Last days of life

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Just need to vent a little bit. There is a patient I have grown close with throughout his stay at the hospital. I was there when he first got admitted when he was somewhat functional and able to help himself and now two months later he has gotten worse. He has cancer with mets and he is hooked up to all these tube feedings, trach and catheters. He is a witty, sarcastic patient who busts my chops but that is the bittersweet part of mine and his friendship. I have seen him decline and it is starting to really break my heart. The doctors have increased his pain medication and although I dont want him to be in pain, I get scared about each dose I give him that it will be his last breath. He gets 3mg dilaudid every 3 hours, he is dnr dni and getting palliative treatment. His breathing becomes very shallow when he is on these medications I would say about 8 to 10 but he appears comfortable. My issue is if a patient is dnr dni and they have pain meds as stated above, do you go forth willingly and comfortably by giving all of the pain medication? I feel the 3mg is alot and when I give it I feel I will be the one pulling the trigger to making this patient pass away. He also was crying to me the other night because he is becoming very forgetful and he told me he just feels different and doesnt feel right and that he hopes he is not being a pest to any of the nurses and apologizes for his behavior. Just need some other thoughts about this situation because I am at home and I keep thinking about this patient and nervous that he may pass away. Is this normal?

I'm so sorry, I know that's a very difficult experience to go through. It's clear from the post that you care about the patient, and just want to do what's right (even though it feels counterintuitive).

Caregiver compassion fatigue and grief can be painful, especially in a situation like this were you feel conflicted. Make sure to take care of yourself! Many staff don't know this, but hospital chaplains are trained to support staff through the grieving process (regardless of religious affiliation), not patients and families. Your hospital may also have an Employee Assistance Program (EAP), which provides free short-term confidential counseling for situations just like this one. If you continue to feel distressed, I'd recommend utilizing one of these awesome resources.

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