I was a very young, too young DON at a care home. I was working late one night doing paperwork. I heard odd noises coming from outside my office. I went out to investigate and I saw Marjean, one of my fav's sitting under a tree rocking back and forth.
I asked what was wrong, she kept rocking telling me she was just gang raped on the pool table of the game room.
Marjean was a hard core, paranoid schizophrenic. It never happened, while we had a game room we had no pool table and, we had cameras in that room. Naw, it didn't happen but SHE totally believed it did, it was one of her hallucinations.
While it did not *really* happen, it did happen in her reality and she was going through the same emotions as a true rape victim would experience.
I finally got it, I finally understood. Hallucination or not, it was still real for her. I just sat with her under the tree rocking back and forth.
We ALL have one or more of those moments, what is yours?
I was a student nurse and this gentleman was one of my first patients. He was in his mid-nineties and delightful. He had scleroderma. I was helping him wash the places he couldn't reach.
We were chatting as we worked. He had been an international lawyer. His stories were fascinating. He and his late wife ad lived in many countries. I glanced at his toes and, to my horror, made a a sickening discovery. He was unaware. One of his toes had come off! I didn't know w hat to do. Finally, as I was about to tell him,.He.noticed. my dilemma. He told me to just pick it up in a washcloth and take it to the nurse. Fortunately, my instructor appeared at the door. Phew! She told me later that my reaction had been fine. I'm still not sure what the proper response would have been.
An elderly gentleman with multiple cardiac and pulmonary issues along with dementia. The family's anxious, fearful response to his deterioration was almost palpable; they wanted anything and everything done for him, which led to a string of surgeries and procedures that ultimately did nothing but stabilize him for a short time.
He could barely speak; sometimes he would mouth a string of disconnected phrases. He refused to eat anything during my shift. I offered him thickened water and he allowed me to put it to his lips to sip. In that moment his eyes locked on mine. I cannot fully describe what I perceived in his expression, but what I can describe is a look of grief and weariness I will never forget. It was like the confusion cleared from his eyes for a moment and he could see his world and situation so very clearly.
His family finally decided to take him home with hospice care. Unfortunately, weeks later I saw him back in the hospital, a temporary NG tube insertion before PEG placement. More deterioration, more confusion.
I've met so many patients in situations like this. There are worse things than death.
I might have sat in Dunkin Donuts this morning reading this after my shift with tears streaming down my face. Thank you to everyone who shared!
I'm just shy of a year of being an RN, but I have a couple stories that tug at my heartstrings.
My first is from my brief job in psych. We had an incredibly sweet, intelligent man in his 40s with bipolar. On meds and with the proper sleep, he was the nicest, friendliest man. Any little tweak, and he got so violent and so dangerous that it put the whole unit on edge until he cycled back. The doc was attempting to switch him to...Clonipin? Can't remember, but he was having a particularly hard time with this transition, and he could just feel himself losing control of himself again. He was sitting there talking to her and just went, "For you, this is as easy as writing a prescription on a piece of paper, but for me, this is my life. When you do this, I know I could go off and kill somebody because of one little change you make. I could spend my life in jail or at this place because of one action while I'm 'adjusting' to these new meds. Do you know how scary it is to feel like you are controlling that?" That kind of knocked the wind out of me, knowing that this weighed so heavily on his mind, and it made me really sad for him.
My other big one was with a bipolar patient I had at my current job (hospice IPU). Woman in her 50s with recently diagnosed pancreatic ca. One night, she just went OFF. Could not keep her in bed or geri chair, she kept running into walls trying to find a door to escape, screaming and crying and hallucinating good knows what awful things. She got combative and tried to choke me, stab my aide, and spent all night biting and hitting and kicking anyone she could reach. She had moments of relative lucidity every now and then where she would slow down, look at us, and say, "I'm so sorry. I'm just so scared. I don't want to hurt you. I don't know what's wrong." This poor lady was not on the proper medications, and I couldn't get **** from the on call doc. She was scared and agitated up to the hour she passed. I feel like we failed that patient. Even though we kept her safe and she never hurt herself or anyone else while in our care, she never got comfortable before dying, and that breaks my heart. =/
A Family members 14 month old grand child choked on a grape at the Los Angeles Zoo 2 weeks ago. Huge delay in care because the child's mother was hysterical and the aunt was occupied with Heimlich maneuver begging someone to call 911 while bystanders were more concerned with taking photos and video of the child choking to death with their phones. The childs' heart stopped for an hour and he was brought back in the ED but not without a severe ABI. The Connor Phoenix Project has more details.
3 weeks ago my DNR patient with mets had just finished lunch, was doing well and scheduled to go home the next day. K+ replaced, Mg infusing and I was in her room with daughter discussing the POC. Her eyes rolled back and she started agonal breathing. My phone rang to say she was in Toursades. Cardiologist was at the nurses station and ran into he room, updated the daughter and per her wishes we stood and watched her die. The daughter took her moms hand and told her what a great mother she had been, how much she was loved and to go be with her dad in heaven. I lost it and had to hang out in the break room for a bit, snot and tears flying.
When, as the doctor is working on him, a very sick patient with his BP in the 70's (Systolic) is squeezing my hand and looks at me and says; "You know something? This needle in my back really doesn't hurt that bad because I'm holding the hand of a pretty lady)." An hour later...we were intubating and performing CPR on that same patient. Broke my heart. I cried on the way home that night.
Or when a young girl has been hit by a car and I'm doing compressions to the best of my ability, praying to God that this precious baby gets a heart beat back and we can be the hands that perform a miracle. But our best wasn't good enough. She passed away. Cried then too.
Or when a former patient of mine came in as a code and I saw his face as I started doing compressions and realized who it was. I couldn't believe I had just taken care of him not long before and had joked around with him as always and now I'm fighting to save his life. He passed away also. Again, I cried.
Nursing has so many gut-wrenching moments. But we also do get to pull off those miracles. Somehow, by the grace of God we are able to save people's lives. I always love my job. Some days I hate that I love my job too much. Some days I wish I could hate my job. But I can't and I don't. Nursing is a strong part of who I am. I love helping heal people. It's my addiction and I love it fiercely.
Even though we kept her safe and she never hurt herself or anyone else while in our care, she never got comfortable before dying, and that breaks my heart. =/
Your story reminded me of one of my recent ones. She was an elderly lady with COPD that we extubated way too soon - she went into respiratory distress within an hour of the ETT being removed. She immediately made herself a DNR/DNI. I'd had her the night before, intubated and unstable as all get out, and I was a little sad to hear her wishes. Sometimes it just feels like that the butt whooping you just yourself through before to save their lives was for nothing when they immediately make themselves DNR - do you guys ever feel like that?
Anyway, she didn't want to wear the BiPAP again either. Palliative had already seen her and agreed. The only reason she was still in ICU was that she was on pressors, and we weren't just going to turn those off and kill her - so she was on that funny line where she was still in ICU with multiple vasoactive drips, but she didn't want everything done. It was a heck of a gray line. If we're doing ICU level interventions, what exactly are we NOT doing?
She started desatting into the low 80s on nasal cannula.
I don't take care of palliative patients often, the tele person was blowing up my phone telling me about her O2 sat, and I didn't know what to do. I was quite sure I was going to get written up if I didn't get a O2 sat goal. That was the new thing management was auditing us about - O2 sat goals needing physician orders if we were going to turn off the O2 saturation alarm or adjust the parameters. I went to the intensivist at the desk and asked if he could put in some sort of order that it was okay for her O2 sat to drop so I wouldn't get dinged on my charting.
He found this unacceptable. In hindsight, I wish I'd asked him if he'd read the palliative note, but I didn't, so he immediately barged into the room and insisted that the patient wear the BiPAP. Her husband wasn't helping either - he was pleading with her to wear it even though she'd specifically mentioned she didn't want to. Between her husband and the physician, she halfheartedly agreed. Unsurprisingly, she didn't tolerate it at all because of her anxiety. The physician ordered Precedex and told me I could restart the Fentanyl drip so she would keep her mask on.
I was pretty uncomfortable at this point - she had made her wishes clear that she didn't want to wear the BiPAP, but I thought, heck - we're already doing this, her O2 sat is 100%, and maybe she won't die tonight after all. Maybe we can fix this. Maybe we are doing the right thing and she will get better and be able to leave. I turned up the Precedex and the Fentanyl until she was mostly snowed but still breathing fine, but occasionally still trying to take the BiPAP off. I hit a point where I wasn't comfortable turning either up anymore for fear of inducing apnea, which I let the physician know.
He agreed that the drips were high enough, and said that I could go ahead and restrain her hands if she continue to try to take off her mask, and wrote a restraint order. This was probably the only time the whole night that I made the right decision - I never tied her down. She died a couple hours later anyway, mostly snowed, with the BiPAP mask that she hadn't wanted to wear on her face. It was the most peaceful I'd seen her all night.
In hindsight, I really should have pushed the intensivist about not treating her aggressively. It turns out he hadn't read the palliative note, and thought she was a regular DNR and not a palliative patient. I could have avoided the whole drama with putting the BiPAP on her, her being anxious about it, and me having to start drips to keep it on her face if I had just made sure the intensivist knew what she wanted. She could have been lucid enough to spend quality time with her family right up to the end. So, my actions didn't succeed in prolonging her life - I just added to her suffering as she went.
I still feel awful about the whole situation whenever I think about her.
Specializes in Medical-Surgial, Cardiac, Pediatrics.
I had a patient who was a DNR/DNI on the floor. He'd come in because he'd lost his appetite, had been having increasing weakness, and had just been tired for a while. He had heart failure from COPD, and just three months before had an ejection fraction of about 55%. When he came in to me, he had an EF of 15%, his pulses were barely palpable, and a CT had shown a possible mass in his abdomen. His BP was also 90/50, would drop, then come back up, but his heart rate just wouldn't respond, and he looked so.. Tired.
He wanted to go home. I took one look at him in the morning when I rounded and wanted to have hospice come and talk to him. He was just tired, wanted to be home, wanted his bacon, and was always cold. He wanted his own slippers, his own chair.. He'd only come in because his wife had called his doctor's office, and they told him to go in to the ER, so she took him in. She kept talking about how he'd just need some time in the hospital to get stronger, and then he could come back home. She was so hopeful, no matter how we educated her on the very serious issues with his heart, and kept on the idea that he just needed to get stronger and eat.
I actually talked the hospitalist into allowing him to have bacon in the morning, just because he kept saying that's all he wanted, and I got him a few extra pieces.
The cardiologist had come in earlier, seen him, and had decided just about the time that the patient had talked to his wife and told her she should just go home, he was just tired, he wanted a nap, to start a dobutamine drip to try and get his pressure up. 10 minutes after his wife had left to drive home, I came in, started the drip, ran his vitals. He was baseline, still tired. 20 minutes later, I came back to check his second set, and he was incredibly agitated, kept saying "I can't sit still, I really can't, can we stop the medicine? Can I just be alone? I just want to be alone, leave me alone, I can't sit still." His BP and heart rate hadn't changed at all with the vitals I took, so I sat and tried to talk to him. He collapsed in my arms, and went completely unresponsive. I laid him back down, called a rapid, but there was nothing to be done. His heart simply went from beating to asystole, in the matter of about 60 seconds, according to the tele monitor, and there was nothing to be done. His heart just couldn't do any more, and all he'd wanted was for his wife to go, and for me to go, so he could just be left alone. The entire rapid response team could do nothing but stand there and watch him pass, in a circle of contained anxiousness, because people should die in peace, not in the hospital with beeping and drips and controlled chaos.
I was more heartbroken, not because his wife came back and was completely hysterical, or because many family members came in to sit with him after he passed and were all clearly distraught, but because I knew he just wanted to go home, with his warm bed, his slippers, and his bacon, and he didn't need the drip. I got the distinct feeling even when I was hanging it that it wouldn't help anything, but that's what was in the orders. I never ended up asking case management about hospice, or having the doctor talk to his wife about hospice, or advocate for him to be able to go home with his slippers.
To this day, I look back on him and know that was my turning point with being able to advocate for patients when I would get a gut feeling for their sense of tiredness, and I've had many subsequent patients that I helped to hospice where they died shortly after with their family and peace and no pain, that I was able to advocate for because I remember how his eyes looked when he asked to be left alone, and I never wanted anyone's eyes to ever look that desperate again with death, because it can be so much better than that.
My only consolation was that he got his bacon that morning that he had wanted so badly.
I had a pt in the ER years ago who came in who had just graduated from college at 58 and was so happy. She had been having respiratory issues and they could not be diagnosed. We did every test available to R/O P.E., Heart Issues, any other issue which might be causing her issues. We were discharging her home after about 8 hours of testing. The tech was taking her to discharge in W/C while I was completing paperwork when she slumped over in the chair. I had gotten close to her and her husband all during her stay. When the tech yelled at me we somehow got her back on the cart and she was in full blown code. We moved her to Trauma room and desperately tried to save her. She died. I had to go to the waiting room and tell her husband she did not make it. One of the hardest things I ever had to do.
These moments can make you stronger, wiser and better person, or wear you down.
You may have been young, but you did right by that patient. Thank you for being there.
So very true! I was just thinking the same thing. After 30+ years in ER and ICU, so many things have happened that I had forgotten, probably intentionally. To think of them is very sad. Life is Life and Death is part of it. We do the best we can do as humans, sometimes it just isn't enough!
One night on med/surg I was taking care of a 76 year old retired nurse. Helen (not her real name) was in excellent physical and mental condition. She had actually JUST retired 3 months before her hospital admission. Up until her retirement she still worked a full 36-48 hour work week. She never married, or had children- she dedicated her whole life to her career, she had been employed as a nurse for over 50 years. Helen told me that she decided it was time to retire so she could travel, party, and enjoy her life before she got "too old and feeble to have fun." Helen had come to the ER with complaints of abd pain, N/V x3 days and generally "not feeling well." She told me that she thought it was probably her gall bladder.
An abdominal CT was done in the ER, Helen told me she was looking forward to the doc coming in the morning to give her the results, and schedule a lap chole. Later that night, I noticed that the CT report was available to view in the computer so I read it. I wish I hadn't. It showed a large pancreatic mass, probably malignant, also a mass on the liver. She had pancreatic cancer with liver mets, and she had no idea. Helen had worked hard her entire life to have a good retirement, and now she couldn't even enjoy it. I gave the oncoming day nurse the heads up that Helen was going to be receiving some life-changing news, and then I went home to cry and have a drink.
Farawyn
12,646 Posts
I'm guessing it wouldn't be: Eeeeeeek! A TOE!