have a security guard to flag down a button
depressed to get immediate help. Allison, just stay right there,
don't move. I can't backing away now. I hear Jake downstairs,
still cleaning dishes. The sound of the pots and pans
clanging must have covered it. I'm calling nine one one.
You're okay, You're okay, I promise. Just try not to
move her. She's locked into place. The old woman's grip
on her wrist is not letting up blood is now
pooling from the spot she's latched onto. I back away
into the hallway, phone in hand, typing in the number
it rings. You've reached emergency services. All operators are currently busy.
Play stay on the line, and do not hang up.
Your call will be answered in the order it was received. Hey,
they're kids. It's me mister keepypasta. And before we say
good night, I just wanted to say thank you so
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