Well... i dont usually share patient stories but...you guys can relate...
Anyway, took care of a patient who had CABG about 3 weeks ago, did well, went to step-down for a few days...then came back to the unit for respiratory failure. The respiratory failure was mostly due to his copious secretions and inability to clear them/ resultant pneumonia. Was tubed, vented for a few days, then extubated about a week ago. However, same story...couldnt clear his (copious) secretions, aspirating, etc. Had adamantly expressed his desire to his family that he didnt want 'tubes and life-support' to continue living.
So...i get the patient on a non-rebreather, saturation 89%, breathing 40 times a minute...barely arousable. This was all due to his respiratory status...and potentially 'fixable' if the patient had agreed to trach for secretion management, suction, etc.
He was made a DNR the day before, family wanted him kept 'comfortable'.
Pulmonologist comes through in the AM and we discuss this 'sad' case...and i ask if i can give morphine for 'comfort'. 10 minutes later, i'm walking into the patients room with a syringe full of sympathy...ready to ease his struggling. cardiologist was at the bedside trying to hold a conversation with the patient and get him to agree to trach. Pt is barely arousable, doctor is a foreigner with a BAD accent. Patient nods his head yes to the doc (probably didnt realize he was doing it)...and we get the ball rolling, he's trached 6 hrs later.
Patient did well. Up in chair and interacting with family. Left yesterday for LTAC/rehab/eventual removal of trach.
Had i walked into that room a few minutes earlier on that particular day...
Or had the cardiologist come a few minutes later on that particular day...
He'd have gotten morphine, undoubtedly gone to sleep and been unable to nod his head for the cardiologist...
Sometimes it's strange how the universe unfolds...