The Patient I Failed - page 23

by nerdtonurse?, RN | 375,455 Views | 321 Comments

She knew what she wanted. She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself. So, she wrote a Living Will, had it... Read More


  1. 0
    Quote from RyanSofie
    My friend's patient has a tumor large enough in his neck that he has dysphagia, a PET scan has shown several "spots" on his lungs.He has end stage COPD. He is anemic and severely underweight. He is 76 years of age. The "team" has told him he needs to have an immediate tracheotomy and a peg tube.They also have advised radiation. No biopsies have been done. He has had a caratoid blockage and has two cardiac stents. I have spoke several times to his nurse who is a dear friend of mine asking her to address Hospice with this patient and his family. I foresee this man having alot of suffering ahead and a poor quality of life for the remainder of his life . The physicians of course will suggest all possible interventions as their first priority is to preserve a life. Life is not merely breathing (in his case the liklihood of a vent is very high) nor is life a chemically sustained heart beat. The patient did sign a DNR and I am concerned his 6 daughters will also convince him to forego this. If this were your loved one ,what would be your suggestions?
    this really boarders on the line of offering medical advice because this is someone close to you and therefore we can't offer suggestions or advice as per Terms of Service
  2. 4
    My reply as an Oncology/Hospice Nurse but more so as a human being/Nurse that has watched a lot of patients suffer simply because they are wanting to please their family and do what they want; but even more profound the doctor's encourage and at times insist on chemotherapy and radiation. As you have stated, the cancer has obviously spread and no doubt is far spread through the lymph nodes and more than likely also to the brain; it would be in the patients' best interest to adjust his diet to high protein easily swallowed foods and nutition shakes and let him enjoy what life he has left while preserving his grace and dignity. Many patients would just like to wake up and see the sun come up, watch the birds, trees and flowers grow; and above all have their Children and Grands around to love and support them in their decisions and not make him feel that he would be a disappointment if he doesn't comply with what they feel he should do. It is very sad that some, if not most doctor's cannot bring themselves to realize that they may not be able to save this patient and their hypocratic oath prevents them (or so they think) from advising the patient to do anything else but allow the treatment that will no doubt further debilitate him and make him weak and miserable. You are a good friend for wanting to intervene and try to help these girls understand the implications and what their father would be enduring. Please feel free to run this off and provide it to the daughters and their father. If it were my loved one, my Mother, Father, Son, Daughter, Brother or Sister or even a Dear Friend, this would be my same advice. I have actually been through this with a love one (my Fiancee'), he had Stage III Lymphoma and we chose to fight; I did not have the knowledge or the experience that I have today or I would have encouraged him differently. I watched him suffer and even go through a bone marrow transplant; he did well with the transplant but suffered greatly and in the end he took pneumonia and even though we were still in the bone marrow transplant unit they were unable to save him. If I had it to do over I would encourage him to enjoy his gardening, and we would take walks and go on picnics and just enjoy being together instead of sitting in doctors offices and chemo/radiation treatments and then watching him suffering through the side effects (i.e., nausea/vomiting, weakness, weight loss, hair loss, malaise), I could go on and on but I think you get the point and if his daughters are compassionate and they love him then they will make the most of the time he has left. Respectfully Submitted, a Caring Nurse
    Dragonnurse1, Soozul, HeavensNurse, and 1 other like this.
  3. 1
    Quote from emshook, rn
    My reply as an Oncology/Hospice Nurse but more so as a human being/Nurse that has watched a lot of patients suffer simply because they are wanting to please their family and do what they want; but even more profound the doctor's encourage and at times insist on chemotherapy and radiation. As you have stated, the cancer has obviously spread and no doubt is far spread through the lymph nodes and more than likely also to the brain; it would be in the patients' best interest to adjust his diet to high protein easily swallowed foods and nutition shakes and let him enjoy what life he has left while preserving his grace and dignity. Many patients would just like to wake up and see the sun come up, watch the birds, trees and flowers grow; and above all have their Children and Grands around to love and support them in their decisions and not make him feel that he would be a disappointment if he doesn't comply with what they feel he should do. It is very sad that some, if not most doctor's cannot bring themselves to realize that they may not be able to save this patient and their hypocratic oath prevents them (or so they think) from advising the patient to do anything else but allow the treatment that will no doubt further debilitate him and make him weak and miserable. You are a good friend for wanting to intervene and try to help these girls understand the implications and what their father would be enduring. Please feel free to run this off and provide it to the daughters and their father. If it were my loved one, my Mother, Father, Son, Daughter, Brother or Sister or even a Dear Friend, this would be my same advice. I have actually been through this with a love one (my Fiancee'), he had Stage III Lymphoma and we chose to fight; I did not have the knowledge or the experience that I have today or I would have encouraged him differently. I watched him suffer and even go through a bone marrow transplant; he did well with the transplant but suffered greatly and in the end he took pneumonia and even though we were still in the bone marrow transplant unit they were unable to save him. If I had it to do over I would encourage him to enjoy his gardening, and we would take walks and go on picnics and just enjoy being together instead of sitting in doctors offices and chemo/radiation treatments and then watching him suffering through the side effects (i.e., nausea/vomiting, weakness, weight loss, hair loss, malaise), I could go on and on but I think you get the point and if his daughters are compassionate and they love him then they will make the most of the time he has left. Respectfully Submitted, a Caring Nurse
    Your reply was well worth quoting! "As an Oncology NURSE and Hospice NURSE" Thank you! My question was " if this were your loved one what would you suggest". As nurses we are patient advocates. It is not beyond reason to suggest Hospice/Palliative care to a patient who is as ill as the one I described. My point was NOT to give MEDICAL ADVICE but to give COMPASSIONATE NURSING ADVICE . Thanks again for your response.
    HeavensNurse likes this.
  4. 2
    it never ceases to shock me how a situation like this can give someone a power trip. the daughter and doctor should be ashamed of themselves.
    Soozul and morte like this.
  5. 0
    First of all I must say this was beautifully written, so much dignity in your words. As PP have said, you DID NOT fail your Pt. As a medical professional you have only so much control, you take control of what you can and handle the rest with as much professional, empathetic ethics as you can muster. You definately achieved all of that. i honestly believe this woman felt your warmth and caring as well as your empathy in her final days, and that is what a great nurse, a great human being does.
    Now please excuse my ignorance as I am a pre nursing student, but what I don't understand, which Im hoping you can help me to, is having a Living Will in the chart, why were these interventions continued by the doc? I understand when EMS arrived and the daughter lied, but when they reached the hospital as well as the codes that occured after that time, why were heroic measures performed and the Living Will ignored? Working in hospital envirnoment in the past I have seen occasions where the doc has had to basically apologetically inform a family memeber that they are following the Pt's wishes. Is it because heroic measures had been taken from the beginning so they must continue? i don't quite understand the protocol or legalities behind that. I would have thought that once the Living Will was discovered they would have to follow it regardless of the wishes of the daughter. Did they bring in a social worker or anything to discuss the ramifications, etc with the daughter? How does that all work? Its awful that docs should have to take a "I dont want to get in the middle" stance on such things, when they know full well the Pts wishes are not being respected. But I can understand out of fear of the every looming possibility of a medical malpractice suit, they really have no other choice.
    Thank you so much for sharing this with is, i am finishing up a human develop psych class and we are studying death and dying as well as DNRs and Living Wills , etc so it was interesting to read this and gain this additional perspective. In fact, would it be alright if I put a link to this post on the discussion board for my class (its online)? I think that my cohorts would really appreciate it.
    Thanks in advance for your time and sorry for the novel I hope I'm not being to nosy with all my questions, ust trying to undertsand .

    Karla
  6. 1
    A DNR is a legal document which allows EMTs, nurses and PCPs to allow natural death when someone either stops breathing or looses a heartbeat. A Living Will (at least as I've seen it used) is often treated like a suggestion -- it has no legal standing, in that it can't override the wishes of a next of kin. At the hospital where this occurred, the MD in question was notoriously gun shy about not addressing end of life issues in general (ever seen someone put a PEG tube in a 103 year old with end stage Alzheimers, cancer, COPD and CHF? I have, and it should be outlawed). Ethics committees run the spectrum from awesome advocates for the pt to legal beagles who try to keep the hospital and PCPs from situations that can cause a lawsuit. It's been a long time since this happened, and I've seen this situation in various degrees more times than I ever thought I would. I am very happy that I now work at a hospital which brings families in to watch a code -- it helps people know that we did everything we could, especially with a pediatric code, but it also tends to make the unrealistic expectations fall away when the families see what they are making us do to the patient, especially if it's a futile situation. I am a big proponent of hospice. Just because we CAN do something doesn't always mean we always SHOULD do something. Feel free to link to the article, and thanks.
    HeavensNurse likes this.
  7. 0
    That was written very proficiently and articulate; thank you so much.
  8. 1
    I have been a nurse for 50 years. However, whenever, I read sad stories about families not following patient's wishes and hospitals without the back bone to see patient's wishes are followed I feel very sad for them. Have been their when this has happened and inside you hurt to see the patient suffer and the family that cannot stop something like this when another family member goes over the patient's wishes. Most of us have seen it occur more than once. Nurses do not fail patients in these situations when they give good, responsible, loving care as long as the patient is on their watch. Keep your head up and go forward caring and loving and helping those patients that are in situations they cannot help. God Bless you one and all.
    Soozul likes this.
  9. 0
    Wow. I won't forget this. Wish I could make a copy of it and give it every family member that insists on not listening to the wishes of the patient.
  10. 0
    This made me cry....thank you for sharing it. It illustrates quantity vs quality of life perfectly.


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