A beautiful thing happened today...

  1. 31 You know the 90yo LOL/LOM, advanced dementia, has an advance directive stating DNR & comfort measures only, sent in from the facility by ambulance because they're "just not themselves". You know the one I'm talking about.

    You carefully place the advance directive on the top of the stack of papers sent with them from the facility, place the chart in the rack for the doctor, and don't begin any interventions because it's clear that the person has end stage disease, and it's clear from the advance directive that the person doesn't want any aggressive intervention.

    But of course, the doctor orders bloodwork, fluids, and a cath UA. Who here hasn't had to pry apart the contractured legs of a demented LOL that doesn't understand what you're doing down there, or have someone hold down the hands of the demented LOM so he can't hit you when you stick the tube in his urethra? Who here hasn't felt like dirt poking those birdlike little arms a half dozen times, trying to cannulate spiderweb thin veins to have them blow, one after the other, all while knowing this was not what the person wanted?

    Family members stand by, wringing their hands helplessly, wanting you to do something to "fix" Momma, to make her better so she can go back to "living" at the facility. There is no fixing here! This needs to STOP, you want to tell them. And yet, you understand their reluctance to "give up" on their loved one; their grief.

    Today, my LOL was admitted to the hospital. The hospitalist who came to see her had a heart to heart with the family, explaining to them that even though we could fix this particular problem, we could not fix the bigger problem; that she was at the end of the road, and that here was an opportunity for her to die peacefully, in comfort, surrounded by family, rather than prolonging the inevitable with needles and drugs and tests and procedures. She explained why antibiotics and IV fluids are not comfort measures, and what kinds of things could be done to keep a person comfortable during the dying process.

    I went into the room and removed all of the cords and cables, discontinuing cardiac monitoring and vital signs. I stopped the antibiotics and IV fluids ordered by the ED doctor mid-infusion.

    "Thank you" said the LOL.

    I bundled her up in warm blankets, and draped her with one of those quilts sewn by the volunteers that we're supposed to give to the sick children who come through. She didn't know I gave her a special quilt, because she couldn't see, but her daughter at the bedside saw and knew. I packed up her belongings into a plastic bag and sent her upstairs to the inpatient unit, to die.
    Last edit by Anna Flaxis on Sep 18, '11
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  3. Visit  Anna Flaxis profile page

    About Anna Flaxis, ASN

    Anna Flaxis has '11' year(s) of experience and specializes in 'Emergency'. From 'U.S.'; Joined Oct '10; Posts: 2,396; Likes: 6,465.

    12 Comments so far...

  4. Visit  Altra profile page
    6
    That is a good day, Stargazer.

    JRP1120, RN, nrsang97, MaryAnn_RN, and 3 others like this.
  5. Visit  mochamonster profile page
    3
    That is beautiful, thanks for sharing. Hopefully she dies with some dignity with her loving (and well-informed) family with her. Bless you!
    JRP1120, RN, nrsang97, and Anna Flaxis like this.
  6. Visit  orthonurse55 profile page
    4
    Beautiful. Thanks for sharing. And thanks for a well informed hospitalist who is not out to save the world!
    Jarnaes, Orange Tree, JRP1120, RN, and 1 other like this.
  7. Visit  Ruthiegal profile page
    3
    Thank you for being a loving and caring nurse.
    Jarnaes, JRP1120, RN, and Anna Flaxis like this.
  8. Visit  Anna Flaxis profile page
    0
    Quote from Ruthiegal
    Thank you for being a loving and caring nurse.
    Actually, I'm an uncaring nurse lacking in compassion. But thanks all the same!
  9. Visit  JeneraterRN profile page
    3
    Your loving care made the end of her life much easier. It was also a wise hospitalist to see the entire picture. May your LOL find rest.
    Jarnaes, JRP1120, RN, and Anna Flaxis like this.
  10. Visit  Pixie.RN profile page
    3
    I cannot tell you how different it is to be in an Army ER ... I think the oldest patient I've seen was 81, a retiree who lives in the area. Most of our patients are young-ish (but you'd better believe the sick-sick ones show up on my shift, haha, that hasn't changed!). I do not miss taking care of the numerous geriatric patients in the manner you most aptly described, Stargazer -- when it feels like a violation, not the kind of comfort care they need. And we need about a gazillion of those hospitalists to return the dignity to our aged population. Thank you for this.
  11. Visit  nola1202 profile page
    1
    I'm suprised the hospital let her stay, most hospitals, even if the loved one is minutes away from death (i remember one with a heart rate of 40 and irreg, no bp to speak of, the hospital called hospice and I wondered if they'd get her before she died or if she'd die on the way to the hospice. I've worked utilization review and couldn't find a way to make a dying person fit criteria, ironic.
    Anna Flaxis likes this.
  12. Visit  Anna Flaxis profile page
    0
    Quote from nola1202
    I'm suprised the hospital let her stay, most hospitals, even if the loved one is minutes away from death (i remember one with a heart rate of 40 and irreg, no bp to speak of, the hospital called hospice and I wondered if they'd get her before she died or if she'd die on the way to the hospice. I've worked utilization review and couldn't find a way to make a dying person fit criteria, ironic.
    Our hospital has a Palliative Care Team and a Comfort Care order set. I've taken care of many comfort care patients on the inpatient unit.
    Last edit by Anna Flaxis on Sep 19, '11
  13. Visit  prmenrs profile page
    1
    Good job for you and the doc. And the family.
    Anna Flaxis likes this.
  14. Visit  Anna Flaxis profile page
    1
    Yes, I definitely give a lot of credit to the family for being open to it. I understand how hard it is to let go, and how it must feel like you're failing your loved one somehow. I think we're so ingrained in our society to resist death at all costs.
    Jarnaes likes this.
  15. Visit  ~Mi Vida Loca~RN profile page
    0
    Quote from nola1202
    I'm suprised the hospital let her stay, most hospitals, even if the loved one is minutes away from death (i remember one with a heart rate of 40 and irreg, no bp to speak of, the hospital called hospice and I wondered if they'd get her before she died or if she'd die on the way to the hospice. I've worked utilization review and couldn't find a way to make a dying person fit criteria, ironic.

    We have an acute hospice unit at the 2 hospitals the company I work for runs. This case just mentioned would be exactly the type of patients that would be sent up there. It's usually those that have hrs to a few weeks. Very nice units. I actually think it's great. Patients like this should go to hospice, whether in a hospice facility, hospice in the hospital or at home. Much better then dying in a hospital room. The hospice unit in our hospital is utilized a lot.


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