This story is being posted with no identifying information to protect the innocent parties involved.
I am an ICU nurse. Last night, I was taking care of a patient in her late 70s who has been in the hospital for about a month now. She is septic and had a colectomy performed in early January due to c. diff colitis. Her abdomen remains partially open. She was only recently extubated and is not doing well. She has developed a secondary pneumonia, has terrible edema and wounds, is in great pain, can barely move, and is certainly suffering by all standards. The patient is confused at times, but also mouths and sometimes (when able) verbalizes that she does not wish to have this type of treatment.
The family approached me last night and told me that they have decided that they would like to make her a DNR/DNI. They told me that she never wanted this kind of treatment, and that since she is not getting better and the possibility of her recovering is slim, that they wish not to "code" her if her heart would stop beating and that they do not wish for her to be on the ventilator again.
As I would normally do in this type of situation, I paged the surgery team in charge and told them about the family's request. They were annoyed that I had even paged them. Even though they were in house, they did not come up to the room (this was around 2100). The chief resident spoke with one of the daughters but then refused to write a DNR/DNI order and did not talk to me again. The daughter was upset and nearly in tears and told me that she felt bad for asking. Apparently, the chief resident told her that there was "a chance" the patient could get better in "three months" and that she didn't need to be a DNR. I explained to the daughter, husband, and patient that there is nothing wrong with discussing this, and that if that is their wish, then they do have the right to enact it. I also explained that DNR/DNI does not mean we wouldn't treat her any differently, and we would still give her all the meds, abx, wound cares, etc, if that is what they would like for us to do. I told her that since the surgery team was not on the same page with them, that I would page the ethics consult person, which I did.
After initially speaking with the ethics consult, I was instructed to page the patient's attending. The chief resident had failed to even mention the DNR request to him. However, he basically reiterated to the family that the patient "might get better in three months" and that she "might" make it, doesn't need to be a DNR...yada yada. Meanwhile, the entire family is extremely upset as it has taken them a lot of time to make this tough decision, and they feel like they are not being listened to. I tried to speak with the attending after he got off the phone with the daughter, but he hung up the phone.
I then paged the ethics consult again to let her know what had happened. She agreed with me that not everyone was on the same page, and that there was definitely an ethical dilemma, and that she would come in to speak with the family in the morning. I charted that I had done all this (and with whom I had spoken to), mainly to cover my bases in case the patient would have coded during the night. The family thanked me for sticking up for them and even told one of the other nurses how appreciative they were for what I had done to help them in the situation.
Apparently, the chief resident must have read my electronic documentation this morning, because she called me and was infuriated that I had called ethics. She told me that it was "inappropriate" and that apparently "you don't understand what's going on with this patient." She asked me why I had called ethics and I told her that as a patient advocate, when a patient/family approaches me with the request to make their loved one a DNR/DNI, it is my duty to accept their wishes and that when not everyone is on the same page, a mediator is needed so that we can do what is best for the patient. She got even more upset and asked to speak with my charge nurse, who relayed the exact same information to her.
I can't believe I got chewed out for this! I printed out the policy and procedure regarding an ethics consult, and I followed it completely. I've previously had a decent relationship with this resident, and now I'm afraid what's going to happen when I go back to work and need to call her for something. :angryfire
