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?
Oh...I wanted to say that I worked in a critical care unit (pre-hospice years) and we used Diprovan only on intubated patients. We also used it in surgery for general anesthesia. I have never heard of it used for pain control in a non-intubated patient. Can anyone clarify?
Oh...I wanted to say that I worked in a critical care unit (pre-hospice years) and we used Diprovan only on intubated patients. We also used it in surgery for general anesthesia. I have never heard of it used for pain control in a non-intubated patient. Can anyone clarify?
diprovan, barbituates and benzos are frequently used for continuous sedation.
it serves as a final intervention when all other meds have failed.
the patient is sleeping, therefore oblivious to any pain.
Yes… I think that relieving pain can hasten death, but not necessarily or entirely through the usual mechanisms of what we think of in terms of “cause of death” (respiratory depression etc.)
Pain can grab or hook one’s attention… and one IS where one’s attention is focused. A dying person… sitting on the boundary between worlds so-to-speak… can, at some point, decide which world to step into. But if that person’s attention is hooked by physical pain, then that person can be held in the physical realm… in a physical body… against their will. Relieving the pain allows them to focus elsewhere… and thus, go elsewhere.
Terminal sedation is tough. All people are connected and at certain times, especially intensely emotional times, we can feel that connection almost directly… and it is powerful.
It does seem rather ironic that at moments of great stress and anguish we are made aware… on a very deep level… of our connection to all human beings. It may seem odd, but that is one of the attractions of war; i.e. the intense emotional stress breaks through our usual defenses and makes people aware of their connection. Ironically enough… it makes it possible for people to experience love on a different level.
We often bewail our negative emotions… but they are often the bearers of great gifts.
Leslie… you now “know” things that you may not have known before… at least not on the level that you now “know.” In that sense, your patient and his suffering were a great gift to you… a personal gift. You felt your connection to that patient on a powerful level… one that normally eludes us in the work-a-day world. And one of the natural consequences of acquiring insight… or “knowing”… on that level is a feeling of being alone. Few people have it. You can’t just talk to anyone about it… most would not know what you were talking about… and some would think you were nuts.
The more you learn (on a substantive level) the more alone you become. That is why few venture there.
Yes... I think that relieving pain can hasten death, but not necessarily or entirely through the usual mechanisms of what we think of in terms of "cause of death" (respiratory depression etc.)
Pain can grab or hook one's attention... and one IS where one's attention is focused. A dying person... sitting on the boundary between worlds so-to-speak... can, at some point, decide which world to step into. But if that person's attention is hooked by physical pain, then that person can be held in the physical realm... in a physical body... against their will. Relieving the pain allows them to focus elsewhere... and thus, go elsewhere.
Terminal sedation is tough. All people are connected and at certain times, especially intensely emotional times, we can feel that connection almost directly... and it is powerful.
It does seem rather ironic that at moments of great stress and anguish we are made aware... on a very deep level... of our connection to all human beings. It may seem odd, but that is one of the attractions of war; i.e. the intense emotional stress breaks through our usual defenses and makes people aware of their connection. Ironically enough... it makes it possible for people to experience love on a different level.
We often bewail our negative emotions... but they are often the bearers of great gifts.
Leslie... you now "know" things that you may not have known before... at least not on the level that you now "know." In that sense, your patient and his suffering were a great gift to you... a personal gift. You felt your connection to that patient on a powerful level... one that normally eludes us in the work-a-day world. And one of the natural consequences of acquiring insight... or "knowing"... on that level is a feeling of being alone. Few people have it. You can't just talk to anyone about it... most would not know what you were talking about... and some would think you were nuts.
The more you learn (on a substantive level) the more alone you become. That is why few venture there.
well req, i must agree with everything you've stated.
not only is pain a highly undesirable feeling for the pt., it interrupts task work and can cause a notable delay in dying.
once an effective regimen is implemented, the pt is free to (a) resume the tasks at hand or (b) continue in their journey, what we call 'dying'.
i am always amazed at the stories my pts tell.
family members, healthcare staff often think the pt. is confused and disoriented.
most times, i have interpreted this confusion to be an acutely heightened spiritual awareness. as the bodies' systems shut down, i hear of journeys they've taken, while they sleep.
often, they cannot describe where they've been.
but it's not your regular dream, i can assure you.
i too, believe that all emotions can be opportunities for learning.
there's probably more to be learned when dealing w/negative emotions.
and the learning curve is reciprocal, for my patient and me.
as for feeling alone in correlation w/how much one learns, i don't know if there's a direct relationship.
i do feel alone in many ways; and i don't share my philosophies, my observations, insights, etc., as i'm confident that many wouldn't agree. it's not a science afterall.
but my belief in spirituality has enabled my patient and me to dance in rhythm.
Yes… one must always be cognizant of not proselytizing in any way. But I do believe that since we are all spiritual beings it should not be entirely out of bounds to share that with patients in private, intimate ways… so long as they (patients) are comfortable.
There are a couple of contributing factors to the feeling “alone” phenomenon. One I have already alluded to; i.e. when you are a leader in your field… a pathfinder… a scout… part of that job description has to do with a willingness to go out on your own. What is a scout? A person who is willing to go out ahead of the masses on their own. That naturally instills a feeling of being alone… because you are alone.
But there is another factor… the same one that we all know as… you must have experienced the dark to truly understand the light. To understand what it means to be warm you must have been cold.
We are all connected… we are one. At the same time, we are all utterly unique. When that patient looked into your eyes and you felt the connection, that was real. You and he are (not “were”) connected. At the same time, you are you… utterly unique. You cannot fully grasp how unique you are unless and until you fully understand how connected you are. So when the profound nature of your connectedness washes over you, what follows is the profound realization of your alone-ness. On the surface they seem incompatible, yet they are both true… they compose a paradox of truth.
Studying dying process is to study life… they are one and the same… not opposites.
The opportunity of being with the dying is almost sacred. Dying process offers the opportunity to peak into the very essence of who we are as humans. For those who have the courage to grasp that opportunity the rewards are beyond description. From your various posts I can see that you have been there… and posses the requisite courage.
When I was young and rode motorcycles there was a saying… if you ever get to the point where you are not at least a little bit frightened when you get onto that thing (motorcycle) you had better get back off. Similarly, if you ever get to the point where you can give terminal sedation and not feel rattled, you had better quit doing it.
You know how that makes you feel… as well it should. Yet there are times when it need be done… and you obviously have the courage to do it. When the going gets tough they call on you. Why?
You are a leader… pathfinder… scout. You know that dying is not the “end of life.” You know perfectly well that patient’s life went on and that you helped him get there… with a little less suffering. You know you hastened his death… but you also know his death was not the “end of life” for him… it was the end of his physical suffering… not his life.
Distinguishing the difference between “end of life” and “end of suffering” is a highly specialized thing. You and I have differed on various topics here… but I would trust you with my life… or death... because I can see quite clearly that you understand what dying process is… and few do.
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Hospice4me
21 Posts
Oh...I wanted to say that I worked in a critical care unit (pre-hospice years) and we used Diprovan only on intubated patients. We also used it in surgery for general anesthesia. I have never heard of it used for pain control in a non-intubated patient. Can anyone clarify?