today i had a very intense experience and even though i've gotten a tremendous amt of support from my colleagues in the break room, i'd like to know who else has experienced the following:
i need to keep this as vague as possible. i was called in to replace another hospice nurse who was having alot of difficulty handling a specific pt.
i got report that this pt. was receiving 700 mg (yes, 700 mg) of iv morphine along with sev'l other iv meds. when i arrived, the pt was screaming; his wife was frantic as was his parents. the nurse was crying. i called the doctor. we increased the ms04 w/o any effect. the final step was iv propofol. i discussed this w/his wife, the parents, who readily agreed. they just wanted him to die w/o pain. i titrated the valium up til i got the desired response, and then explained the next step to the pt. this poor man agreed and i told him that this med would more than likely hasten his death. he was all for it. i hung the propofol and ran it in....within 15 minutes my pt. passed.
but he passed peacefully. you could see its' effect within a few minutes. he had looked at me and thanked me, then closed his eyes.
i don't care to get into the many emotions that flooded over me but would like to know if anyone else has been involved in this type of case? i don't know why but i feel so alone. anyone?
We are connected here. The man I wrote about as he was actively dying whipsered to me, " I think we have made a mistake here." Whether he was talking about his death, his way of death or whatever mental work he was doing , the comment hit me like a fist in the chest. I would have freaked out myself but I could see a man ravaged by years of aggressive cancer and equally aggressive treatment. The "mistake" was the disease and that was NO ONE'S fault. He had a talented, strong personality
with rascal thrown in. I still can't always tell the difference between physical pain and emotional pain. And we know emotional pain is real and can cause those terrible screams for help.
And we know emotional pain is real and can cause those terrible screams for help.
your story begs me to recall a story of a man who had metastatic ca throughout his failing body. he had a combination of potent narcotics and had been heavily dosed. despite increase after increase, his screams persisted. he presented with signs of imminent death and i was getting panicked. as i went over his hx, i noticed he had abandoned his family some 40+ yrs ago. to simplify, i contacted his sister, who contacted this pt's eldest son. eldest son called me and told me to tell his dad that he and his brothers all had happy lives, and that all was forgiven.
i immediately told my pt. the tears flowed freely from his eyes, he thanked me and died.
yes. emotional pain exists and commands just as much intervention as the physical. we are connected.
My Dad had spinal mets. I am forever grateful to the hospice nurses.
He has said, "If I could just flip the switch and have it over I would. I don't want to call Dr. Kavorkian."
He had two 20 minute periods of excruciating pain in his last week while waiting for meds to work.
The last time an RN came out and started PCA subcu. After he felt better he asked for chocolate. My step mom was surprised I had brought a package of pudding mix.
He enjoyed it.
The next evening he died.
I cared for a critically ill heart patient for two 12 hour night shifts the weekend before his death . He was comfortable on drips and a balloon pump. He was frightened and unable to sleep. talking about his life.
He had married at 18 and his wife went back to her parents leaving him with a months old son who he loved so much.
He knew he was never a good husband. He worked only to earn a living.
He was proud of being s good Daddy. He talked with his son in another statetelling him not to come see him.
When I returned to work after a couple nights off and learned he had died I looked up his sons address and sent a card with a note. The son called the hospital asking for me.
I told him how much joy he had given his Dad. He was the light in that mans life and I wanted him to know.
Leslie, you did well. It is not an easy job feeling so much.
That is what makes you and so many nurses special.
I had to look up propofol and I found a web site that has Clinical Practice Guidelines of the Sustained Use of Sedatives and Analgeics in the Critically Ill Adult that compares the serious analgesics and sedatives. You can find it at www. diprivan.com. I do not like to use these measures unless all else has failed and pt is still in crisis.
I had to look up propofol and I found a web site that has Clinical Practice Guidelines of the Sustained Use of Sedatives and Analgeics in the Critically Ill Adult that compares the serious analgesics and sedatives. You can find it at www. diprivan.com. I do not like to use these measures unless all else has failed and pt is still in crisis.
that was certainly what happened in my case. this pt. was receiving iv ms04 700mg/hr! it's definitely the final hope that any pt in crisis will receive.
I'm going to take a stab at this one based on my own experiences. When I have a really intense case, I often end up at the end of the night feeling very much alone. To me, that's because I have extended myself as far as I possibly can to walk the walk with the dying person. There may be lots of people in the room, but you are doing a very special dance with the patient when this happens. It's incredibly intimate. When they pass, quite frankly I feel a real void as I regather my energy. I feel exhausted and empty and wiped out, but exhilarated at the same time.
It takes guts and heart to get into the trenches with somebody like that, leslie. Way to go! :bowingpur
When I returned to work after a couple nights off and learned he had died I looked up his sons address and sent a card with a note. The son called the hospital asking for me.
I told him how much joy he had given his Dad. He was the light in that mans life and I wanted him to know.
what a lovely and meaningful gesture, kathy. often sharing such sentiments is the best medicine anyone can offer.
I'm going to take a stab at this one based on my own experiences. When I have a really intense case, I often end up at the end of the night feeling very much alone. To me, that's because I have extended myself as far as I possibly can to walk the walk with the dying person. There may be lots of people in the room, but you are doing a very special dance with the patient when this happens. It's incredibly intimate. When they pass, quite frankly I feel a real void as I regather my energy. I feel exhausted and empty and wiped out, but exhilarated at the same time.
i read and reread your post since i was quite emotional when it was all over. then i thought of a line aimee wrote to me, that had me unexpectedly bawling my eyes out. it referred to the brief but intimate, powerful bond between me and my pt. we've all had very difficult, challenging cases. what hospice nurse doesn't? certain questions saturated my brain in regards to the care this pt had received up until the time i arrived. i took issue with certain things, and i'll leave it at that. so i think you're right katillac. i was totally horrified at this pt's level of suffering/anguish/despair. after i hung the diprivan and saw the results through my pt's eyes, i just wanted to cry and cry; the relief. no more piercing screams. i cried for alot of reasons. but you and aimee are so on target about the intimate and sacred bond between hospice nurse and pt. such a privilege. the only notable difference between what you experience and my experience, is i have never felt that void you speak of unless my pt. died in pain. i feel peace, when the pt dies peacefully. but what a dance it is. thanks for your perspective katillac. it really helped me.
...i told him that this med would more than likely hasten his death. he was all for it. i hung the propofol and ran it in....within 15 minutes my pt. passed.
but he passed peacefully. you could see its' effect within a few minutes. he had looked at me and thanked me, then closed his eyes.
i don't care to get into the many emotions that flooded over me but would like to know if anyone else has been involved in this type of case? i don't know why but i feel so alone. anyone?
leslie
God bless you, leslie.... I don't know if I could have handled that.
I cared for a close friend's father for the last few months of his life as his hospice nurse. One day I was called to the home as he was restless and agitated. I knew he was actively dying. My friend who also is a hospice nurse was at his bedside. I received an order for Roxanol and administered the smaller of the 2 dose strengths I could have given. After 45 minutes he was still very uncomfortable and restless. I gave him the 2nd dose. Immediately after he began to relax. We held his hands and cried together. He died 15 minutes after the last dose of Roxanol. I remember leaving, thinking Did the Roxanol cause he to pass away sooner? Would my friend think I hastened his death? As it turned out, my friend later said the same thing. She said I wander if the Roxanol made him pass away quicker? She said "if it did, I don't care, he was so peaceful. That is the way he would want it".
BeExcellent
93 Posts
We are connected here. The man I wrote about as he was actively dying whipsered to me, " I think we have made a mistake here." Whether he was talking about his death, his way of death or whatever mental work he was doing , the comment hit me like a fist in the chest. I would have freaked out myself but I could see a man ravaged by years of aggressive cancer and equally aggressive treatment. The "mistake" was the disease and that was NO ONE'S fault. He had a talented, strong personality
with rascal thrown in. I still can't always tell the difference between physical pain and emotional pain. And we know emotional pain is real and can cause those terrible screams for help.