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 ER - trauma/cardiac/burns. IV start spec.

I have experienced the same thing with many patients in the ER. There are many times that a living will never makes it to the ER and so many times family threw fits because their loved one did not have any dignity when dying. I can not count the number of times I had to "code" a patient that was on autopilot. Rubs I broke, medication I gave because the patient did not have a DNR. Then the family and the private physician would get there and finally the DNR was given. One time I had a nurse that refused to turn off the vent and was enraged when I did. He did not care what her family wanted or what her physician wrote. I could not get him to see that the heartbeat was mechanical (paced) and after all she was still breathing - she was on the vent. I told him he needed to get out of the ER until he could show compassion.

From Jan 2007 to Aug 2007 my mother was bed-ridden and slowly dying at home. I had been called on many times by Mother's friends when their family's had to consider how to proceed. I live 19 miles from my parents home and one early morning the phone rang. It was my father, I knew what had happened. I called my eldest son - he lived within 1 mile of Dads house - and got him over there before the medics arrived. I had taught him what to do. He was able to run interference wth the medics and she was pronounced.

You did not fail her. Her "family" did, her doctor did, yours was the only voice she noticed in those last moments and she knew you had tried and she loved you for it.

Thank you for trying when others would not.

Thank you for the caring you gave and

Thank you for being a good nurse.

Patty:cry:

That is so terrible. You wrote it very well. Thank you

Specializes in MICU, SICU, CRRT,.

Would there be something wrong with the physicians and nurses clarifying with a patient or family, upon the decision to make life saving choices, what a "full code" actually entails? I dont have a lot of experience yet, but end of life measures are very dear to me. In the few situations i have been in, the family was informed of what to expect in a code..fractured ribs, loss of function, tubes, wires, everything. In most of those cases, the family saw what could happen with coding a "brain dead" patient, and often times shown the CT scans and EEG report in order to see it for themselves, and chose to allow their loved ones to pas away peacefully. I think that being up front and providing no false hope could be an eye opener. Please note, that this applies to terminal patients or those determined as brain dead, not just anyone who randomly codes.

My best example is a 28 year old patient with a ruptured AVM. The family was adamant that after "three days" she would miraculously wake up and walk out..this would NOT happen due to the immediate brain death caused. However, they kept her on life support for the three days, and the physician and nurses tried their best to show them the actuality of the situation. The patient passed away (after receiving fourth code) while the family was in yet another conference.

This was so beautifully written, thank you. It should be copied and given to family members who go against those express wishes of their loved ones, and there are alot of them.

that is a beautiful story. very sad - there area tears running down my face at work! You will be blessed. You were just doing your job and i'm sure she knew that. At least she isn't suffering anymore. thank you for sharing that story with us.:cry:

a real piece one 'ere. :heartbeat:yeah:

it came to mind as i was rereading this.....perhaps we need to add to living wills/advance directives/POAs....persons whose wishes are to be ignored, ie this crazy daughter.....this would have allowed the docs to ignore her and allow the woman to pass in peace....without fear of repercussions (for the most part)

Specializes in interested in NICU!!.

omg, as i type this tears are making the computer screen blurry, my heart aches for this woman. how in the world can her orders for her last days just be thrown away? i hope to never be selfish with my parents, husband, or kid. i love them to death, but god please give me the strength to love them more to help them in your hands instaed of keeping them alive for me, may she rest in peace now. :cry:

Specializes in Hospice/Mental Health/LTC/Home Health.

The children only see it as their parent is still alive, but never consider what life really is.

made me cry.. ilove our patients.. no matter the ups and downs of our job.. ill share this to my nurse friends..

Specializes in Geriatrics, MDS Coordinator.

I am going through a similar situation myself right now and as a geriatric nurse it is very sad to me to watch these patients suffer needlessly. Very well written.

This is beautifully written and well thought out, however, and I hate to be buzz kill here but there are a few discrepancies in this piece. I worked for 30 yrs in ICU/CCU and never saw anyone who was not "eligible" for DNR status. Secondly, I rarely saw a physician who would not follow a patient's living will, esp one that was so specific.

Most would not code a little lady like this anyway. But, I worked with some pretty incredible docs... Also the author mentioned putting a peg tube down the patient's throat. Peg tubes are placed thru the abd wall... These details almost killed it for me, however, I absolutely understand why this was written. I lived this many many times in the old days when docs were afraid to "not" do anything for fear of lawsuits.This was back when patients really didn't have the rights that are given to them now. I have seen family quarrels over what to do with mom or dad and it is really heart breaking.

"

+ Add a Comment