The Patient I Failed - Page 6

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  1. Sep 9, '08 by
    Sometimes family members are thinking about themselves instead of their loved ones. It takes an incredible amount of love and strength of character to let go.....say good bye for the last time. My dad the the baby of his family has watched his entire family of origin die and each time with great love I saw him make and carry out a decision either not to seek further treatment or limit it so they could die in peace. So it does happen even though I see the opposite every day. There is hope for a better way.
    pyriticsilence, UnicornNinja, and nerdtonurse? like this.
  2. Sep 9, '08 by
    What an eloquent way to describe such an awful situation. I have printed this out and am going to have all my children and husband read it, and let them know I will haunt them if this happens to me! I can't imagine how the daughter will ever forgive herself if she ever realizes what she has done. The physician should be drug out in the street and shot for allowing this to happen. I've seen docs act in both manners, protective of the patient's rights, and also afraid to stand up to an ignorant family member throwing their weight around. I can only surmise that the daughter had some tremendous issues of her own to deal with, and likely needs counselling and prayers. I do think this article should be submitted to a major publication (non-nursing) so others outside our field can have some idea of the issue and begin dialog. Congratulations on a well written piece!
    june42, maelstrom143, frenchfroggyRN, and 3 others like this.
  3. Sep 10, '08 by
    sorry to hear that about your grandmother i know that losing someone you love is really difficult, but thank goodness the right choices were made!!
  4. Sep 15, '08 by
    Just beautiful....
    nerdtonurse? likes this.
  5. Sep 17, '08 by
    What a sad and beautifully written story. If I am ever facing the end of life in a hospital ICU, I hope I have a nurse with a heart like yours.
    nerdtonurse? likes this.
  6. Sep 17, '08 by
    So sad but so often true.
    nerdtonurse? likes this.
  7. Sep 17, '08 by
    My goodness! I had no idea I'd win. Thanks for all the votes.

    And I've taken up the suggestions, both public and private, that I do something with this, and I've sent it to Reader's Digest.

    Thanks again!
    neenan242, pyriticsilence, june42, and 6 others like this.
  8. Sep 17, '08 by
    had me in tears thank you so much for that story
    nerdtonurse? likes this.
  9. Sep 17, '08 by
    I couldn't have expressed that experience better, even though I've lived it many times.
    I was fortunate enough to stay with my mother at home during her passing and able to continue her comfort measures despite my siblings' protesting.
    Today is the anniversary of that day. Thanks!
    nerdtonurse? likes this.
  10. Sep 17, '08 by
    Re:

    So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

    "I do not wish my heart to be restarted through usage of any
    chemical, mechanical or physical intervention..."

    Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.
    As far as I know, the initial decision to perform CPR was correct. A living will applies only if the patient is terminally ill or permanently unconscious. Some states prescribe a period of time in which death is expected to allow invocation of a living will. In Pennsylvania at least,

    http://www.aging.state.pa.us/aging/l..._brochure1.pdf

    The advance directive or living will declaration
    becomes effective when:
    • Your doctor has a copy of it; and

    • Your doctor has concluded that you are incompetent and either in a terminal condition, or in a state of permanent unconsciousness. For terminal conditions or permanent unconsciousness, a second physician must confirm your doctor’s conclusion.
    Since the woman in question was neither terminally ill nor permanently unconscious when she collapsed, paramedics would have attempted to revive her even with a living will right in front of them. On the other hand, it sounds like the living will should indeed have taken effect after the efforts in question failed to prevent irreversible and terminal brain damage.

    I went through a similar situation in which my father, who had Lewy Bodies' disease (per autopsy), stopped eating and drinking. I was going to have a feeding tube put in because I envisioned him being hungry and thirsty. (The subsequent Terry Schiavo case certainly reinforces this perception, although I understand that they would not offer her liquids by mouth either). Also, his living will said only that he wanted to refuse CPR and artificial ventilation, not artificial nourishment.

    (Perhaps fortunately) he died before I could act on the feeding tube. Furthermore, none of his doctors ever pronounced him terminally ill, so I am not sure I could have even refused CPR or ventilation on his behalf. One ER doctor (he was taken there after being unresponsive in the nursing home) asked whether I wanted anything done if his heart stopped, and I told him I had no idea because he had never been pronounced terminally ill as my state's living will law requires.

    Although in this case it sounds like a family member was indeed an obstacle to the patient's wishes, the doctors also have a responsibility to make it clear (in writing) their belief that heroic treatment will only prolong the dying process. This is a legal requirement in my state.
    june42 likes this.