Inspiring Patient Story-Why we do what we do!

Published Aug 17, 2008

51 Posts

Specializes in Medical/Surgical.

I recently had an amazing experience with a palliative care patient...

I am orienting a new nurse to the floor who at this point is ready to be on her own. It was her second to last day so she was doing her thing and I was there for support. She took the entire load of patients so when the ICU wanted to send me a palliative care patient, I took her as my "only patient". I love end of life care and was glad to have the opportunity to be able to devote all of my attention to this patient and her family.

It was an 89 year old woman who had come in for an pleural effusion in the rt lung. Her condition on arrival was grave enough that she recieved a chest tube and was sent to the ICU. She was placed on BIPAP where she stayed stable for a week, but with no improvement. On the lady's 90th birthday, the family decided to remove her from the BIPAP. The ICU staff took her off with the family gathered around, but to everyones surprise, she kept breathing on her own... effectively. She required oxygenation but only with a nasal cannula. She was still unresponsive at this point. The decision was made to transfer her to the floor and put her on palliative care. Her transfer orders were for diet as tolerated, (she was unresponsive), NS @ 10cc/hr to KVO for Morphine 2mg hourly as needed, 02@2liters, and q2 turns. The chest tube was put to waterseal and that was that.

When they brought her up, I took one look at her and just knew that the transfer from the ICU bed to our bed would be it. Transfers on patients that looked that bad were always it. But she survived the transfer. During our fourth turn of the night, she opened her eyes. I stayed in and did a neurological eval on her. She was not verbally responding to me but she would follow me with her eyes, and could nod her head. The Hospice nurse had already been in to discuss with the family expectations at the end of life so they understood that there is often slight improvement before the final decline. But something felt different to me about this one. I let the rest of the night ride out just taking care of her but not pursuing anything aggressive.

When I came back the next night, the nurse reporting to me said "I just don't think this is it for her." I had had that same feeling the night before. I took her as my only one again that night and when I went in to do my assessment, she was in a semi fowlers position and alert, looking around the room. I asked her how her day had been and to my suprise she said "I feel terrible, honey." !!!

Granted her speech was VERY garbled and difficult to understand (she had been lying for 10 days with her mouth open and didnt have her teeth in) but I could make it out. I proceeded to talk with her and ask her some neuro check questions and she was oriented. She was a little confused about the dates obviously and a little foggy on EXACTLY what hospital she was in, but was easily oriented!! She told me that it was 2008 and Bush was in office and asked me if she had had a stroke!! I was flabberghasted at this level of improvement. The family had no idea what to think. They couldn't understand her speech so I had to interpret. Everything she said was so appropriate and she even joked around and told me stories about her late husband and their gardens and her baking pies... just 100% oriented and I was amazed! I sat in there all night. She was stiff so I exercised her legs and she expressed an interest in her daughters ice cream. She ate a half cup of that. Drank some water. Then wanted some Pepsi. I just couldn't believe what I was seeing. We tried to get her teeth in so we could understand her better but her mouth was so dried out and they wouldnt stay in place. She was able to voice things that made her uncomfortable, tell us that she didn't want so much Morphine. I was so excited to be able to pamper her that night and spend so much time with her and the family. Closer to morning, she told me to go to her house and get her tan shoes ("they are the only ones that fit right") and her rolling walker because she wanted to walk!!!

Keep in mind, ALL we are doing for this woman is 10cc of saline per hour and iv morphine. Better bet after that night I was on the phone with the docs getting her fluids increased, getting the surgeon who put the chest tube in back on her case, getting things ordered to support her if she was gonna turn her bus around and head back our way! As I left that morning, she was sitting up in bed eating cream of wheat and thickened OJ. I told her that I was going to be off a few days (going on a weekend trip) and she squeezed my hand tight and said "Thank you, precious, for taking such good care of me." I teared up like a baby, but I had spent a LOT of time with her. And I figured that when I got back to work that case management would have already had her home. She teared up, the daughter teared up... It was so touching... When I got back from my trip I dropped in to see if she was still there. She was. I walked back in the room and she had her little rolling walker and was sitting in the chair in her tan shoes eatin oatmeal. Her face lit up like Christmas. She had her teeth in and talked as plain as you or me. Chest tube was gone, she was on po pain meds and she was headed home that day!!!!

To me, that situation was miraculous. To be a part of it and have a hand in it was just amazing. Things like this are unforgettable and they make you realize why you do what you do.:redbeathe