A few minutes meant difference between life-or-death...or something

[Dinith88]

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...

[cathlab1]

Everyone should settle down. While clearly a profound moment, and clearly a profound result. Everyone did respect the patient's wishes, but... I am only playing devil's advocate here, but... I am wondering how much the patient and his family really understood about being a DNR. While he was obviously very ill, sometimes the patient and family really do not understand all the options. ... Thank God for that cardiologist, he had the guts to offer another treatment modality for the patient and saved his life(with the nurse of course)

[steelydanfan]

Everyone should settle down. While clearly a profound moment, and clearly a profound result. Everyone did respect the patient's wishes, but... I am only playing devil's advocate here, but... I am wondering how much the patient and his family really understood about being a DNR. While he was obviously very ill, sometimes the patient and family really do not understand all the options. ... Thank God for that cardiologist, he had the guts to offer another treatment modality for the patient and saved his life(with the nurse of course)

A clearly profound result, and hence my reply. Profound is not normal, and everyone is rejoicing at this particularly ABNORMAL outcome.

This pt's wishes were NOT respected, hence my first post.

The pt. stated he did NOT want artificial means of support, but the cardiologist obtained consent from a pt. who was not capable, according to the poster's writings.

I don't understand the kudo's for the cardiologist, he went into a near comatose pt;s room, obtained a challengable consent, and '"saved" a life that will be played out with a long stay in a nursing home with tid rt, and

not much else to support him.

Yes, he lived. But is he living? And would YOU want to?

[Mymimi]

I would like to pose a question in the midst of this discussion. As nurses we are liasons for our patients, their advocates. In my almost 20 years of practice have encountered many situations in which I spent a great deal of time educating the patient, family on the DNR status, quality of life, and the options available. There have been times that the patient and family wishes were not carried out, and it was directly related to one or more interventions of physicians that were not willing to carry out family and patient wishes.

Do any of you believe that maybe some health care providers are not secure in their own afterlife, along with their training, cultural issues, whatever it may be driving them perform interventions that may keep the patient alive, but not give them quality of life? Could the root of this be they don't know where they will go if they die? I will continue to be an advocate for what the patient wants.