I was taking care of a patient yesterday who was extubed and care withdrawn. She's going to die from liver and kidney failure. She didn't die from extubation. In fact was alert and at the time of my assessment breathing easily. The husband said "she seems comfortable", she shook her head no when I asked if she was in pain, and even smiled when I talked of her marriage for 47 years.
Apparently she complained to her husband she was hungry, (she has a trach, so I guess somehow he figured this out). He then was a little torn if he was doing the right thing.
His kids wanted me to sedate her to sleep so she isn't suffering with hunger, but also to help the dad cope.
The chaplain who is on the ethics committee even asked to medicate her.
It was ackward because at the time of my assessment a few minutes ealier we decided not to medicate. She's terminal and will die soon, but was not in an active dying process and alert and didn't report pain, or give nonverbal cues, and I felt I was medicating only to help the family, not the patient.
I am a big advocate for pain/sedation at the end of life during the dying process and realize this patient will need those meds soon.
Any advice. I did call hospice and ask them to come see the family again, although they had just been there earlier in the day.
