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?

[WhiteCaps]

Her wishes were not honored. The medical director should have known better!

But, if we work long enough most of us are haunted by situations we wish we handled differently. Don't let it destroy you! Learn from it. Continue to seek answers from administration so it won't happen again. Honor her that way.

She was a nurse, I'm sure she could have understood your position and has forgiven you for your part. :kiss

[Audreyfay]

Do you have an ethics committee in your facility. Request that it be brought to be reviewed. It will not help your friend, but at least they will learn. You did the best you could. I would ask you to care for me or my loved ones...any time!

[Dinith88]

Wow...what an awful case. Why, if the documentation/living will was available to you (and to everyone else with access to her chart??), was she put through this? Was family involved who 'over-rode' her wishes? How could/did the docs justify their actions???

...Sorry you had to go through that...

[Todd SPN]

I feel your pain and am touched by your post. You are the kind of nurse I would want taking care of me or my loved ones. Being an advocate is not always easy and being in the rank and file of a facility, one is often overruled by those who think they know better. Many do not understand the caring and compassion a nurse has that has brought them to this health care position. I hope that the change you are talking about does not involve leaving the profession. It would be a sad loss for the lives you could touch that need nursing care. You might consider Hospice nursing. But being the advocate you appear to be, maybe you have found your niche where you are and the dreams are a way of working this through and an answer will eventually come to you. Good luck.

[CactusFlower]

I was surprised to see a reply so soon. Thank you all for your kind attention and soothing words.

This situation was a tough one. Yes, the family was involved and anesthesia brought in the ethics committee before they would do the first surgery. At first, the surgery was to be performed for comfort measures. It was not acceptable to allow this woman to die of an overwhelming infection and not to try to remove the burn eschar. In the beginning we all had to agree,but it just didn't stop there. In this case, death was the iminent outcome. I wish we had chosen a different course.

[WhiteCaps]

As I re-think this situation, I have to add that living wills usually state refusal of heroic measures in conditions determined to be terminal, as in end stage cancer. Burns might not qualify.

Perhaps in the beginning, the physicians saw the possibility to pull her thru the burn injuries. I expect it was a tough call for everyone.

Forgive yourself. Forgive the doc's too. Investigate and learn. So everyone can make a better decision next time and live with decisions past. Now, sleep well. She's at peace.

[Liddle Noodnik]

Thanks for listening--anyone else out there doing some sole searching? [/b]

One thing I do is just what you are doing -- talking and writing. Not much more we can do now.

I wonder if you guys could do a case study on this lady so that people know what to do in the future.

Man, rotten. And unfortunately common.

My heart is with you.

[gwenith, BSN, RN]

Better than just writing it up if you can write her story and try to get it publshed in a newspaper or magazine. Somewhere where anyone can read it and feel for this poor woman and what she was put through.

We have a program here RPA it is a "real life" documentary from one of our hospitals about real cases. A couple of ordinary people were talking about it and saying how they did not realise what was involved in............. until they saw it and how they would not put thier loved ones through that.

Many times the push for extraordinary measures comes because the people (relatives) do not fully understand what we are talking about and feel unable to say no.

If you tell her stroy with the empathy you have shown herre you will touch someone and maybe that someone could make a big difference in "next time".

[Liddle Noodnik]

A good idea Gwenith!

[VivaLasViejas, ASN, RN]

Whatever you do, whatever comes out of this, don't let it be the loss of another compassionate, caring nurse from the profession! Now, more than ever, nurses like you are needed to advocate for patients as health care and ethics become increasingly complex. Like another poster stated above, I too would want you caring for me if I were to find myself in a situation like the one you have so eloquently described. Hang in there, and be assured that your patient is in a place of light and peace.

[Spidey's mom, ADN, BSN, RN]

I agree with Gwenith . . . and the idea of bringing this up before your ethics committee.

You are a wonderful nurse.

steph