The Patient I Failed - page 30

by nerdtonurse? 374,319 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
    It is so sad that families has the ability to over rule a Living Will. We had to do chest compressions on a lady that was so contracted that it took extra staff to help hold her extremities out of the way because of an instance like this. She had a peg tube already I place and was non-verbal before the cardiac arrest. She had no quality of life before the event and the CPR didn't help her at all. I can understand not wanting to let a loved one go but I can't imagine being so selfish. The lady we worked on was one of the few that we have had survive. I can't imagine wanting to continue seeing a loved one in that state.
  2. 0
    [QUO[IMG][/IMG]TE=nerdtonurse?;3076263]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.[/QUOTE]
  3. 0
    OMG this is awful I am thinking of doing a living will or advanced directive as they are called now, but all my 4 children know what I want & I know they will abide by it, but the poor woman & the daughter putting her through all that suffering.When we get a patient in from another hospital or the community & they have a DNAR we have 24 hours to get our own Drs to change the forms over to ours, as we are a GP led community hospital, otherwise if the patient codes then we have to resusitate.
  4. 0
    yes this # 10 is a common problem, we are not that powerful. The Serenity Prayer is a great philosophy of life and when applied in this situation the nurse can let go and know she has been a great nurse. I hope I have a nurse like you should the time come. Thank you for being a wonderful nurse and person.
  5. 0
    Oh God I want to cry. D:
  6. 0
    Quote from nerdtonurse?
    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 anychemical, 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 myrespiration if my body is incapable of sustaining it on itsown." 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 asnasogastric 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 preventpain 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 lifeto 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.
    I have stressed to my family members, the importance of having a LIVING WILL, and ADVANCED DIRECTIVES....KNOWING what CPR entails, which most laypeople don't and having performed it, feeling ribs crack and break under my hands...is terrible, and I don't want my loved ones to go though this. For the family members the hardest part is to love their loved ones enough to let them go, with dignity and peace...sad but excellent article...very very sad indeed...
  7. 0
    Quote from nerdtonurse?
    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.

    [...] Finally her heart was broken.

    And so was mine.
    I won't quote the full article, but just wanted to say, thank you Nerdtonurse, for expressing what so often passes through my mind when I take care of this type of patient.
    When I know my patient is dying and the family is unwilling to let them go, when I see the patient's suffering, when I feel my own pain as I carry out doctors' orders that are being done simply to make the family happy, when I hear "full code" and I see my patients being robbed of dignity and comfort at the end of their day, my heart breaks.
    When my patient looks at me and begs me to let him/her go because he/she is "tired and ready", my heart breaks.
    When a DNR is denied because the family &/or doctor is not ready to accept the inevitable, it breaks my heart.
    I have no choice but to follow the orders, as they are legally binding; but once I am done, I cry my heart out because it really does hurt to cause these people so much pain at the end of their lives.
    Thank you for such a wonderful, well worded article that clearly shows what so many of us are unable to express, except through tears.
  8. 0
    Your story brought me to tears, so beautifully written yet unsettlingly heart wrenching. My heart breaks for that woman and everyone who had to bear witness to her suffering, knowing what was happening was wrong. This story happens too often. Sometimes it feels like we as nurses are in such seemingly helpless positions, trying to advocate for our most vulnerable patients but unable to have our voices heard.

    At the same time, I think of my own family and wonder if I am capable of betraying their wishes in the same way, loving them so much you are blind to their suffering by keeping them sustained physically, in the hope of averting (cheating?) death. As much as it makes me angry I sympathize on some level with all involved.
  9. 1
    I love this story. I started to tear up. Greatly written.
    brian likes this.
  10. 1
    This is so sad and it is so selfish of her children.
    brian likes this.


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