The Patient I Failed - page 25

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

  1. by   BellionRN
    Thank you... this article sums up my feelings. One of the main reasons why I've left ICU & moved to Emerge.
  2. by   rnglimpse
    been there in that situation but you presented it very well.. congratulations!
  3. by   NunyaBizzness
    I know this was posted 5 years ago, but I happened upon it while reading about the 2013 story contest. That being said, WOW! What a beautiful, well-written, powerful, (I could go on forever) heartfelt story! It actually brought tears to my eyes! I love how you added the bits of the living will along with what was actually occurring. KUDOS TO YOU!
    Oh, and by the way, you, in NO shape or form, failed this patient. Her daughter, who I'm sure was grief-stricken and distraught and a little bit selfish, did.
    Two thumbs up!
  4. by   Emergent
    Very moving story, anyone who has worked in that setting can relate to this heart wrenching situation.
  5. by   krisiepoo
    I just saw something similar as a student, I was so saddened by this and even more upset because I use to help people write their living wills and at the time didn't realize they weren't followed

    Thank you for caring for her so tenderly
  6. by   Lev <3
    This is so sad, but drives the point across very strongly.
  7. by   Glycerine82
    I am bawling. *sob*
  8. by   martymoose
    Sad situation. Could Ethics have been brought in?
  9. by   Blue Roses
    This is unspeakably horrible. I don't really know what to say. I was crying after reading this and my husband was looking at me like "What's wrong" so I read it to him. He's not in healthcare but he was horrified.

    You did not fail the patient.

    That daughter failed her mother.
  10. by   heatherj76
    What a beautifully written, devastating post. We struggle losing the ones we love, but at some point we need to let go, and when we don't the results are rarely positive.

    Just...stunning post, writer. I don't have many more words.
  11. by   NutmeggeRN
    You did not fail your patient, the child failed their mother.
  12. by   gypsyd8
    This is why I hate this job.
  13. by   Eastern RN
    I read this just now and hope you have now know that you did not fail the patient. Her family did. It seems one family member did not respect her mother's wishes, and once she was resuscitated and procedures to "save her" had been started, the remaining family members could not get it together enough to recognize that this was NOT what their Mother wanted and make the decision to have her made a DNR - and have their Mother placed in a Hospice or at least a palliative care environment where her wishes for end of life care would be respected and carried out.

    I see this ALL the time. In our province of approx 500,000 people - the 2011 census had the # of people that were age 65 and over just shy of 100,000. That's 20% of our population. How many of these people have advance care directives? From what I have seen over the years - VERY FEW. And - as the poster said - it only takes one family member to challenge that - and BAM - the ball starts rolling..... downhill.

    To be fair - if someone presents in ER or the EMS arrive at a scene and there is no family present and it's not immediately known that the patient does not wish any advanced life support measures - well - in most cases we are going to try to save that person. Unless of course they are cold and blue, or they are obviously already dead or near dead. And who makes that decision - depends on the EMS, depends on the physician. We try to do what is ethical.

    BUT - I cannot tell you how many times in my 32 yrs of nursing that I have heard a doctor have a discussion with a patients family about a DNR - and put it something like this - "If your Mom's heart stops or she stops breathing do you want us to do everything we can to save her?" For real - if the doctor is having that discussion with the family - generally it means the **** is about to hit the fan so to speak.

    People who are not in the medical profession have no idea what that "everything" is. So many times over the years I wished someone had produced a video that shows exactly what goes on in a code, shows exactly what happens when people are placed on ventilators and remain there for extended periods of time - and basically just rot in the bed. Just pop in a CD for people to see - the good, the bad and the ugly - all of it. I would imagine families would make some different choices for their loved ones. I'm not saying that no physicians I work with explain and present the "DNR" issue properly. I have seen the issue of making a patient a "DNR" explained to many, many families in a clear, easy to understand manner - and families have been able to make informed decisions that they are comfortable with.

    Another thing that irks me - patient comes in who has had the DNR discussion with family at some point already. The family they live nearest to. The patients wish is to be DNR. BUT - there are other family members as well who do not live close by - and are unable to get there quickly. So then it's "Well, Mom said she didn't want to be on life support - but I can't decide that on my own - I have to wait until - my brother - or whoever the rest of the family is - gets here. So lets put her on the breathing machine for now until the rest of the family gets here and then we can make a decision" . I have heard this more times than I care to remember. And anyone who had read my rant this far knows what happens when the rest of the family does get there. No one wants to be the bad guy and be to one to suggest that life support be discontinued. Every now and then it does happen. But rarely. Poor old Mom usually stays on the vent and slowly deteriorates - sometimes quietly, sometimes dramatically - and I would expect not without discomfort. Which does not leave us nurses with a warm fuzzy feeling.

    There may just be something to having a DNR tattooed on your left chest. It can probably be done quite elegantly. Anyhow - peace out - my rant for this month is done. I hope.