Twice this past week we received two hospice pt's, two days apart, who were actively dying. Mind you these hospice pt's were DNR/DNI/DO NOT TOUCH ME I WANT TO DIE IN PEACE! One pt wasn't even in the ER 20 minutes and she passed. Thankfully the family made it to the hospital and was at the bedside. And it was a horrible night in the ED. We were getting our butts kicked bad. Every bed filled, flying out a critical, and several other critical pt's to care for. I was so angry that this poor pt was uprooted from her bed, taken from her normal surrondings, shoved in an ambulance and brought to us. The bright lights, hard beds, unfamiliar faces, weird sounds and sometimes horrible smells. What happened to dying with dignity in your own surrondings. But the nursing home didn't want to do the paperwork so they sent her to us. The pt's nurse was tied up with the critical pt being flown and I couldn't stand the family in there by themselves. Her sats were in the 60's, HR in the 20's and she was only giving an occasional gasp. I went in and stood by the bed quietly. I explained that her heart was slowly stopping and that her breathing would soon stop. After a few minutes I watched her heart go into v-fib then a few seconds later asystole. I stayed a few more minutes with the family until the other nurse could take over.
The next night again, another hospice pt, actively dying. This time because the dr. didn't want to give the hospice nurse V.O. to increase the morphine to make her comfortable without being medically cleared! Granted she was getting a pretty hefty dose of morphine Q1 hour, but her lungs were diminished in the bases and full of fluid you could hear her breathing from across the room. So, we had to do as the family and dr wished. Put her on bipap, put in an iv, push lasix yadda, yadda yadda. I believe these were comfort measures because it did help her breathing but the poor lady just wanted to be free from her pain. She did pass later that night.
It's interesting... I know I might be digressing from the OP's topic slightly... But I had a talk with my mother what her wishes are. No matter what, she doesn't care about the situation, she NEVER wants to be DNR. She is a retired RN as, so she knows what that might mean. In this case, even if my sister and I thought she was suffering and there was no hope, we would have to respect my mother's wishes to do everything possible no matter what. She doesn't want to think she will ever die and refuses to acknowledge her mortality...
Today I received a 94yo LOL by ambulance, with a health care directive that explicitly said DNR, comfort measures only. I could have kissed the doctor who discharged her back in less than 30 minutes with a doctor's order that said "Please respect patient's health care directive."
Granted she was getting a pretty hefty dose of morphine Q1 hour, but her lungs were diminished in the bases and full of fluid you could hear her breathing from across the room. So, we had to do as the family and dr wished. Put her on bipap, put in an iv, push lasix yadda, yadda yadda. I believe these were comfort measures because it did help her breathing but the poor lady just wanted to be free from her pain. She did pass later that night.
yotaka
7 Posts
It's interesting... I know I might be digressing from the OP's topic slightly... But I had a talk with my mother what her wishes are. No matter what, she doesn't care about the situation, she NEVER wants to be DNR. She is a retired RN as, so she knows what that might mean. In this case, even if my sister and I thought she was suffering and there was no hope, we would have to respect my mother's wishes to do everything possible no matter what. She doesn't want to think she will ever die and refuses to acknowledge her mortality...