Well - I did received a call at 12:15 last night. But instead of the patient that is dying, it was my grandma. She had a heart attack and died at 74.
My patient is still holding on. I got orders for Ativan and Scopamine (sp). I don't want her to be frightened when shes suffocating = she is rapidly filling up with fluid. I can't hear any breath sounds in lower lobes, and upper lobes is a terrible rattle/rhonchi. I can't feel a pulse, not even a carotid, and hearing her heart (which is so weak) through the stethoscope is almost impossible with her lungs sounding the way they do - but outwardly they aren't bad yet.
I haven't slept but 3 hours last night, I'm so tired. But I'll explain my patient further.
She has had a few brushes with death. 3 years ago her family was told she would never leave the hospital. She has severe CHF, and is on massive amounts of lasix and spirolactone. Well when she made it through the last time at the hospital, her son is now convinced that she will pull through this. I think she's holding on waiting for the words from him, that it's okay to go. He won't accept it. She's lingering and he won't say it. He still thinks she'll pull through. I can't convince him otherwise even though he has seen and heard her talking to people who are not there and grasping at the air. Talking to her husband (died 30 years ago) and her sister (died 5 years ago). She is barely waking. Her legs are purplish, have been though for a couple of weeks. Her eyes are glossy and almost opaque. She said last night in one of her ramblings, that 'I can't see anything' Which tells me she's lost blood supply to her eyes. She's only urinating about 100 - 200cc/day. Not eating anymore, but I suggested they hold food, only because she has had problems swallowing for some time now, and lately she has no appetite. I am suggesting they offer her boost (nutritional drinks) and water, but not too often because shes so overloaded with fluid that she has +3 pitting edema in her ankles and her belly looks like she's 9 months pregnant. I have implemented a turn schedule every hour if possible. She doesn't awaken when turned. Hasn't had a BM in 2 days, last one was uncontrolled.
It's just hard not being there. But the family is there. I just can't be there all the time.
If you remember correctly I'm the only RN on staff, in fact I'm the ONLY medical person on staff. I had to give the family instructions on when the staff can give the ativan and scopamine. Because I don't feel comfortable leaving the choice up to the staff. I have written 2 page instructions on the meds and that they are recording them (yet they haven't been started as of yet).
I'm going to go check on her tonight. I just wish her son would let her go, so she can go in peace. I plan to talk to him tonight when I go in.
I am doing everything I can to comfort her, to keep her comfortable. As well as give the family plenty of time with her. This is a private run facility. So this is just the way things are done. I have made alot of changes but in no way is this place in perfect running order, I've only been there a month and have changed so many things that haven't been changed in 40 or more years. So change takes time.
Anyway - I plan to go in before I go to bed. Just to check on her. I just don't know what else I can do. It's too late for hospice and it was veto'd by the board but now they are seeing the need, it's too late to help my resident much at this point.
Will she linger until he says it is okay for her to go? Seriously? It may be weeks of her suffering if so.
Anyway - just adding to my rant. I'm so tired, but can't sleep, my head is pounding because of the stress (grandma included of course). I just am a little overwhelmed.
Sorry to ramble a book this time. I guess I really should just be journaling this instead of sharing it with the world, but your kind words do help.
Thank you
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