Feeling Guilty

[kwaziness]

I work on a Telemetry floor (only 1 year of nursing experience) and I recently had a patient post Burr hole surgery for a subdural hematoma. She didn't recover well and was basically in a vegetative state, although she was awake. She could barely talk or move, just stared at me and her family, and was fed via OJ tube feeding. Her family made the decision to stop the tube feedings and send her to hospice care. Her husband did have power of attorney and a copy of her living will was present on the chart, which was in accordance with her husband's wishes. I then removed the OJ tube and she was given comfort measures only at that point until she was transported to a hospice facility.

Maybe it's just the fact that I haven't been doing nursing long enough and this was my first patient like this, but I felt so guilty about stopping her feeding and when I left that day I cried. I know it was her wishes to not be kept alive by "artificial" means, but I feel like I was killing her. I feel like I killed another person!!!! I know it's silly to feel this way and that to the patient and her family I was only respecting her dignity as a human being, but my conscious feels guilt that I contributed to the "death" of someone. I know that medicine is not always about "curing" the patient and that she didn't have much quality of life at that point, but I can't help feeling this way.

I tried explaining this to my family (none of whom are in the medical field) and they just don't get it. I was depressed for a week after that happened, and my family doesn't understand. Anyone ever face anything similar? Is this something that will get easier with over time?

[ricksy]

The feelings you have inside are because you are a human being, with feeling. Even though a nurse is a patient advocate, it is difficult in (our) heads to rationalize what needs to be done. As a nursing student, you probably began your journey wanting to be a great caregiver and advocate. I guess we all figure out at one point or another that someone's wishes don't always coincide with ours, and there are always contradictions in our heads. I attribute your feelings to my solider son who signed a paper that said he was "to protect and honor," yet when deployment time came, he had serious doubts about weather he was doing just that. Meanwhile, I would definitely want you taking care of my loved ones...you have guts and feelings. God Bless.

[tryingtopass]

Yes, I have looked at the other posts and most everyone is right on. We all must make decisions and when we look back, it's hard to know what is best. But you just have to go with the best info you have at the time.

Blessings

[vmommyx4]

I have been in your situation many times. I have also seen patient's coded multiple times, every effort to save them only to prolong the patient suffering and inevitable death. I have watched a patient say, "let me go" to loved ones only to be coded yet again because the family could bear losing them. And same patient to be kept alive for months via machines.

We call it respite care at my facility and I have found the process can be very peaceful. As a nurse I offer every comfort to the patient and family. I have cried with the family, hugged family members and I have been quiet and gotten out of the way so they could have privacy. I have opened the window and said a private prayer when the patient died alone. My daughter at nine said it so well to me when my own father passed, "dying is part of living". I see it as an honor to care for a patient at the end of their life. To offer respect, provide dignity to the process and support the family.

I know I have made my wishes very clear to my family, if I can only live via machine, "LET ME GO!" do no prolong my suffering or yours, do not let me live without quality of life, do not let me live without dignity. I want to be remembered in life, full of life. Not the last X months in a hospital bed wasting away after numberous codes and hooked up to machines.

But that is me, aways respect the wishes of the patient and hopefully they have made their wishes well know to family and family respects their wishes. Perhaps you should do some reading about end of life care, it might help you to look at it differently without the guilt. So long as you are providing the best care you can to the patient you have nothing to feel guilty about.

[nrsang97, BSN, RN]

OP you aren't the only one to have this feeling. Just remember you did the right thing by following the pt and family wishes. Do you have other nurse friends you can talk to or the suggestion of EAP or pastoral care are good people you can talk to.

I had a new grad one night tell me she turned down the morphine drip on a hospice pt. I asked her why she did that trying to understand her line of thinking. She said that she didn't want to hasten the pt death and would be no part of hastening someone's death. I explained to her she isn't going to hasten the death with morphine, death was coming weather she was there or not. She was there to make the pt comfortable. I went into the room and assessed the pt and told her the pt needed more morphine for symptom management and told her to turn it back up. She turned it back up, but told me that she still felt that it was hastening the pt death. I kept reassuring her that she was in no way hastening the pt death but making her comfortable until that inevitable moment came.

[benegesserit]

Yes, it's hard. Even though I'm totally on board with the hospice model of care, there is always a part of me that questions whether I could or should have done something more, whether there was something I missed that would have made a difference. And I've heard nurses with much more experience and education in hospice care express the same feelings.

I think that it's inherently a hard decision for anyone ethical to make, even when it's the "right" choice.