The Patient I Failed - page 25

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

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    You feel you failed, we feel the physician failed, we know the system failed. A suggestion--the POLST is a tool that can help. If your state does not have a POLST program, help make it happen. Check out POLST.org or http://www.ohsu.edu/polst/index.htm. Sometimes we participate in care (or lack thereof) that is unethical, as the author did here. It happens to all of us, though not always so dramatically. It's highly complex, and for better or worse the patient's family becomes our patient, too. All I can say is, utilize your resources and push all your colleagues (that includes MDs) to deal with these difficult issues. Call your social workers, your nurse manager, certainly your Palliative team (if you're lucky enough to have one), a patient advocate, a care planner, an ethics consult. I'm spoiled by having a lot of resources at a university hospital, but in another setting perhaps hospital administrators or social workers pinch hit when there is no patient advocate?

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    i worked as a hospice nurse for 12 years and this story is far too often the truth. we are selfishishly scared and do not let our loved ones go because of our own personal loss issues.

    please talk with your family members and get a health care proxy completed today. it is free and accessible on-line. all you need to do is have 2 witnesses sign it and give a copy to your family member and doctor. believe me it is so much easier to talk about these issues in the non-crisis mode than the crisis icu situation described in this article. also, your hcp representative is legally supposed to agree to uphold your wishes not theirs! so pick someone that you trust and that is strong and reliable. blessings to all those who have suffered unnecessarily due to these issues.

    and no narcotics...unheard of! my brother complained at my mother's death bed.."they have you all doped up mom"...yeah becasue she was in terrible pain. miss you mom and dad...glad hospice was there for you at your end of life process and that you were not attached to tubes and machines in the icu receiving futile treatment.

    thank you to all the nurses who care enough to make an immediate ethical consult when these issues occur in their care!
    Soozul likes this.
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    Beautifully written! As nurses we have all experienced this at least once in our career...and the other end of the scale...where the patient's family wants you to euthanize their family member...what is wrong with people??? What is wrong with a system that allows a person's wishes (when made of sound mind) to be ignored? One can only hope that people who force a family member to go through something they have specifically requested to not have to endure, will receive their share of karma.
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    It's amazing the spectrum of response to impending death. I've had people who couldn't be in the room, we had to go get them from the waiting room and pull them into the crying room when the patient died, all the way to a guy who crawled in bed and held his dying father in his arms. I've been the unwilling witness to families that fell to fighting and letting every suppressed slight or moment of anger over the lifetime of the patient explode all over the unit. I've had people who wanted me to keep a dying person alive at any cost (to the patient) so they could continue to live off their check. I've had "camp euthanasia" who wanted the patient to pass on immediately because "everyone's here this weekend, and that way they wouldn't have to come back again."

    For me, it's an honor to be present at a person's passing. Those who've been in my care their last night on earth are gently washed, made as comfortable as possible, I hold their hand and tell them it's okay to go, not to be afraid. I give the family as much or little support as they want, and I tell the patient that I'm looking after their family, too. I've made sure folks who were diabetic got something to eat, sneaked warmed blankets out of the PACU for family members who were cold in the middle of the night, and I've been cried on, had people ask me "why?" and called out of state family members in the middle of the night for that one phone call you never want to get. Right now, I split my time between ICU and ER, but when I get too old for my knees to take it on the floor, I hope I'm good enough to work for hospice.

    Thanks for all the reads, folks. 3x the population of my county has read this article. Maybe I've done a little bit of good somewhere.
    maelstrom143 likes this.
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    On May 16, 2011, I lost my mother to pneumonia among other things. We had no living will, but I felt certain she would not want to be intubated. She was on bi-pap most of the time, but occasionally they would try to wean her from it and put her on a non-rebreather. She couldn't talk, but could nod her head yes or no. I asked her if she stopped breathing if she would want to be intubated and she shook her head no. Two days later, she passed away. I have felt so guilty since that day thinking I should have told the nurses to do whatever they could to save her... Your letter makes me think my mother and I did the right thing. It has helped me heal a little. Thank you for sharing this with us.
    maelstrom143 and nerdtonurse? like this.
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    Why do family members do this I am currently a terminally ill nurse with IPF and have a living will. If either of my children or husband ignore it I swear I will haunt them till THEIR dying days. I have been vented before and I DO NOT want to live the rest of my life like that. Right now living with an oxygen saturation of 82 I know it won't be long but my daughter still refuses to believe that ther is anything wrong with me. So, she is the one I am afraid of as I know she will say: "do everything, she'll pull through this just like all the other times" I wish she would realize I am at the end of my life and just enjoy it with me rather than fighting me.
    Last edit by obienursern on Jul 9, '11 : Reason: mis-spellings and additional information
    maelstrom143 and nerdtonurse? like this.
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    God commanded to honor our father and mother. It's sad that even the very last wish of a parent, the child found it hard to just obey.
    BunnySan27 likes this.
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    I am so very very glad that my mother was there for my grandma when she was dying. They knew the end was coming, and Mom asked Nana, "Mommy, do you want them to keep trying things to help you get better, or do you want to go on home to see Jesus?" Nana replied as emphatically as she could in her feeble state, "Want to go HOME! Want to see JESUS!" I know that it was really hard on my mom to be the one to convince my grandpa that that was the right thing to do (he can't wrap his head around medical things). But she did, and Nana went peacefully about twelve hours later. I am so so glad it was my mom. I'm not sure her sister would have made the same choice, and Nana would have suffered more than she already had.

    I know I've already responded once to this thread....but again, nerd....thank you for being there. You're a great nurse.
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    Thanks, Elvish. I needed to hear that today....
    Elvish likes this.
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    to hell with the legality.. i would have done the same..

    though i do believe that someone has to be an advocate of dignity- however no one has the right to say a person is in his/her RIGHT TIME to go. only God knows.

    i ddnt sign up for the resuscitation team for damn dnr's


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