Did I do him a moral favor?

[tattooedrn]

At beginning of my shift I learned who my pts were going to be. One pt was one I had taken care of before. I assisted in his care about 5 months earlier. He has ALS disease. Pt is now trached and pegged and is unable to move. I mentioned to a couple of coworkers I wonder if I really did him a favor by assisting another nurse when pt deteriated and placed on ventilator. Couple hours into my shift, I asked him if he needed anything? He mouthed the words no. Then he attempted to tell me something and I was unable to read his lips very well. After he mouthed the words about 15 times, I thought I knew what he was trying to say. I said, are you trying to tell me- thankyou for allowing me to live? He mouthed the words yes with small smile. I said your welcome. That my coworkers and myself, that is what we do here in ICU. I was glad that we were able to get a good outcome. He smiled and mouthed the words I apprieciate it and thankyou. It has been 2 weeks now and it still is with me. I make a retorical question and couple hours later the pt answers my question that he had no idea I made earlier. So if you ever wonder if you did the right thing, I would have to say yes. God made it clear to me that I had done the right thing. ethically everything was done correctly and quickly between my coworkers and drs and myself as a team effert.

I wonder how many other nurses get this feeling when they see a pt come back at another admission to hospital? That pt is not at previous base line prior to deteriation of disease. Does anyone else ever get such a feeling? If so did you get a sense of yes or no in that situation?

[jadelpn, LPN, EMT-B]

ALS is one of those disease processes where a patient has very little control. What they can control, however, is their wishes prior to deteriorating to the point of total care. And some choose to continue to live on a vent and peg. It has little to do with the moral right, it has everything to do with your ethical practice. I wouldn't say God was speaking to you, as much as the patient having his wishes carried out by nurses who do not question the "right or wrong" of it.

[firstinfamily, RN]

ALS is one of the most debilitating diseases there is. I have watched perfectly healthy young adults gradually go straight downhill with this disease. To think my instructor, when I was working on my BSN told me I would not see this disease but rarely, and would not allow me to do a case study on it! I watched a sheriff who was diagnosed early with ALS gradually deteoriate, he came in and out of our ICU frequently. He had his wishes legally documented(I encouarge you to look into this for your patient if they have not already been done ) he was with us when he died and he had become a friend at that point. It was very sad, but I never felt that I did anything immoral or unethical. He wanted to extend his life as much as he could, he was having a very difficult time adjusting to his continued weakness and inevidible death. But he was good to us, as we were good to him. We talked to him about things we may not have told other patients just because we knew his time was limited. I think we all get a little closer to those who we care for and especially those who we know are going to continue to decline. It is gut wrenching to watch someone we cared for continue to get worse, sometimes we may feel torn as to whether we did the right thing. But it is ultimately the patients decision and we as healthcare providers must honor his decision even if we know the end result will not be good. Wouldn't you want to do as much as you could before you left this world if you knew that was the end result?? Yes, there are some of us that may question "why?". But it is not for us to question, it is his right and his body to make that decision. Some co-workers will ask "why isn't he a no code at this time?" IT is because that is his decision and if he still wants to be a full code it is up to him. We all have a purpose on this earth and if we get to chose when to leave it then, all the more power we have. Give him what he needs, the loving care and tenderness along with all the medical care he needs. He may be back again or he may not. and it is how he will remember you caring for him that will make a difference. He gets to chose how his quality of life will be, not us. God uses all of us in different ways, if the pt wants to be a full code and want to pursue life, who are we to decide otherwise?? He still has a purpose, even if it is to teach the rest of us to be humble.

[AnnieOaklyRN, BSN, RN, EMT-P]

We had an ALS patient at home, vented and pegged and she would consistently mouth the words NO when we were doing stuff... I can only imagine if she could still speak she would have told us to take her off the vent and let her go!

[tattooedrn]

Just to clarify my post. I do not question what i did. Or if i would do it all over again. I am a senior ICU nurse. If pt is full code I only stop for 1 of 2 reasons, dr tells me time of death or family says stop and let nature take its course. If dnr/dni i go all the way to that point of code. It's a sad case. This pt is a retired dr. Who has no paperwork in place. The reason it has stayed with me is, I didn't allow him to live. My coworkers and myself did our jobs. We gave him the chance to live. It is God who decides the rest. God gives me my knowledge, wisdom, and skills to do my job daily. The rest is in his hands. To this pt he has what he wants, time with family. He is mentally sharp, body just doesn't work. To him he has quality you are right though, it is hard to watch someone deterioration . It is how choice. I do thankyou for your input.

[ArtClassRN, ADN, RN]

If the patient was ordered to be placed on a ventilator, you had no choice but to help place him on the ventilator. Not doing so would have been killing him whether anyone thinks a god wanted him to live or not.

We can, and should, always debate the ethics of situations. There have been times when patients or families have made extraordinarily bad decisions regarding their care. Even though I disagree with it, I still perform the cares. If I am especially bothered, I will request to not be assigned that patient again.

Because a god doesn't make decisions or judgments regarding my actions. I do.