just a vent

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    Okay, so I spent one shift with this fella who's dying. I love palliative care; it's like ER to me, a vacation. I don't think I could do it every day but it's enjoyable.

    What I enjoy is the hands-on care, the little "common sense" things you do for the drowning chf'er, that help make them comfortable, and the family education. In a lot of cases it's possible to help both the family and the patient have a better experience by the time the patient dies. Plus it's nice that you have another small group of people out there who have a better understanding of nursing's role in palliative care.

    So the patient's daughter is what my coworkers call "high maintenance," and what I see as common in the situation of watching one's parent die. Anxious, weepy, terrified of the term "hospice," afraid to touch or speak to the patient, totally out of her element. So by the end of my shift she has had some intensive education, and she's doing his mouth care, putting lotion on his arms, talking to him, etc. Woot!

    Night two, still in our unit, much the same, different nurse though. We frequently shift assignments if it's emotionally draining. Night three, official withdrawal of pressors (he was already a DNR, sometimes things happen backwards), and a trip to medsurg to see what happens. His nurse tells me the daughter's driving her bananas. On my only break, I stick my head in his door to see how he's doing.

    I've heard how he is, of course, and I agree with the other nurses. His lungs are about gone and he's going to go into his agonal breathing soon. But the rattle is gone, the grimace is gone, he's looking peaceful, and it's the most serene I've seen him. It's that nice place where he's not in pain but can probably still hear us, so this is the time when family, if they haven't already done so, can spend some good time with their loved one. What I'm seeing is a successful journey so far.

    Then the daughter looks up and says, "I thought they were going to give him morphine." I tell her it's scheduled, the nurse will bring it on time, no problem. "Well I just wish he would hurry up and go. Can't we give it to him a little early?" The tone of voice from her is edgy and impatient. I thought, "who are you? Didn't I already explain all this to you?" I told her that he's not in pain, and he can hear you, so please just spend some time with him.

    It would be nice if I don't ever see that woman again, it really would.
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  4. 11 Comments so far...

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    Sad...
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    Very sad.

    Not to excuse her but.....it can be very hard to watch someone die, especially for the first time.

    Our lives are so sanitized now, that it is rare, (in my opinion) that people deal with even the death of a pet when they are young. Often, the first experience many people have with death is when it is with a loved one, and it can be agonizing.

    I was very lucky to be brought up as a "country kid". Old dogs didn't go to "live on a farm", the barn cats were occasionally picked off by owls, and cows occasionally died giving birth to a calf. Cows also gave birth to stillborns, and I remember clearly fostering orphan calves on mourning mothers.

    Not equating animal life w/ human by any stretch of the imagination. But in the past, the death of a pet often opened the door to conversation about death in loved ones. I don't know that it necessarily happens that way as much anymore.

    It seems a lot of parents try to shelter their children from all the unpleasantness in the world.

    Just an opinion, I am more than willing for someone to tell me I'm wrong.
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    I hate to say it but when I worked hospice there were more "insurance vultures" than I care to remember.
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    What I'm seeing is a successful journey so far.
    That's what you saw. What she saw was her father slowly dying.
    "Well I just wish he would hurry up and go. Can't we give it to him a little early?" The tone of voice from her is edgy and impatient. I thought, "who are you? Didn't I already explain all this to you?"
    Patients and families in these situations do not process or retain the majority of what we tell them. They are on overload.
    It would be nice if I don't ever see that woman again, it really would.
    From your description of the patient, it sounds like you won't have to worry about that. But don't be surprised if at some point she returns to find you and thank you for your care. While she didn't process your teaching or understand the full scope of what was happening to her dad, I guarantee you this daughter will remember the time you spent with her during this frightening ordeal, and taking your time to seek her out to check on her and her father.
    Last edit by Emmanuel Goldstein on Nov 4, '07
    Angie O'Plasty, RN, dria, nuangel1, and 4 others like this.
  9. 1
    IMO, you did a good job. Dau not as frantic as before, even if she couldn't remember everything. Probably didn't realize how long the process could take. She gets a lot of props in my book for staying w/him.
    Emmanuel Goldstein likes this.
  10. 0
    Well, thanks for listening. Like I said, just a vent. I was so tired and her comment hit me just the wrong way, that it felt to me like I had wasted good teaching time on someone who wasn't listening at all. I feel a little better now.
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    I've been there... held my Dad's hand while he was taking his final breaths.... Yes, it was hard... yes, I would do it again...and I admit, I felt the same way this daughter did... in my case it wasn't that I wanted him to hurry up and die... But I NEEDED to get on with Life...
  12. 0
    Quote from Indy
    Then the daughter looks up and says, "I thought they were going to give him morphine." I tell her it's scheduled, the nurse will bring it on time, no problem. "Well I just wish he would hurry up and go. Can't we give it to him a little early?" The tone of voice from her is edgy and impatient. I thought, "who are you? Didn't I already explain all this to you?" I told her that he's not in pain, and he can hear you, so please just spend some time with him.
    It would be nice if I don't ever see that woman again, it really would.
    just when you think you have seen and heard it all...."so sorry that your dad is not dying at a convenient time for you" Although-having been at the bedsides of parents,a child and a friend you do get to the point that you think you can't stand one more minute.People say things in grief that are really not what they mean-and then again-some people really DO mean " how inconvenient for ME"
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    keep in mind, the dying pt's journey is very different than the ones watching anxiously.
    even if the pt was in good place, families always, always, always wonder, "when" the big moment will come.
    hospice nurses need the patience of a saint.
    we are always repeating information, over, and over and over.
    and even then, we know they're probably not retaining anything.

    next time, i wouldn't focus so hard on teaching.
    your presence, your patience, your knowledge base (for when you need to answer the same question, 100 times) and your sensitivity, will provide much more comfort, than a paragraph of the whats, whys, hows and whens.

    i'm glad your pt's death was a peaceful one.

    leslie
    Emmanuel Goldstein likes this.


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