Haunted

[CactusFlower]

I am new to the discussion boards, but have browsed thru many times as a quiet observer. Today, I need to get something purged from my soul--I must put it into words and hopefully make some sort of sense to it. "It"" has haunted me, coming into my dreams and caused me to consider what it is that I do.

Not long ago I had a patient who was in her 80's who was a retired nurse, being one all of her working life. She had been independent up untill the accident happened that brought her to my facility. This patient had fallen asleep on her patio smoking, and had burned herself into the chair inwhich she sat. Terrible injury.

Prior to this she had properly made herself a "DNR", and had made sure she had completed everything required to document how she would be cared for if the unthinkable happened. Well, the unthinkable happened.

She died on my unit on full life support--ventilator, PA cath, art line, on continuous renal replacement therapy, several vasoactive drips as well as many more, and survived many complete arrests. Her hand was black from an ill-fated arterial line placement, she was also unable to tolerate pain medications, so these were withheld. She had been taken to surgery two times to remove the burn eschar. This senario was unstopable. I watched and participated in this. Yes, I did my patient advocacy part, but ended up eye to eye with a medical director. I then stepped aside and took another assignment.

I have been a nurse for many years. This patient and her death has stayed with me, shaking me to my very foundation. My thoughts revolve around-- do we do everything that we can, or do we do everything that works?

I have always been proud of what I do. I have fought the good fight, but I feel so much shame and personal pain. I feel that I must right this wrong if I am to continue and am seriously considering a change. I must be able to provide for my patients a kind and gentle death.

Thanks for listening--anyone else out there doing some sole searching?

[CactusFlower]

Putting this in writting has been powerful. I am at the crossroads of my career, I think that I have felt it for quite some time. When I pause to reflect, and re-read the words I first wrote to you in a dark, and depesate moment, I see that I said that I must be able to provide for my patients "a kind and gentle death." Nursing has always been unconditional for me. I feel that I was always a nurse, I was born to be a nurse, and if I have lived before--I was a nurse. I know that doesn't probably make too much sense. I have been the fortunate bystander in so many peoples lives when they were falling apart, how honored I have been. No, I will not give up nursing, but I now have a condition on it. I must be able to provide for my patient death as an option--it is not the enemy. I cannot tell you that just in saying that is liberating. For most of my career it was never a choice; I looked for every hint of death and warded it away. This patient has caused me to take pause and see a whole new picture of what I am doing. For some reason, she penetrated my thick hide, and touched me when I thought there was nothing that ever could again. So, you see as nurses we live and we learn!

[live4today, RN]

Hi CactusFlower :)

Welcome to the best nursing board I've found in the past couple of years! Your post really touched me as a nurse, and I agree with Gwenith...write an article and publish it for others to learn from in your area. Send the article to nursing magazines for the editors to consider for publication as a teaching tool for health professionals. It should also be published in secular magazines for the public to have access to since many of us have already dealt with (or will deal with) loved ones in positions such as that particular patient and her family. Perhaps it lingers on your mind as a sign for you to bring it out in the open and fight for those who can't fight for themselves. You could be their voice since being a patient advocate is many of what nurses are about anyway.

[Tweety, BSN, RN]

Hi and welcome.

Sometimes there is a fine line between "DNR" and treating a patient. A burn injury could have been considered a treatable condition, not a terminal condition, thus the surgeries, the drips, etc., even if it was futile and prolonged her suffering. Was she put on the ventilator in the field, or did she go into resp. distress on your unit and was intubated, that might have gone against her wishes. Definately a case for an ethics team.

To be honest to, your hospital might have been trying to save their butt so it couldn't be proven that the art-line hastened her passing.

Our medical technology can be a terrible thing. Prolonging misery, it's something I struggle with as well as I'm considering moving to crticial care in about a year.

You did right by your patient, you cared for well and when you felt you couldn't give 100% you stepped aside.

[Rapheal]

What elso could you have done? I am sure she would have been touched by how deeply you cared about her and how you tried to alleviate her suffering. You hurt because you cared. Because you care you became a nurse. You are a patient advocate. Keep up the good work. Beth

[renerian, BSN, RN]

I agree with the EThics committee review. Hubby sits on a hospital ethics committee and they review cases like this all the time.

renerian