Patient comes to ER in respiratory distress(F, 88, AA)-walked in, ends up intubated and on vent.
When I receive report next day, patient is vented, in CHF, pneumonia and possibly septic-heading to ICU when a bed opens.
Family at bedside in AM-broach DNR discussion. Family told by ICU resident(new) she'll be okay-NO DNR on file. Meanwhile, losing lines-can't get any blood for tests from patient. Request central line.
Several hours later....(what took so long?)
ICU attendings(2) come with resident-after several attempts and kits (2 hours)to insert in subclavian, finally they listen to me and place in femoral. My disapproval apparent, very pissed I allowed it to go on as long as it did! Everyone disappears.
Go into room to clean disaster and patient after multiple insertion attempts-all physicians take off. Patient pale-heart rate dropping,goes into junctional rhythm....CODE. Remember no DNR.
What happened? Pneumo of course...what a surprise after she was used as a practice dummy. Given meds, shocked, chest tube, cpr, cracked ribs...
new phone call to family. Patient heart in a varied rhthym-pupils fixed and dilated. "Nobody's home" Family give consent over the phone, on way for DNR signature. Now after "saving" her, I get to give morphine bolus, morphine drip, remove vent and tube, and care for her until last breaths.
Allowing resident to continue attempting access...I should've made a stink regardless of her two attendings on site-they should've known better.
Allowing resident to give the family hope for recovery, instead of making sure DNR paperwork was initiated and signed.
Having to code a patient due to not having DNR paperwork-a frail person who we injured "to save" for a poor outcome anyway. Always a dilemma for me. *will have dnr on my chest!
Removing that vent, and giving that morphine bolus to ease discomfort and air hunger. The drip did not go for very long before expiration. This was the right thing, but waited a very long time. My patient suffered and didn't need to.
I am not sure if this story was helpful for your paper. If you need more specifics please let me know. If I had my way, I'd always let people know all of the facts, and encourage them to take living wills and dnr very seriously. There is nothing worse than being the nurse at the end. Even though I'd feel bad if any patient died, I feel worse when it happens like this story.