The Patient I Failed | allnurses

The Patient I Failed

  1. 674

    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.

    The Patient I Failed

    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.
    Last edit by Joe V on Jan 7, '15
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    AliceTrout, Miathor, lwhatley, and 671 others like this.
  2. Visit  nerdtonurse? profile page

    About nerdtonurse?

    From 'Southeast US'; Joined Sep '06; Posts: 2,119; Likes: 8,329.

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    326 Comments so far...

  3. Visit  sirI profile page
    17
    Beautifully written.
  4. Visit  nightmare profile page
    4
    That is just so tragic.
  5. Visit  healthcarefome profile page
    5
    OMG -I don't know what to say.
    tokmom, lornagj45, nrsang97, and 2 others like this.
  6. Visit  morte profile page
    30
    may there be a special place in Hades, for that daughter
    DU15, KJDaRN81, nkochrn, and 27 others like this.
  7. Visit  kessadawn profile page
    61
    [font="century gothic"]what a sad story. you didn't fail her, her physician and her daughter failed her. you took good care of her, and gave her some dignity in her dying days. nice job!
    DU15, Here.I.Stand, nuangel1, and 58 others like this.
  8. Visit  Pedi-Gree profile page
    23
    Sadly, that scenario plays itself out where I work with distressing regularity, but on children whose wishes are never sought out (and some not-really-children-anymore whose wishes ARE clear, but ignored) and whose quality of life is the last consideration on the list. Thank you for so eloquently expressing what so many of us feel.
  9. Visit  Mermaid in the Sea profile page
    18
    what a sad story, i know that when it comes to someone that you "love" you try your best to keep that person alive, but you must remember that ,as much as you love them, you must give them the "dignity" they deserve ..
  10. Visit  littleRNthatcould profile page
    21
    Oh man, been there and dealt with that. I've never seen it written so beautifully before and from the aspect of what WE see and the sense of betrayal that we feel as we "force" life on someone who's made the choice not to continue. An amazing read, thank you
  11. Visit  tobias333 profile page
    10
    I agree, so beautifully written, I felt every word and was reduced to tears. Thankyou for sharing this very sad experience with us. Sending you a warm hug from oz.
    Last edit by tobias333 on Aug 29, '08 : Reason: typo
    NunyaBizzness, tokmom, TJ'sMOM, and 7 others like this.
  12. Visit  Silverdragon102 profile page
    14
    You didn't fail her her daughter failed her
  13. Visit  UnicornNinja profile page
    39
    Reading this made me break down and cry as I am currently in the same position, but my mom is the patient, and my sister is the one doing everything and anything to keep her "alive", even though mom made it plain and clear what she wanted and did not want.

    Unfortunately mom failed to sit with me and do an advanced directive, nor a power of attorney, which has allowed my sister to continue to push the hospital to do everything in it's power.

    Mom went in to the the hospital on July 31st, 2008 for a triple bypass. She ended up having 5 bypassed, in addition to mitral valve replacement. The surgery that was to last 5 hours actually lasted more than 8. She went into V-fib 3 times and was on and off bypass several times. She was hypoxic for some time, however the doctors did not note the length of time in the OP report, conveniently I might say. Anyway, needless to say, mom suffered major brain damage. She was comatose until just a week ago, and the signs of neuro deficit is there. She has a trach, something she absolutely did not want, but because of my sister.... I tried to inform her of the tremendous risks of a trach, to no avail. The trach was put in on August 9th and on August 13th was Pseudomonis positive in her lungs and Staph positive in her left sided intra-jugular line! Hmmmm sure didn't see that one coming! Of course you realize I have absolutely NO clue whatsoever about trachs, infections, feeding tubes, etc.. cause I'm just a nurse and trachs, vents feeding tubes, neuro, etc ARE MY SPECIALTY!

    UUUGGGHHHH I just want to grab my sister and knock her silly because she knows exactly what mom wants and does not want done, and my sister is only keeping mom "alive" for her own selfish wants. I see my mom laying there in pain, suffering. She looks at me and in those very brief moments of cognitive awareness, she puts her hand to her trach and cries. I ask her over and over, "do you want that out?" ands she shakes her head yes. I tell her "mom, you need to say the word out, you need to mouth it for the nurses and doctors to know that you are aware enough to make that decision, and she tries so hard, but by the time the doctors or nurses finally get to the bedside, she is exhausted from having tried so hard, fighting the vent.

    PLEASE LEARN FROM MY SITUATION! Make sure you have not only and advanced directive, but also a Power of Attorney for healthcare. I love my kids and husband enough that I have hand mine and in my chart at the hospital and with multiple people for the last 12 years. Please don't make your family have to decided and fight. It's bad enough that my mom is going to die, there is no question to that. The question is HOW LONG WILL MY MOM SUFFER due to the selfishness of my sister???

    Sorry this is so long, but everything is still so raw. Today is day 31 post op and it hurts so much to see her like she is.

    Thanks all for listening, as I truly needed to vent.
    Gayla
    Last edit by Joe V on Apr 12, '12
  14. Visit  VivaLasViejas profile page
    4
    This is a tragic story, beautifully told.

    Thank you for sharing it.
    RyanSofie, Soozul, littleRNthatcould, and 1 other like this.


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