I just hate it when I get attached to patients sometimes.......
I admitted this 85 YO gentleman the other night, who had just left the hospital last Sunday following a hemicolectomy for colon CA and now was back with renal failure, and dehydration due to vomiting and diarrhea. I took care of him for two days, trying to get his doctor to actually DEAL with his problems (right-sided abdominal pain, constant nausea, absent bowel tones, and the presence of a bruit that I heard over the right side of his abdomen). MD ordered IV fluids to run at 150/hr., which sent him into fluid overload, and it took two shifts and going to the nursing supervisor to get the doctor to address the IV issue (Doc told the super, "I don't wanna talk to anybody about this patient anymore, I'm coming in to look at him and I'll just write orders"). Finally got the IV rate decreased to TKO, oxygen and breathing treatments were ordered, and a CT scan to find out what was going on in the pt's belly.
I was off for one day, then came back yesterday to find this patient in even worse shape than before. He had crackles everywhere, his urine (what there was of it) was tea-colored, and he still had the bruit and the nausea and the abdominal pain. Finally, the one doctor gave up and had Internal Med do a consult; no sooner had this MD been in to see him and new orders written for all kinds of new tests, than I walked in to see how he was doing with his dinner tray and found him dead!
It was obvious from the position I found him in that he never knew what hit him......he'd been sitting up in bed, nibbling at his soup, and now he was lying across the bed, legs hanging over the side, and he looked utterly peaceful. But it was SUCH a shock.........I'd just been talking to him after the doctor had been in, and he'd showed no indication that he had only minutes to live........I've seen a lot of people die, but I have to admit this one really shook me up. I'd taken a liking to this poor old fellow, who lived with his 60-something daughter and they were basically alone in the world; I knew he probably didn't have very long, since the cancer had been fairly advanced when they operated, but NOBODY was ready for this!
In a way, I'm happy for him because he was obviously NOT in pain when he passed on......yet I feel we all failed him somehow, because we kept having to fight with his doctor to get anything done for him, and some of what was being done was actually making things worse! One of the CNAs was very unhappy about the situation, she feels that this patient's life was basically thrown away for nothing, and a large part of me heartily concurs........when I found him, there was liquid stool literally coming from EVERYWHERE. Two other nurses and I had documented a lack of bowel tones, and it had basically been ignored. I'd reported the bruit, and the doc looked me straight in the eye and said "Don't worry about it". OK, so the patient was a DNR, does that mean we don't try very hard to get to the bottom of what's ailing him and just throw antibiotics at it? Does that mean we allow a patient with a history of AAA repair, a pulsatile mass in the abdomen, and pain in the same area to just blow?
Obviously, I'm still unsettled in my mind about this, and I'm not sure what I ought to do about it. On the one hand, I know the man was dying anyway; on the other, I don't feel his doctor took very good care of him (why did he just sit on this patient, not even calling for an internal med consult until three days after admission?), and I do believe that this patient should not have died like this.
Sometimes I wish I could view my patients clinically and objectively; I've never gotten used to the fact that some docs treat them like widgets on an assembly line. I've also never gotten used to walking into a room and finding them dead in bed! All I wanted to do yesterday was go find a quiet room and cry for fifteen minutes, but I never got a chance even to take a full dinner break so that was out of the question. Damn, I hate it when I get emotionally involved........this stuff just tears me up, and there isn't a thing I can do about it. The practical part of me says "Get a grip, girl", while the marshmallowy side knows that I never WILL get used to it, and that if I ever do I'd better get out of nursing, because I will have lost what makes me a good nurse.
Thanks for "listening" to my long-winded vent........unlike my family and friends outside of work, you all understand the kind of emotional crap I'm experiencing.
