The Patient I Failed - page 26

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   RNBillieBSN
    This happens more than you can imagine. I have cried
    over these patients while providing their care....and at
    home as well. So sad.
  2. by   Ryn RN
    Unfortunately so very true and occurs way too often! So very sad.
  3. by   MarieG
    wow. what an ethical disaster! I would refuse risking the loss of my job. I commend you for being able to face this.
  4. by   Bill Levinson
    The initial decision to give CPR was correct because a living will takes effect only if the person is terminally ill. In other words, if somebody with a living will but no terminal illness collapses from a heart attack, CPR is given. The living will takes effect only if there is a condition such as incurable cancer that makes interventions futile, and serve at most to prolong the dying process.

    E.g. my father should not have been given CPR when his heart stopped, but he was suffering from a neurodegenerative disease (Lewy body disease). Unfortunately, none of his doctors had rendered a diagnosis to the effect that he had less than 6 months to live, so his living will never went into effect, and he did not receive hospice care from Medicare. (I did have a private duty nurse supplementing his care in the nursing home, but perhaps hospice could have done more for him.)

    In Pennsylvania, at least, a living will does not take effect unless its writer is diagnosed with a condition that is expected to be fatal within six months. This means that, if you don't want to be revived, it is important to get this diagnosis.
  5. by   CiaraLopez
    Brought tears to my eyes. So powerful. Great job in such a tough circumstances. Nurses truly are angels
  6. by   MahzieLPN
    I, too, believe you did not fail this patient. You provided her with the deeply desired dignity that was allowable, no thanks to the Selfish Daughter. She must have been some piece of work that the other children didn't band together to over-ride her. . .and at least this dear patient suffers no more. I shudder to imagine holidays in that family. . .
  7. by   m.keeton
    I watched the same scenario play out with my grandmother and her 3 surviving children. My father and aunt were ready to let her go, but my uncle was sure she was going to pull through. She kept telling us she was ready to be with her husband, her mother, and her family and friends that had passed. She knew it was time, and was ready to greet the afterlife like an old friend. I can't fault my uncle for wanting to keep her for just a little bit longer. I know I sure wanted her to stay around, and he had known her 25 years longer than me. Finally, the decision was made to let her sleep and the staff made her comfortable. over the course of a week, the family got to know the hospital staff like extended family, and it was as a family that we all saw her to her final destination. I am thankful to the staff for allowing us a little extra time with her, and caring for her as much as they could.
  8. by   RNBillieBSN
    This type of thing happens so much more than people realize. Children override mom or dad's wishes to perform CPR rather than let their parent (s) go. They have no earthly idea what they have done...or are doing to their parent. And yes, I think there should be a special place in hell for these children if, after the physician has explained exactly what their parent is experiencing and they continue to want "everything done" and "don't want them to have any narcotics for pain".
  9. by   ryan2
    We need to stop this, ethics demands that the pt has a say in their treatment. If we can tell a family their mom signed to be an organ donor and it's no longer up to them what happens to the pts organs why can we not tell family we are abiding by the written wishes of the pt for their living will.
  10. by   Dragonnurse1
    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 have had a few of these patients when I was in the ER. I have performed CPR on an elderly woman and have broken those frail ribs and I have listened to Doctors try to get the family to abide by the living will to no avail. Do every thing possible they said. Vent, pacing, we did it all and once the family arrived an hour later they wanted it all stopped. It took 3 hours for all the stimulants to clear her system so that her heart would register a flat line. She came from a nursing home and the family had "forgotten" to give the no code order to the staff. Many of the doctors that admit to the nursing homes here will not admit a patient without a no code order being signed by family and the above case is why they have started this practice. Some of the Doctors in the ER would run slow codes rather than torture the elderly. I have no understanding of family that will insist on "all measures" when those measures amount to torture of their parents.

    My Dad made sure that I had both his and Mothers living wills and Medical Power of Attorneys as he knew my sister would not follow his wishes. (But Dad learned this the hard way when my Aunt died. He overrode my aunts wishes and she was given the entire treatment. When I got to the ER he was asking what to do. It took 2 days for her to pass but he never forgot what happened.) I was tending to Dad at the end and I ran into the problem with the pain relief. He was in very severe pain (at home) but the Doctor did not want to give him morphine because it would "compromise" his breathing. He was dying! I basically threw a fit until I got him some pain medication.

    You did what you had to do but that does not make it any easier, just know that you did everything with as much tenderness as you could and for that she would thank you. I have one son that will have my medical power of attorney so that there will be no "family" problems if/when something happens to me.
  11. by   directive
    Saw too many of these in my 50 years of nursing, have two sons and if either one of them ignore my wishes they will be removed from my will. Problem solved!!!
  12. by   My Dee
    You have such a big heart and soul in you . You did not fail your pt, her daughter did. This is exactly why I have POA and have made sure my Mom has a Healthcare Directive/Living Will . My Mom will go with dignity and grace when it's her time to go. I will go by her wishes and not the rest of the family's /doctors wishes for her because I love her more then words can say.
  13. by   CeeNurse12
    This was one of the most beautifully written pieces articulating what so many of us feel in such circumstances. Thank you.