Ever wonder if you should have just let them go?

[IamVickiRN]

Hi,

I work in an LTC and I recently had a patient that is elderly (frail, 91 but able to ambulate, communicate, eat, and toilet self) with several disease processes, none of which are necessarily life threatening. Patient is a DNR. I found my resident in respiratory distress to the tune of foaming at the mouth, cyanotic, unresponsive to painful stimulation and literally "gurgling" there was so much fluid overload. Patient is a DNR. I set her up, get help, we get things handled, call the MD who says I have to call her family. Family wants her taken to hospital and they override the DNR. EMS is called, they whisk her away. She was gone about two weeks. She came back just before my shift on Thursday. Basically a vegetable. No speech, no comprehension, suffered a stroke, barely a shell of the person she was. Before I left this morning I saw her and I swear she looked at me like she was begging "why didn't you let me go??" My heart is broken. She is now total care, won't eat, weak beyond belief and truly just looks so sad. Did you ever just wonder if maybe you should let them go? I honestly believe that had I not intervened she would have been gone in less than 10 minutes. Now I feel like I have sentenced her to the prison of her broken body.

WillBRN2009

[MIcrunchyRN]

Oh that's so hard. Such a tough spot. I truely think its absolutely evil and wrong that a patient's family can override their code status/death wishes when the patient themselves made those decisions. . You didn't do anything wrong you just wanted her to get some help to make her more comfortable not start this aweful cycle knowing they would change her code status.

[SuesquatchRN, BSN, RN]

I'm so sorry.

It isn't your fault. The family is squarely to blame for this half-life they'ce thrust upon her.

[TopazLover, BSN, RN]

Hugs. I am very sorry this happened. It does happen more than any of us want. You did the proper things. It was the MD's responsibility to stand up for the ole gal's DNR. Just second guessing here but suppose it had been a really bad bout of Pulm. Edema. Would you have done anything differently? It sounds like she was not at the point of needing CPR when she left your care. With DNR ordr we do initiate appropriate treatment, we just don't do things that are intrusive and mechanical to prolong the death process.

Been there, done that so many times all the Tee Shirts are in rags. Don't hold on this bad experience, just spend some time with her and talk to her. She is still there and needs your love and compassion.

[Acrlady]

I am a hospice nurse, and I see this a lot. Sometimes the family just does not want to let go. They can over ride even the doctors advice at times. We can only do the best we can. Quote" I honestly believe that had I not intervened she would have been gone in less than 10 minutes. Now I feel like I have sentenced her to the prison of her broken body. End Quote. This is not your burden to bear. I know its hard not to. You did what you must. Tender care of the patient and prayer that she will soon go home is all that you can do now. Maybe a little teaching on the subject of end of life issues.

Please don't beat yourself up over this.

[JB2007, ASN, RN]

You did nothing wrong. As hard as it is, we must honor the family's wishes. Even though in our heads we are screaming, do not do this to your loved one. I know this makes you sad and feel like crap, but you did the right thing. I have been in the same place you are right now many times.

[morte, LPN, LVN]

this actually had nothing to do with DNR at all, which does not mean "do not treat"....

[Virgo_RN, BSN, RN]

DNR means Do Not Resuscitate, not "Do Not Treat". You did the right thing. It's possible that her hospital course did not include any CPR, defibrillation, or intubation, only a NRB or BiPap and lots of Lasix. There is no way for you to have predicted she would have a stroke. I agree with you that the outcome is incredibly sad, and I would probably feel guilty as you do. But you cannot turn your back on a patient in distress simply because they are DNR.

Maybe she will continue to refuse to eat and her family will honor what she would have wanted and opt against a feeding tube.

[PiPhi2004]

I am so sorry you have to go through this. I find that this is the one type of thing I struggle with being a nurse. They always seem to be LTC cases and the family just can't cope who get to ICU and we code them for 30min-hr. I usually have to take a break from these patients or I will go stark raving mad at, IMO, 'torturing' a patient who didn't ask to be this way!

[Batman24]

These stories always make me so frustrated, upset, and outraged because the families often put themselves ahead of the patients. The hospitals are afraid of getting sued so they go to the family even when the DNR is on file. The DNR is sadly useless most of the time and my heart breaks for the patient who suffers most when they are so vulnerable.

You did the right thing and aren't to blame here in the least. I hope she passes away on her own and quickly before they intervene with feeding tubes and more torture devices on a woman who doesn't want them. Poor thing.

[Critical_Care_RN]

Sometimes the family just does not want to let go. They can over ride even the doctors advice at times. We can only do the best we can. Quote" I honestly believe that had I not intervened she would have been gone in less than 10 minutes. Now I feel like I have sentenced her to the prison of her broken body. End Quote. This is not your burden to bear. I know its hard not to. You did what you must. Tender care of the patient and prayer that she will soon go home is all that you can do now. Maybe a little teaching on the subject of end of life issues.

Please don't beat yourself up over this.

:yeahthat:

[Eirene, ASN, RN]

This is just my experience...

When a DNR has pulmonary edema at the hospital and can't breathe-- we'll ask if they want the tube.

99% have said yes. The fear of sufficating is overwhelming. She may have made the decision herself if she was able.