The Patient I Failed

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existent, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent. Nurses Relations Article

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 notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

Quote
"I do not wish my heart to be restarted through usage of any chemical, mechanical or physical intervention..."

Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.

Quote
"I do not want any external device to be used to maintain my respiration if my body is incapable of sustaining it on its own."

The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.

Quote
"I wish to die a peaceful, natural death."

She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.

Quote
"I do not wish artificial means of nutrition to be used, such as nasogastric tubes or a PEG tube."

Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.

Quote
"I wish nature to take its course, with only medication to prevent pain and suffering."

The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."

Quote
"Allow me the dignity we give to beloved pets. Let me die in peace."

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existent, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.

Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.

Quote
"Thank you in advance for helping me in the last moments of my life to have a gentle, peaceful passing."

She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.

And so was mine.

The-Patient-I-Failed.pdf

Specializes in Long term care.

Thank you for writing this. This is so powerful and so wonderful. Thank you from the bottom of my heart for being this woman's nurse. You are truly a special person. Sometimes, I truly hate doing what I do.

This was a gift to all us nurses out there working with people that may face this battle. One of the most difficult decisions that I have ever faced was letting my 59 year old father go when his body had just had enough from cancer treatments. I didn't get to say good-bye, I didn't get to tell him that I love him...I could just allow the doctors and nurses do the best that they could to make him comfortable. At the time, I asked his doctor if they could bring him around so that we could say good-bye. He said that he could bring him around or make him comfortable, but he could not do both. But, it was a very painful decision to let him go. What I cannot understand is why the other children for this woman did not step in. I had to fight my mother to let my dad go, but I fought for him. It was so sad to read what this woman's wishes were...and then what was done to her poor body. Great writing by the way!

This is such a powerful story. Our wishes need to be honored and family need to understand that at that moment it may be very difficult.

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 notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

"I do not wish my heart to be restarted through usage of any

chemical, mechanical or physical intervention..."

Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.

"I do not want any external device to be used to maintain my

respiration if my body is incapable of sustaining it on its

own."

The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.

"I wish to die a peaceful, natural death."

She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.

"I do not wish artificial means of nutrition to be used, such as

nasogastric tubes or a PEG tube."

Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.

"I wish nature to take its course, with only medication to prevent

pain and suffering."

The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."

"Allow me the dignity we give to beloved pets. Let me die in peace."

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.

Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.

"Thank you in advance for helping me in the last moments of my life

to have a gentle, peaceful passing."

She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.

And so was mine.

You gave the best, most compassionate care you could given the circumstances. I faced similar situations working oncology. I always tried to counsel family to question who they were really doing all the heroics for. This daughter had some unresolved issues of her own and paid her mother the ultimate in disrespect. I know how heart broken you must have been. Shame on that physician.

Beautifully written.

Specializes in Cardiac.

This makes my heart hurt. :(

I feel that unfortunately sometimes, the legal obligations we have trump any morally/ethically correct obligations. You did your legal obligations. What sets you apart from a lot of nurses is that you knew it wasn't fair, but most importantly, it emotionally affected you. It seems to be rare these days (from viewing the people I've met/seen/worked with....I don't know any of you and I am by no means saying any of you lack in the emotion department :) ). The day where our patients just become a routine is the day we need to reevaluate what we are trying to accomplish.

Recently my mom passed after a week in the ICU, suffering a devastating stroke after an aortic dissection, the CVICU intensivist was more interested in the survival statistics, and recommended waiting and "seeing what happens". As an ICU RN for 23 years, I knew what would happen. I told them about her living will, all of the siblings were in agreement, but not until we were transferred to the Nero ICU was I dealing with a MD that was willing to listen to my moms wishes. We put her into in patient hospice and she died with all of her children at her side, just the way she would have wanted. We as medical professionals need to be aware of our biases, and help families, not judge. It was sad that this woman others children did not step up and speak her wishes, and that the medical team did not take this to ethics, and follow her living will. The fear of legal repercussions drives care and not "the right decision".

You did not fail...the daughter did. How can any child allow their parent to suffer so? At least she is healthy now and with her husband and The Lord.

Specializes in Rehab, Med-surg, Neuroscience.

that is so cruel and sad. the whole story makes me feel sick to my stomach. my heart goes out to that poor sweet patient.

Specializes in Pain, critical care, administration, med.

This is such a sad story and more common then you think. You did the best you could given the situation. When patients have a DNR the physician needs to take a more proactive role and as the nurse we need to constantly teach and reinforce. For whatever the reason this daughter had some deep seeded guilt. Her other siblings also needed to support the mothers wishes. Many times its in the delivery of the message.

Specializes in Maternity & Well Baby Nursery.

Where were the other children that that one lone voice was so much louder? :( I don't have too much of an issue with her (the one dissenting voice). She may have truly believed that something could be done. But the other five? Where were they? Where are they? The other five that agreed with what their mother wanted....

"Bad things happen when good people stand by and do nothing". Shame on the other five children who knew and agreed with their mother for the things that she wanted. They failed her, no one else. Not her doctor, not her nurses. Not even the one who lied and told the EMTs her mother was a "full code". But the other five that agreed with their mother, with what she wanted. Unless of course, they really didn't and were only humoring her.

What a sad situation. "Forgive them for they know not what they do".

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