The Patient I Failed - page 27
by nerdtonurse? 374,500 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
- 5Oct 20, '11 by Lori ByrnesAs a former ER/ICU nurse, I can't count the number of times that this very thing happened to me. It's horrible when you know the patient wants to go in peace, but the family wants everything done, even though the patient is in excrutiating pain from cancer, dying of Alzheimer's disease, or any other disease, including old age. In my opinion, keeping the one that they are supposed to "love" against their wishes is the most selfish thing any family member can do. While working as an ICU nurse one day, I had a patient who coded over the weekend. Her regular doctor wasn't on call, and the doctor on call refused to call the code, even after 45 minutes of non-stop CPR and so many shocks to the heart that we lost count. Finally, I took it upon myself to go to the waiting room and explain to the family that the only thing keeping their mother alive was the fact that we were manually pumping her chest and that it was the only thing keeping her "alive" (even though she wasn't). I gave them the option of coming into the ICU without even consulting the doctors, who were standing around refusing to make any kind of call. They all filed into the ICU, and after seeing what was going on, gave their permission for everything to be stopped. I thought that the doctors would be furious with me, but the cardiologist actually went to the nurse manager the next day and complimented me for taking it upon myself to get the family to stop what never should have been started. Although we know what is best for the patient, we are not allowed, as nurses, to refuse the families wishes, even if they are not the wishes of the unresponsive patient. I'm sure that a lot of you have seen "slow codes" in your careers, but the person who wrote this article didn't fail this patient; she only did what she took an oath to do. Until the rules are changed so that the families don't have the final say-so, this will probably always continue.
- 1Nov 2, '11 by nowwhat1As we as Nurses have seen many things it often changes our thoughts on Living and Dieing....Yes we know what we want for ourselves but put in the place of the deciding one is tough.We are Medical,caring and have families as well,I went against my sister as well to protect my father.All I got was years of not talking to my sister.There will never be an easy way to end the pain and suffering we see everyday,but if I give a patient/family five quality minutes a day I have done my job so to speak.Thanks for bringing us back to WHY WE BECAME NURSES.
- 2Nov 12, '11 by TankwetiI had a similar, although not so horrific, situation with a patient who had a living will while I was in clinicals. He also did not have a DNR and apparently thought the living will would be enough, which it was not. He had constant and severe UTI's which invariably lead to sepsis, inability to eat, altered mental status, just general suffering. He also did not want to be maintained with antibiotics, artificial fluids and feeds. But he was getting all of that against his wishes. I asked my clinical instructor why this was happening to him and she said the courts honor the family's wishes more than the Living Will and that judges do not consider the Living Will as strongly as they do the wishes of the family. Coincidentally, 2 weeks after he was my patient on a Med Surg floor, I was on a rotation to the E.R. and who should be brought in thru the door on a gurney via ambulance but my same friend. He was a nursing home resident as it turned out and his family came in with him, hard on the ambulance drivers heels, to make sure he got every single bit of care that was possible. Care that he did not want. But no nurse can consider themselves a failure in such a case. It is the court systems that are at failure for this, by not signalling that they will enforce the patient's wishes and the family who are to blame for wanting to cling to him when life wants to let him go.
- 3Nov 21, '11 by maelstrom143Nerdtonurse?, thank you so much for such a lovely, thought-provoking article that means so much to those of us that see this all the time.
We had this poor little old man in our PCU a few years back. We had IVF, TPN/lipids, and drips all going . It was heartbreaking. This poor little man was third-spacing, weeping and oozing all over, nonresponsive...the works. They had moved him from ICU to us because the family wanted to be able to stay with him.
On my second night with this patient, I took the daughter aside, explained to her how dire her father's condition was, and how very little we were actually doing for him versus what we might be subjecting his poor frail body to, and how as his family they had a right to choose to withdraw or stop treatment they felt was not helping. We discussed the IVF/drips, their function, and the patient. The daughter then talked to the rest of the family and they decided that I should call the doctor for a DNR. He passed away 6h later, in his sleep, and very peacefully.
The family cried and thanked me. Apparently, they did not realize they could request that the doctor stop what he was doing. I was so blessed to be a part of that patient's care and his loving family. So often, the outcomes are not so humane. So often, the outcomes do, indeed, break your heart.
- 1Mar 2, '12 by sandra5centsHow very sad--I would have gone to my ethics committee with this horrible dilemma you were facing. I'm suprised your director did not come to the plate. Shame on them. You did the best you could to give tender care to this poor women.
I have faced this many time in my career as well, it can be a cultural thing very oftem, I have found also unspeakably, someone wants to keep their family member alive to get the monthy social security payment the first of the month. I am not kidding.
The doc had no backbone. How sad for a critical care doc, in the wrong area IMO.