Blue about Code Blue - page 4
I am a new nurse working on the Oncology floor. The stages of cancer we treat vary from newly diagnosed to metastatic. Some of my patients have good prognoses while others have only weeks or possibly... Read More
0May 7, '13 by Caffeine_IV, BSN, RNQuote from maybelaterRNI disagree that palliative care should be discussed at diagnosis unless they are stage 4 with limited treatment options or none. Most patient want to fight early on. However I think the discussion should come up before they are terminal.I'm a fairly new nurse (just a few weeks shy of a year), working in oncology as well. The situations you've described are the hardest part of being an oncology nurse for me. Unfortunately, the providers I work with do not have end-of-life discussions with patients and their families until the patient is days or sometimes hours away from passing. I've watched multiple patients struggle and be miserable simply because they don't have adequate education about the severity of their disease process and the likelihood that treatment won't be successful. I wish DNR, palliative care and hospice discussions started at diagnosis, and that people understood that DNR does NOT mean "do not treat." While talking about end-of-life care isn't the most pleasant thing for many people, it would enable patients to make educated decisions regarding code status, hospice, treatment options, etc.
1May 8, '13 by CrazierThanYouQuote from chrisrn24I know MANY people who think that and they can't be convinced that anything else is true.My mother thought that DNR meant the person wouldn't be treated.
There needs to be more education about what DNR means so people can make informed choices.
4May 8, '13 by 1feistymama, CNAMy only experience with DNR was with my MIL. She was diagnosed with a very agressive form of cancer just before her 42nd birthday. Her mother had died of a similar cancer, also at a young age, and she knew this would take her as it had her mom. They did chemo only to discover it hadn't made a dent in the progression of her disease. They did a couple of surgeries to remove tumors and in the final surgery, they closed her without removing anything because it was so advanced. She wanted to watch her grandchildren grow up but she was VERY clear that she understood this was terminal and she adamantly refused to be put on a vent.
I was told she had a DNR in place at her hospital, but she was transferred to another hospital in her home town to die there. When I arrived at the 2nd hospital, I was shocked to see her on a vent. MDs at the new hospital had convinced my FIL to put her on one. I was 22 and knew nothing about medical care and all that was involved. But I knew that now my FIL had the burdon of telling them to turn the machines off. I never understood why he would agree to be in that position. But, he was 43 and they were childhood sweethearts. I imagine he just wasn't ready to say goodbye.
The family Pastor showed up and told my FIL she was already gone. The only thing left was a shell, powered by machines. He was the one to let my FIL know it was time to let go. That was 14 years ago and I still get tears in my eyes as I type this. Letting her go peacefully, as she asked, would have been so much easier on everyone and FIL could have avoided the guilt of telling them to turn off the machines.
0May 13, '13 by SNB1014you bring up a lot of points i've been thinking about lately.
my parents are "young" still......57 and 60. but i make no mistake in telling them that codes are heartwrenching, violent and often unsuccessful, and even when they are "successfull"....are they worth it?
i just recently helped an asian family change their son from full code to dnr and placed on hospice. they were very clearly distraught and were scared that medical professionals would "forget" about their son. that is something i hear a lot. "well if i sign that stuff, people wont give a damn if i get sicker".....and i say that is not true!!! their son had went into resp arrest 2x in the past 36 hrs...it was time.
it is important to let families know that to sign a dnr is NOT to kill their family member. many feel this way. a dnr (as opposed to comfort care only) simply means that if during the course of your stay, despite all the abx, cardiac rx, resp tx, supplemental nutrition, that if and when your body decides it is time, that means that we will not pound of your chest and give you meds that will restart your heart.
i just got done caring for a man for a couple shifts who was very specific.....he did NOT under any means, want to be intubated. he had been intubated 2x and he was sick and tired of it. he was sort of tolerating his bipap, his abg was garbage before we changed bipap settings, etc. he said being intubated is the worst and that was a road he wouldnt go down again. ironically, in all likelihood if this man went into arrest, it would be respiratory arrest and would need to be intubated and bagged in order to save his life, but that was not something he was ok with. so i spent a large portion of my shift "playing" with his bipap and keeping him for teetering the wrong way.
i had a 29yr old lady come in for a thyroidectomy. she was going to go under albeit for a overall simple surgery and most of our thyroid pts simply need a trach set at bedside but they are home within 36 hrs from start to finish. i asked her "if there are any complication during or in the immediate period following surgery, do you have any wishes? dnr, POA, etc?" she looked at me like i asked "have you ever thought about *insert something obscure, random and terrible*?"
i also see that there is a very, very special dynamic between the last parent alive and an only child. dear God it is sad and beautiful the way the two are almost codependent, if you will.
idk who said it, but i heard once that it doesn't matter how old you are, when both of your parents have passed on, you feel like an orphan in the world.
last anecdote....when i clocked in in the morning, i heard a code being called sicu 7. and there were like 4 night nurses who rolled their eyes, saying "again???". evidently over night, the man had a code called on him 3x. well by 11am, i heard 2 MORE code blue sicu 7 called. i went to go see on what ended up being the last one. when i got up there, this very frail elderly wife was banging on the glass icu door for her elderly husband to come back to her. she fell on the floor crying and grabbing 2 dr's jacket lapel asking "should we still be doing this? am i a monster? i just want him back" it was honestly just heartbreaking and horrifying. i went in, gloved up and was ready to compress (the morale of the code team was just pathetic, they were exhausted by this point, saddened and i might even say annoyed) when the wife and the attending barged in and she fell on his lifeless body crying "NAME ,sweetheart im so sorry, i love you, i miss you, please come back to me darling. please don't hate me for this, my love. i will see you soon"......it was THAT moment, the sheer agony and love in that old lady's voice for her dying husband that made me understand why some people can't "just" sign the paperwork. because hey, good ol george "came back" the last time we coded him, maybe you can do it again? its a very raw feeling, i think.
the easy answer is to have a living will, a healthcare proxy, a POA, dnr paperwork signed already so that your grieving wife will never ever feel that she would be hated for telling the team they can stop.
here is a website that has the link to all 50 states' official living will forms, and instructions , faq. whatnot.
US Living Will Registry: Advance Directive Forms