Am I going to make it?

[Bormio]

I was watching Emergency Level One last nite on DHC and a 16 yr old gunshot victim came into the ER. He kept asking the nurse if he was going to make it. The nurse finally said "I don't know, we are doing tests and the doctor is the person who would know". I was horrified that the nurse would say this to a 16 year old! (He was fine - soft tissue wounds only)

What do all of you experienced ER nurses tell a patient if they ask you if they are going to die? Does your answer depend on specific circumstances or patient types or do you always say the same thing?

[NurseStephRN]

i don't work in an ER, but i work in a step down open heart surgery unit. sometimes i have patients the night before they go for open heart surgery and they ask me the same thing. i also get asked this when they are in the recovery phase.

i just say, "i don't control whether you're going to make it, neither does your surgeon or your other doctors. i CAN promise you that while you're here we're going to take excellent care of you."

i think it's better to be honest than to say to a patient or a family, "oh yes, you're going to make it! you're going to be fine!" it's a promise that nobody can make. you just have to be tactful when you say it :)

what's to stop that person from going into idk.... vtach/vfib/asystole, etc and despite anybody's finest ACLS, we just can't bring them back? you told that patient/family member/friend, etc that they were going to be fine, but turns out you didn't make good on your promise. i've seen it happen and it was NOT pretty!

[ThrowEdNurse, BSN, RN]

Soooo......here's the difference. You're talking about an, in general, " will I make it" question vs "am I going to die in the next half hour?" I actually had an ER pt ask me this yesterday, "am I going to die?" As in "am I about to die?" Her heart was going bunk, the cards hadn't made it in yet, she was old, and I was still trying to decide exactly what was wrong with heart, and her daughter is at the bedside crying. Here's the problem: it is wrong to lie to someone about the fact that their death is imminent. Not sure if everyone gets that, but it is. It is our job to help our pts through ALL stages of life, including preparing for and actually dying. They need to be mentally prepared and speaking honestly with their families as well as their Gods. Yeah, it sucks and yeah it would be easier and more pleasant to lie but not right or fair. They need to be psycologically prepared as do their families for what may happen in the next ten minutes. She said,

"Dont let me die, I'm not ready. I still have things to do." So I looked at my watch and said, "ok, deal. But I get off in ten minutes. I can't make any promises for the overnight nurse." Sounds cruel, but I think they got the point and they both laughed, at least. It is unethical to lie to a pt about their real possibility of imminent death just because lying is easier for the nurse.

[Misslady113]

I disagree with the above poster. A persons' will is very strong and I have seen and heard of cases where if a person fights to stay alive, sometimes they do. If you tell a person they are going to die, they will lose that fight and might give up the will to live. It is not our place to say either or. I think the best way to handle it is to tell the patient that the team is going to give them the best care they can, and for the person to hold on and stay strong. To tell someone they will die or it's possible just isn't right. It's just not our place, as we don't know what anyone's future holds. :heartbeat

[Bormio]

What about in the situation I memtioned with a 16 year old who doesn't have any family present? If you know someone is going to die, an adult, I would definitely be honest with them. If you really don't know,however, wouldn't it be better to be positive and encouraging. Could you say something like, you're doing good right now, we'll let you know if things change?

[JulieCVICURN, BSN, RN]

I guess I'd just say, "I don't know, but we're going to do everything we can to not let that happen."

[traumaRUs, MSN, APRN]

Agree, I say: "We are working very hard to see that doesn't happen."

[prplscrubs]

i agree with the majority of the above posts. i do not work in the er but i do work in the or and we have patients that are worried about making it through, or we have families of patients that are scared of what could happen. if my patient is sick and on their death bed, or healthy as a horse i tell each patient and family before i take the patient into the or that i will be with them the whole time and that we will take the best care of them as best as possible while they are with us. if i was taking that 16yr old patient to the or and he was asking me that question, i would say the same thing. we will give you the best care possible. that is all we can offer. we cannot say that these patients will make it or not. what if he hemorrhages because the bullet did more damage then what you can see?? i agree with throwednurse it is not right to say things the patients want to hear because it is easier for the nurse, we need to be honest, with all patients, not just the ones we think can handle it. and if they can't handle it, then we help them and their families deal with it. thats our job, like it or not, we signed up on our own free will.

[Bormio]

Wow, talk about a tough job ... so challenging mentally.