The Patient I Failed - page 10
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... Read More
Oct 1, '08 by oncologynurse77It is so heartbreaking to live in a culture that so adamantly denies death that advanced directives can be overlooked, or, more often, never written leaving patients to suffer. This is the part of my job that I really, really hate.
Oct 2, '08 by nerdtonurse?It may vary from state to state, but in our state, you have to have a "terminal within 6 months" diagnosis (just like hospice) before the doc will write a standing DNR.
Oct 2, '08 by RyanSofieWell remind me not to become unresponsive in your state. That is very barbaric if you ask me, espeacially if they do not honor advanced directives.You obviously did not fail the patient, the state laws are probably from the first century.With the next generation of elders being such a large part of the population in the U.S. and the lack of healthcare for so many it is time these laws are revisited and updated to reflect reality.
Oct 2, '08 by interleukinIt may vary from state to state, but in our state, you have to have a "terminal within 6 months" diagnosis (just like hospice) before the doc will write a standing DNR.
Wow, is that true? In which State do you live?
But in this case, the patient was clearly "terminal" and yet the DNR was, essentially, worthless. The term "terminal" can be defined and perverted in a thousand ways.
Oct 2, '08 by CandiceA:heartbeat Thanks for sharing your heart with us. I was also moved to tears...
I wonder if the daughter was really being selfish or was she holding out for a miracle that she thought could come. Please don't get me wrong, this was tragic and the patient's living will should have been honored. It's just that sometimes we forget that folks outside of nursing/medicine don't understand the progression of events that lead to end of life. We've seen it so many times that we can almost predict it. But they can't because they don't have that experience. And, truthfully, IMHO medical advancement has contributed to blurring the lines. A trach/vent sometimes works and sometimes it's the top of a long, horrible slippery slope. Many times patients are thought to be beyond hope and they somehow defy the odds. So is it selfishness or is it hope, however unrealistic, that is fueled by faith, media, and even doctors who won't admit to families they can't save everyone?
I have no answers...only questions. I do know this, you should have no guilt and I hope that your spirit is lifted by all of the supportive posts and hugs you have received. All the best to you. - Candice
Oct 2, '08 by rustyshacklefordwell done on writing a very eloquent and poetic piece of your nursing career. wishes of patients often seem to be ignored, forgotten or just lost along the way, eh? i dont know if it could be seen as a good or bad thing, but over here, neither patient nor family need be consulted as to a DNAR decision.
as for failure, i dont think so. as long as you put your heart in to caring for someone, irrelevant of any circumstamces, i would agree with everyone else that you've succeeded in your role as a nurse...
Oct 4, '08 by : margaux :gosh. what a story.
it made me cry. really.
and i agree to them, it was beautifully written.
thanks for sharing it.
Oct 4, '08 by landesmummyThank you so much for this story. I am half way through my rn degree programme and I recently had a stage 4 breast cancer patient--who wanted to go to hospice but the medical team, not the oncology team, wanted to debride the 'monster alien' growing out of her chest. She cried so much and said it was time for her to go--her mother agreed yet her brother said that she could not leave the hospital for hospice until this was done. Thank god she finally signed a DNR because if she codes, her chest will collapse, she will explode and we will kill her. Thank you so much for your beautiful words. I have just finished writing my own will, using these words as a template. Thank you for caring. You have touched alot of people with this post.
Oct 4, '08 by brownsugarsixI don't know how to thank you for sharing your story. I know this was difficult but I plan on sharing it with everyone I Know thanks again
Oct 5, '08 by PeriThank you for writing about your patient, it was so moving.
I especially liked the way her wishes had been inserted to add poignancy.
I understand that the daughter didn't want to face the pain that her mothers death was going to bring, but I don't know how she can live with the brutality that was inflicted through her desperation.
My own mum died peacefully after suffering with Dementia.
It was her decision many years ago that we abided by.
I miss her
Oct 6, '08 by amdaleWow, I'm not even sure what to say. I think you are impressive I don't think you failed her. Thank you for your story.
That daughter was only thinking of herself. I'm sure shell never comprehend what a horrible way her mother passed.
Thank you again.
Oct 13, '08 by msfuturernWow that is just something we would only like to see in a movie. Heartbreaking!!
Dec 31, '08 by thegreenmile, ADNThis is one of the main reasons I do not work in emergency medicine or ICU any longer, thank you for this deep expression to remind me of why I made this choice. Fabulously written!