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Topics About 'End Of Life'.

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Found 39 results

  1. MBar1

    QOL vs Preservation of Life

    I am always curious to hear others thoughts and opinions related to a topic that is on everyone's minds, in private conversation with colleges, and sometimes inferred in conversation with patients and families, however, that is never really explored head on, for what it truly is. How do you reconcile preserving life if it is not one of quality? Is it that preserving life is easier to justify ethically because attempting to create parameters for a quality life & describe what that should entail is far more difficult? The answer is probably yes. But what do you think? Do we attempt to rationalize certain things in medicine that perhaps aren't rationale by themselves, at there core? Topics such as mortality, suffering, and self-determination? Who says these problems are based solely in medicine? I see philosophical, ethical, and sociological dilemmas here. Also, anthropological and theological implications. The human condition is so characteristically subjective. To each of there own, our experiences are simply different from one another. The way we think, learn, believe. On the contrary, medicine is predominately objective (with a few exceptions of course) in nature. How do we reconcile tackling both realities and spitting out a universal truth that is applicable to both. I believe the answer is, you don't. And this is where the messy grey areas begin to infest. A reality that most ignore, but should come to recognize as chief importance to the quality of individual and collective life. Comment below 🙂
  2. curlygirlie3

    Caring Vicariously

    It has been two weeks since I found out that my grandmother was in the hospital, ten days since her surgery, five days since I last spoke to her, four days since she moved to hospice, two days since the last time she was awake. For 81 years my grandmother has been a vibrant, healthy woman. Bike riding, swimming, square dancing, crafting, and enjoying time with her boyfriend filled her days in her small Florida retirement community. She must have known that she was sick. Colon cancer does not reach stage IV without a person experiencing symptoms. Waiting, ignoring, and deferring treatment was her choice; I respect that. The difficulty comes with the swiftness of decline - a sudden drop on the carnival ride that leaves one's heart in their throat. As a nurse, as a granddaughter, and as a person I want to be there for her. I want to swab her dry lips, arrange her pillows, and hold her hand. The gulf between me and her bedside is filled with geography, time, money, and obligations to my family and work. The guilt at not being there to care for her is enormous. After all, I work with cancer patients daily. I do all of the things that I want to do for her for strangers. Wait...I do it for strangers. Another family recently experienced a profound loss. I first met Ms. Smith when she was recovering from cancer surgery on my unit. She was beautiful, kind, generous, and funny. She was a gentle soul and I could tell that she had worked with children for most of her life. When I meet patients like her, my fondest hope is that I will never see them again. Don't take that the wrong way. If I don't see them it means that they are doing well. Ms. Smith was readmitted to the unit more times than I can remember with complications from her treatment. Despite losing her hair, appetite, and eventually her physical mobility, she never lost the qualities that made her so special to the staff and so loved by her family. In her last days I was her nurse. I swabbed her lips, I kept her dry, and I gave her medications to keep her comfortable. When she passed I paid my last respects as I placed her in the shroud. Unsurprisingly Ms. Smith has been on my mind for the past two weeks. I believe my memories of caring for her are helping me cope with the fact that I cannot be there for my own grandmother. I also believe that there is a nurse somewhere in Florida who is caring for my grandmother in the same way that he/she would care for their own family member. Providing nursing care for the sick and dying requires a sort of suspended reality. That is not a stranger in that bed, that is your mother, father, grandparent, or child. As a profession, we have a collective belief in the Golden Rule. This belief may be tested daily by the stresses of the job but we must never let it waiver. Somewhere out there a family member is holding out hope that you are treating their loved one as your own. To every nurse that reads this, please keep the belief in the Golden Rule alive because, one day, as I have, you may find yourself in a similar situation.
  3. b a nurse

    A Perfect Ending to a Perfect Day

    The window curtains were wide open. I kneeled down beside her where she could hear me and I grasped her hand into mine. I closed my eyes and I began to pray for her. The hall smelled of urine and that fecal odor that always permeates every breathable space in the facility. It was usual at this particular facility. There were loud TVs and call lights on above every other doorway. Through all this hallway madness my mind was on my time constrained day. It was filled with my usual patient load plus five. I had covered for a fellow co-worker who called in sick that morning. Up until that afternoon, my day had been filled with many hurries up and wait for situations but this next assignment would put time into perspective. This particular room had two patients, both separated with a curtain. I came to her around the curtain in the second stall. My eyes fixed upon her and I instantly surmised that she didn't have much time. I lay my backpack down at the foot of her bed. I reached to grasp her hand and could only feel cold. Her eyes were half open and her mouth was drawn open. I quickly felt her forehead and it felt hot. Raising my hands up I quickly said a prayer. My hand then caressed her face and went to work. The wash basin, soap, and hot water were in hand as I began to look around more closely. There on the nightstand and dresser were religious deity pictures accompanied by small statues of the Mother Mary. A thought quickly came to mind. I instantly turned on the TV to the all Religious channel. I knew she could hear even though she had labored breathing and half-closed eyes. I was on a mission. I had to get her comfortable and ready it seemed. I didn't stop but to only clean up from my procedures. Then I settled into bathing her. Methodically I began to clean her and I could tell as she seemed to become more relaxed as I progressed. Each part of the body received its individual care. I would rinse ever so carefully and then dry. First her face, then hands, and thirdly her body. Just as I started to care for the lower half she moved her hand and pointed to the window. After a few attempts to understand her, she spoke in a very mumbled and slurred tone, "Open the window." I dropped the towel and did as she told ending a prayer once more. She went back to her unconscious state of labored breathing and rest. I then was moved to comfort her. I wanted her to be calm and the best thing I could do was hum the hymn, How Great Thou Art. Once again she seemed to not respond and didn't seem to mind that I was humming the most comforting music available to her. I soon finished up with the bath and dressed her in a gown trying to do so with little to no extra movement all the time humming to her. My clean up took little to no time. I still felt compelled to comfort her more and more. Her breathing became more shallow. The time was coming close. I finished up and went to her side. I placed my hand into hers and I bowed my head. I began to pray to the Lord on her behalf. I felt better now that she was comfortable. I could read no pain in her face or body. I exited the room to start my "end of visit" paperwork and I returned no longer than five minutes later. She had passed. She was at peace. Many days after I could only think about her and how God worked his perfect timing. Throughout my entire day with all of the schedule changes, hurries and stops I was in perfect timing to be present for her on her journey home that late afternoon.
  4. TheCommuter

    Death Happens. Get Used To It!

    Here's a truthful horoscope for you: we're all going to die! Before we get started, ask yourselves the following question: What exactly is it about death and dying that disturbs you? Once you pinpoint the source of your fears, keep in mind that other people who once had the same reservations have moved on to become stellar nurses with solid careers in the nursing profession. If you cannot identify what it is about death that makes you fearful, that's also okay. It's probably a sign of our modern times. Let me explain further. In previous generations, death still remained a sad and dreadful time for people who saw family members die. However, the main difference between the past and the present is the fact that death and dying used to be highly visible, very out in the open, expected, and an accepted part of life. During yesteryear, 'passing away' was a personal event when people died at home encircled by loved ones who said their goodbyes. The surviving kinfolk lovingly gave post-mortem care at home in the hours after death. In the modern 21st century, the vast majority of death now occurs in healthcare settings such as hospitals and nursing homes. In other words, death has mostly been removed from intimate home settings, so many people fear what they have not seen. American society now does too efficient a job at hiding death from view and this contributes to making death seemingly creepy to some. Is it bad for you to fear dead bodies? No. Your fears are actually normal due to the society in which you were probably born and raised. Regrettably, death is all around us, and you will need to become acclimated to it if you plan to work in most areas of nursing. Don't worry, because you'll start to become more familiar with death as you get more exposure. You'll actually be relieved by some deaths and saddened over others. Although death will never be easy on you, it will get easier over time. What do you do if a patient dies? It depends on the code status, healthcare setting, and situation. You would immediately call for help if you find a dead or dying patient who is a full code at a hospital. Press that code button, call the rapid response team (if available), lay the patient on a board or hard surface, initiate CPR, and so forth. The sooner you summon assistance, the quicker your patient's room fills with people to help with the resuscitative effort. Patients who have current DNR/DNI orders are dealt with differently. We want to notify family promptly if the patient is in the process of actively dying. In an ideal textbook world, someone would remain with the dying patient until family arrives to ensure the person doesn't die alone. Dying patients who are on hospice or end-of-life care receive comfort care such as frequent turning, bed baths, pain control, oral care, and other measures to maintain dignity before death. When the patient dies, someone makes a pronouncement of death. In the state where I practice nursing, pronouncing death is within the RN's scope of practice. Some families want to spend time with the body, so we give them time for that. What happens with the dead body? The nursing department is usually responsible for post-mortem care such as cleaning the body and rendering the patient fit to be seen by any family members who may want to say goodbyes to their loved one at the bedside. At many hospitals, the nursing department is also assigned the tasks of placing the deceased inside a body bag, attaching toe tag identification, and transporting the body to the morgue. The mere thought of dead bodies might send chills up and down your spine right now, but I assure you that dealing with death will become easier with the passage of time and the accrual of more exposure. After all, death is a natural part of the circle of life. Don't let your fears deter you from nursing.
  5. Death is the reason why I decided to become a nurse. I know, it's a rather strange thing to say and I probably don't mean it in the way that most would. I don't see myself as a caped avenger, fighting death. In fact, in many cases, Death is welcome. The journey to me becoming a nurse all started with an end; I got laid off from a factory job. Where I live, the government had an initiative that would pay for your education and some expenses if you had been laid off. When I first applied to school, nursing seemed like an okay option: it fit the requirements of the financial assistance program. But then, my grandmother started failing. She had been in a long term care facility for approximately three years at this point. Her doctor had called my mother to say that she would likely not last the night. Of course, my family being how we are, we all rushed to the nursing home and were at her bedside. My grandmother's nursing home was a small one; only about 50 residents lived there. When she made it through the first night, the staff moved her into their family room. It was there we stayed, keeping vigil. The room was small and my family is fairly large. But we spent the last week of my grandmother's life in that room. I say that this experience made me decide to become a nurse for several reasons. Sure, I had already applied to school and had been accepted but I had no real concept of what the word "nurse" really meant. Watching my grandmother and the people who cared for her was the way I began to understand its meaning. When my grandmother was hot, they would give her a cold compress. If she was in pain, they would give her medication. If she was cold, they would adjust her blankets. If my family was concerned about something, they would talk with them, teach them and simply comfort them. When the time came that my grandmother took her last breath, they came in to take care of her. They talked to her as though she was still there and they had tears in their eyes when they said their own goodbyes. Since then, I have graduated nursing school and have passed my licensing exam. I am working as a nurse at a local retirement home. In the two years that I have worked there, there have been 15 deaths. I remember each one. Death is not a battle that is fought, because there can never be any true winners. But for each of those residents who have died, I have been there. Death can be many things to different people: friend or foe, adversary or companion, silent partner or looming threat. I believe that the most important thing about being a nurse is how you help others deal with death and how you can help them go through it. You are there for the dying person as well as the living.
  6. YelenaV

    Singing with the Angels

    There are times, however, when the patient can't improve. To our frustration, we all remember times when our patients were terminally ill. Some we didn't know very well, so the feelings inside were sadness and reverence. Some were our favorites, and we cried together with their families. Yet I learned that death is not always a failure on the part of a patient or his medical staff. There is a powerful event which when happens is able to make peace between life and death. This event is called reconciliation. After graduating with my B.S. in Nursing I worked in a small hospital in eastern Kentucky. Being born and raised in Russia, it took time for me to get used to the local accent. However, I found people delightfully simple and friendly - they tried their best to understand my Russian accent and I was often telling them funny stories about how people live in my country. That day was my regular day shift. I had 9 patients, but they were unusually stable and therefore I was rather cool, calm, and surrendered. At the end of my hallway was a room for just one patient, and earlier in the day the patient was admitted there by another nurse. I was walking down the hallway in the afternoon when I heard this patient's IV beeping. I went in to see if it was just kinked and maybe could be easily fixed. A man in his late fifties was lying on the bed with Dr. E seated by his side and a lady about 40 years old standing in the room. I was surprised to see Dr. E because it was long after the doctors' rounds were finished and this doctor was pregnant, so I knew she would not come out to the hospital unless there was a serious reason. While fixing the IV, and sure enough it was just kinked, I heard bits and pieces of a conversation. "... Unfortunately Mr. J, the picture we got a week ago and a picture we got today are drastically different... It grew to the size of a grapefruit... This is a very rapidly growing cancer..." The IV was fixed; I exited and went on to check on my own patients. 15 minutes later the IV began to beep again, and I went toward that private room, thinking about how unwise it was to give this client to another nurse, the majority of those patients were in another hallway. I quietly passed by Dr. E standing outside the room, holding the lady and talking to her quietly, trying to comfort her. The lady turned out to be Mr. J's daughter and right now she was sobbing inconsolably. I entered the room and looked at the man with some degree of curiosity, I'll have to admit. He was lying quietly staring at his sheets. I fixed the IV, but I couldn't just leave him. We both could hear his daughter crying in the hallway. I sat down and took his hand. What do you say to a man who just received his death verdict? "Are you scared?" I whispered. He looked at me and tried to smile or say something, but I don't recall that anything actually left his lips. He just looked lost. I was so young, only 21, and this was the first time I was witnessing a person's reaction to the news of his death. I felt the sacredness of this moment and I could almost hear the world pausing, waiting for his reaction. And then suddenly something broke the silence - to my ultimate surprise, it was my quiet singing. I often sang to patients: little funny songs, Christmas carols, Russian songs. But those were cheerful songs meant to brighten the day. I never sang to a dying man. And now in this room, touched by the shadow of death I was singing an old hymn: When peace like a river attendeth my way, When sorrows like sea billows roll... Mr. J closed his eyes and squeezed my hand, and to my dismay, the tears started rolling down his cheeks. Usually, I would have been afraid that I had done something wrong, but deep down inside I knew whatever I was doing now was right, and the song went on: Whatever my lot, Thou hast taught me to say: It is well, it is well with my soul... I don't remember how long I kept singing, but I remember the words that came out of his mouth finally: "Thank you! Thank you!" And I knew immediately he wasn't thanking me. When Mr. J opened his eyes, he looked straight at me and said: "I saw heavens open and angels singing. And now I know that God accepts me." This man from Eastern Kentucky probably didn't know that he practically quoted the great composer George Frederic Handel, who several centuries ago said the same very words after composing his famous "Hallelujah Chorus". His whole countenance changed. It was almost as if his confidence had returned. Chills ran down my back. I realized that I had just witnessed reconciliation between man and God. In the next several months I saw Mr. J quite often in the hospital. Sometimes I was his nurse, sometimes I would just stop by to say "Hello." When he would see me, he would say: "Here's my angel," but I knew I was no angel. I was only grateful for the privilege to be a small part of a miracle. His daughter called me when he died. Six years have passed since then. I moved back to Moscow, but in the rush of life in the capital, I still remember the lessons I learned from my encounter with Mr. J. I learned that each one of us longs for reconciliation with self, our loved ones and with God. But more important, I learned that God longs for reconciliation with us. I learned that God has a special way of talking to us, making a conversation that is understood only by Him and the person He is talking to. Other people may witness that conversation, just like I witnessed the reconciliation between Mr. J and God. One might even be a messenger of such a conversation, but this conversation is too intimate and cannot include a third person. What I remember the most is my feeling of gratitude and humility. What a privilege for a nurse to be an instrument in a healing process that is still possible even in the face of death.
  7. didi768

    Not Always What They Seem

    I didn't know nurses drank and smoked. Okay, call me naïve but hey, I was young and stupid, I actually bought the hat. I was also under the impression that all nurses were Christians. WHAT KIND OF UPBRINGING DID I HAVE? WAKE UP NUN. Her name was Heidi. Man did I hate Heidi. She represented everything in life I was NOT. She flirted with every doctor and drank like a fish. She did have spunk though, I'll hand her that. Some nurses have no class. She was one of them. Don't ever trust a loved one with this girl, especially a dead one. One day I was in the room of her patient who had just died and she was dancing and laughing with her gloved hands swinging washcloths around. I was horrified. How disrespectful. This nurse went out for FLUID ROUNDS much too frequently and it damaged what brain she had left. I knew I never wanted to be that kind of nurse and I knew that nurses were NOT always what they seem, or what they appear to be. I grew up a Christian girl and out of naivety, I thought all nurses were God's little helpers; who took on the cares of the world and loved people. Never gossiped. And smoking? A nurse would never smoke, I was doubly sure of that! Wow. I must have been very sheltered. Nurses do smoke. A lot. Nurses do drink and party. Nurses do gossip every chance they get. They do complain about their patients. They do get upset when someone wets or poops their bed. Of course, they are not going to tell you that, but it will be discussed. They will discuss it because they can. That's right. They are human. So are doctors and dentists. Just because they are so-called "professionals" does not mean they act the part. Do nurses do the best that they can? Of course they do. We all do. Humans are funny. We all mean well, but like with everything else in life, we make mistakes and screw up. There is only one perfect person and no matter how hard we try, we will never measure up. Therefore, if you ever need the bedpan, look out. Hand it to the nurse, smile, and say, " Here sweetie, enjoy" Then just leave it at that. You "will" be discussed, you can bet on it.
  8. Palliative care services are a very important resource for those patients who have been recently diagnosed with a terminal illness. Care needs fluctuate throughout the course of any life-limiting disease. No longer are patients required to terminate aggressive treatment, and possibly give up all hope in order to receive much needed services. These Palliative care services may include: Help navigating the healthcare system. Multiple symptom and pain management. Guidance with difficult and complex treatment choices. Emotional and spiritual supportive counseling. Patient and family open communication. Unfortunately, there continues to be a lack of knowledge and understanding among many Physicians, who are resistant to the idea of Palliative care. They continue to have the idea that if their patient considers Palliative care services, that the patient is actually giving up and is ready to die. But that is simply not the case. According to the American Nurses Association, Palliative Care is recommended for: Any stage of illness. Used in conjunction with treatment. Helps with the transition from curative care to Hospice. These patients can continue with their aggressive disease- oriented treatment, as ordered by their Physician, while receiving much needed services. The network of support from the entire Palliative care team, may even aid the patient in continuing with their treatment. Palliative Care is beneficial, not only for the seriously ill patient, but their families as well. This also makes for a much smoother transition or "bridge" to elective Hospice services at a later time. This bridge provides for the movement of the pre-hospice patient, on to full hospice services, without an actual crisis. This new Hospice patient admission can now be a direct result of a tranquil, peaceful, and an elected personal choice. It is important that all healthcare team members have an understanding of the aspects of Palliative care services. Detailed information and a referral about these important services should be initiated at the actual diagnosis point with the Physician. The Journal of Hospice and Palliative Nursing explains, that although the Physician makes the initial diagnosis, it is the important universal communicative role of the Nurse, which takes on special importance during such intense times such as serious illness and end-of-life care. It is the Nurse who provides accurate information so that individuals can make informed decisions following the shock of such a diagnosis. As our vastly educated population ages, the planning of our own personal end of life journey will become increasingly important. No longer will patients be faced with the "treat or not to treat" decision following a diagnosis of a life-limiting disease. As Physicians become more informed, and learn the importance of Palliative care services for their patients, this transition will become a peaceful and tranquil experience. There are so many advantages to the patient as they receive Palliative Care services and then bridge peacefully on the Hospice Services. End of Life should be respected, and all resources should be offered and provided to the patient and their families at the point of diagnosis. All treatment options as well as a referral to Palliative care services should be initiated in order to assist the individual with the most beneficial and personally detailed plan of care.
  9. obasnurse

    The Living Room

    I was just twelve when my parents called me and my two brothers into the living room. I knew something was going on because we had a family room where we watched television and played board games. The family room is where my dad put on the music and we all danced around, it was the fun room. The living room was reserved for guests, for when my parents considered someone special, they visited in the living room. I always knew not much living went on in that stuffy room. My dad sat forlorn, looking at the chocolate brown carpet that was so popular in the early 1980's. My mom did most of the talking. She usually did, she was good at explaining things to us. She knew the right words to use with her kids. My dad was good at other things, fishing, mowing the grass, playing the banjo and building campfires. My mom was good at talking. They made a good team. My dad hadn't been himself for a while. He was tired, moody, and spent alot of time sleeping. He had gotten pneumonia and a weird rash in his mouth before he would finally go to the doctor. He liked doctors well enough, but he was from the generation where real men didn't get sick, and sickness meant weakness. My mom was using words like blood cells, and lymphatic. She was trying, but she wasn't doing as good of a job as usual. She was stammering and crying as she tried to tell us that my father had leukemia. Those first few months we spent too much time in that stuffy living room, talking about my dad dying. As anyone with nursing knowledge knows, my father began chemotherapy treatments. I began 7th grade as my dad began dying. It was a scary, stressful time for everyone. He was merely 38, my mom just 33. He had a large family and out of five siblings, three matched on five of the six proteins needed for a bone marrow transplant. All of that news was delivered in the "living room" too. I had never seen my hard motorcycle riding uncles cry before. If they were crying were things worse than I knew? I suddenly felt the stuffiness of that living room spreading through our whole house. The only time when things felt good was when my dad sat under my bedroom window and played his banjo. "Therapy", "coping" I had heard the nurse say. The nurse. She was warm, she didn't feel at all like the living room. She smiled, and she laughed. Her eyes never looked at the floor, she always used them to talk to my dad, and us. She has so much time, and her voice never trembled when she said the words radiation, chemo and white blood cells. We lived in a rural town where the number of cows might have matched the number people. We were a tight knit community. That also meant the hospital was small. It also meant the hospital was tight knit. I always wanted to go to my dad's appointments when ever I could. It wasn't often, as he was private about the cancer, to himself he had become weak. The nurses at our hospital were amazing to me. I looked at them like a kid looks at fireflies on a June night. In awe, in amazement, all with a jar in hand. I wanted the nurses to talk to me. They always said things like " How are you?" and their tone always invited me to tell the truth. Their arms were strong as their one hand rested on my one shoulder and their stethoscope bopped off my other. They always hugged my mom, and some of them cried with her. I always noticed their tears were different, not cried out of fear, but out of need,the need to take away some hurt, physical and emotional. Their tears seemed braver than mine. My family spent twelve years in and out of that hospital. We went to larger ones too of course. We went to several larger ones, and not all the nurses had the same faces, or names, but they all felt the same. They all mesmerized me. I watched everything they did. I watched how they treated my dad. He smiled when they spoke, he visibly felt better. They made him feel alive. They didn't treat him like he was dying. They treated him like he was living, like he was living in the family room. My father passed away in that same small hospital twelve years after his diagnosis with Chronic Lymphatic Leukemia. He had endured chemo, radiation, experimental drug treatments, blood transfusions and numerous other interventions. He had lost hair, teeth, and 75 lbs. He lost his sense of smell and taste only after everything he smelled or tasted made him sick for a year. He lost his nose to an infection. He lost his ability to work, to walk long distances. He lost his pride when he had to sleep on those horrible chux. He lost so much to the cancer. He had also gained the marriage of two children, the birth of six grandchildren, the anniversaries of twelve years, eleven Christmas trees, 98 birthdays parties of kids and grand-kids, and hundreds of nights playing the banjo on the back porch under the window his grand-kids were now sleeping in on warm Saturday nights. We in turn experienced in our nurses' lives, four new babies, three new homes, two weddings, five new grand-babies, some new cars, canning recipes, and garden tips. You know the things families share. It took years for the house to lose the feeling of the living room. It started on a Sunday evening, just a month after my dad was buried. Four of the nurses from the hospital stopped by to check on my mom. She was living alone now, we were all grown and living our lives. I happened to be there when they came. Of course my mom invited them into the living room to visit. They were special, important, guests. I sat listening to the conversation. I brought coffee and tea, some homemade banana bread a neighbor dropped off seemed perfect to serve too. As I sat there looking at these special guests I realized this was the perfect room to bring them to. It no longer felt so stuffy, so oppressive. The furniture began to look inviting, and the chocolate brown carpet looked unusually soft. This was a good place to bring such special guests. They represented everything the last twelve years had been. Their care, their expertise, their dedication enabled my family to live, and the room began to feel like a place I could sit to read, or play with my babies. It also felt like the perfect place to start studying for my own nursing degree.
  10. kurisuchine08

    The Broken Man

    When I went to work that day, it was with a heavy heart. I was preoccupied with my own thoughts and was just wishing that I could just go through with my shift as peacefully as I can. Little did I know that I was about to receive a wake-up call from reality. Little did I know that I was about to be slapped with the cold truth that I really was living a sheltered life. My problems were so little compared to what others are going through. This, I was about to find out that day. Hopeless- that's the first word that came to mind when I met him. I've seen many people who suffered from all types of illness and go through such excruciating pain, but none exhibited the same look of hopelessness that I saw in that man's face. It was the look of a man who has accepted that his life has come to an end. It's the expression of a man whose spirit has been broken. It's the look that would later haunt my dreams. What do I know about drug mules? Nothing much, I guess. I see them in the news all the time. Desperate people who, in exchange of food in their bellies, chose to be drug couriers. At that time, I would just shake my head, and say, "such a pity." Then life goes on for me. But now, I doubt I could just dismiss this as easily as I did back then. This man had tears in his eyes while trying to push out all the drug capsules he was forced to swallow. These capsules were as thick and long as your average man's thumbs. Imagine being forced to swallow 97 of these and again being forced to squeeze all of these out of your body. It was pure torture to witness this. It makes one wonder what drove this man to do such thing. But then again, the answer comes back to mind. It's the same thing that made me work away from my family. It's the same driving force behind every expatriate worker: to be able to provide a better future for one's own family; to be able to keep food in their growling bellies; to be able to provide roofs over their loved ones' heads. It's for his and his family's survival. But being without means to do it the legal way, he subjected himself to be used by drug syndicates, those vultures which prey on desperate victims. He allowed them to defile his own body, risking his own life and his family's safety. Who is to say, he did the wrong thing when it was the only option he was dealt with? Yes. He, too, is a victim. As a nurse, I was trained to provide care and comfort to our clients. It is my job to make sure that I ease my patient's suffering and help him make the transition from sickness to optimum health. But how do you nurse a wounded soul? How do you help him when he has lost the will to help himself? It destroys me to know that no matter how much care I give him, he will still be sentenced to die. I am my patient's advocate but I, too, am bound by the rules that govern the land. Someone callously remarked, "Why do you care that he should sleep peacefully tonight, when we all know he is going to die anyway?" I really wanted to rush at him and rip out his tongue. It was all I could do to rein back all emotions I felt. i went home that day carrying with me those terrible pictures in my head. Despite the exhaustion, I slept fitfully. I kept seeing that face of hopelessness. How do I go through these experiences unscathed?
  11. madwife2002

    Death came to visit

    Death came to visit Friday, it was not kind, and it was not peaceful for my friend's mom-it was hard, she struggled so much, her mind was ready, but her body fought her to the bitter end; causing trauma to her loved ones who stayed by her side so she did not die alone. The family had discussed end of life choices, and treatment was stopped on Tuesday, with the only intervention being pain medication. Death is still a taboo subject that many of us prefer not to discuss. Why is this? Unless you work as a healthcare professional, the clergy and funeral directors, many people are not able to talk about it freely. As a nurse who has been with many patients as the end of their life, I know you cannot prepare their loved ones for the final end. You cannot say that it will be peaceful, you cannot give a timeline and you cannot promise how it will be because you really don't know. There are relatives who have no clue about what their loved one wanted. There is often no discussion about end of live choices. I have been fortunate to be with my sister and my mom when they breathed their last breath and it was peaceful, calm and a relief that their struggle was over. I have been with patients who have passed away peacefully without pain, without struggle and without suffering. I have also been with patients who have fought to the bitter end, every last breath being a struggle for them. It was like something from a horror movie only it was real life. My question is why? Why do some people have horrible deaths and some people go quietly. It certainly doesn't pertain to how they lived their life; I can vouch for that with my own eyes, experience and knowledge. My mother was a feisty firecracker of a woman who fought for everything in life, never gave in to anybody and would never hold her tongue. Yet her death was one of the most calm, peaceful I have ever experienced. When somebody passes what determines if it is peaceful? What would determine if death is going to be horrible? Is planning important, should patients and relatives make known what they want near the end of life? You still cannot guarantee that death will be peaceful, however everybody involved knows what their loved ones want. Is it the environment they pass in? Can we choose where to die? Hospice is a wonderful environment, where the nurses, aides and doctors are amazing. I have never seen such caring individuals. When my mom passed many years ago they were amazing, I will never ever forget the kindness my mom received and how supportive they were to my husband and myself. The atmosphere was incredible in a hospice where everything is available for support. Nothing was too much trouble; nobody seemed rushed or didn't have the time to spend with her. Hospital can be a frightening place for many people, yet many will die in the hospital this year. Some expected deaths and some unexpected deaths. Relatives can add peace or trauma when their loved one is dying. The circumstances of impending death play a huge role for end of life decisions. Is the hospital environment a good one for a peaceful death? Yes it can be. It can also be a very traumatic experience. How many things can contribute to peaceful versus traumatic-who or what determines the definition? Hands up! How many of us nurses have witnessed needless interventions, pain and suffering? How many of us have experienced relatives prolonging life as long as they possibly can? Does this add to the trauma of their dying? End of life discussions can be very difficult; but it shouldn't be; as it is something we are all going to experience as our only guarantee in life. Many people do not have a living will. Many people do not even understand the terminology 'Living Will'. It makes no sense to them, although we as healthcare professionals are much better at promoting living wills. Even with a living will there can be struggles to make sure your wishes are followed, but without one relatives can fight and disagree with each other about what they want. Clear precise instructions can at least highlight your choices helping relatives to make better decisions on your behalf. In 2007 only 41% of the population in the United States had a living will. In 2009 President Obama made it more popular by publically talking about his living will, saying it is a sensible choice. In 2013 only 1 in 3 people had a living will, 32%, Findlaw.com In March 2016 "American College of Emergency Physicians' stated that two thirds of Americans don't have a living will! Question of the day-Do you have a living will? Or are you part of the 2/3rd's that don't have one? Less Than One in Three Americans Have a Living Will, Says New FindLaw.com Survey http://newsroom.acep.org/2016-03-21-Nearly-Two-Thirds-of-Americans-Dont-Have-Living-Wills-Do- The living will needs resuscitation For young and old, it's wise to have a living will to state health-care wishes - The Washington Post
  12. With the advent of chill winds and falling leaves, it almost seems as if the world is in a hurry to finish its business before winter comes: animals grow thicker coats and store up food for the long, cold months; flowers fade and vines wither; humans stock their pantries in anticipation of the upcoming holidays. And all too often, the change of seasons heralds not only the end of the year, but the lives of the sick and old. Letha* was a ninety-year-old, ninety-pound train wreck of a woman who arrived on my long-term care unit the day we turned the clocks forward last spring. She had previously been healthy and independent, but a series of strokes followed by medication-induced diabetes had robbed her of most of her sight, as well as her ability to walk, toilet herself, and perform most of her own ADLs. She was alert and cooperative, and she never complained, but with fingersticks and insulin coverage, plus two large decubiti, plus frequent urination, she required a lot of care.........just what we needed on a unit that was already overpopulated with IDDMs and wounds and LOLs with half-ounce sized bladders. And then, there was Letha's family. Letha had three daughters and a son, and the most polite way I could describe the daughters was 'intense'. These women were at the facility a minimum of 16 hours a day, endlessly fussing over Letha and demanding that we wait on her hand and foot whenever they were out of the building. Letha had a twenty-minute ritual for mouth care in the morning, and an equally involved routine at night. Letha needed to have her feet elevated just so whenever she was in bed. Letha may not drink any juice other than cranberry. Letha was not to wait more than two minutes for assistance after pushing the call light. Letha must get up for all meals, but be in bed for the night no later than 1930. Letha's 'needs' were so numerous, in fact, that they didn't fit on our one-page care plan form, so a PeeChee folder with the play-by-play was placed on her closet shelf for staff reference. Well, as is usually the case with these situations, Letha herself was not the problem. Her sweet nature and cheerful outlook made her an instant favorite with other residents and staff alike, and despite some dementia, she had such a quick wit about her that we were always taken by surprise. One afternoon as I was checking her blood sugar, I was bemoaning the sad state of her fingers, all of which were so bruised and mangled from QID fingersticks that I almost couldn't bring myself to do the deed; instead of complaining, she quipped, "It'll hurt you worse than it does me, 'cause I'm gonna take a bite out of your arm before you do it." Weeks, then months slipped by as Letha began to grow stronger with the help of our physical therapy team and the ubiquitous presence of her daughters, who continued to encourage/force their mother to do things she didn't want to do in order to achieve their goals for her (which, as many of us privately believed, included staying alive forever). For a while, it looked as if she might just walk again.....until she caught a bad cold that promptly turned into pneumonia. We administered antibiotics and breathing treatments every four hours round the clock until she was out of danger. She contracted C. difficile after this episode and landed in the hospital, then returned with several new medications added to the arsenal of drugs we had to crush and administer, one at a time, due to her dysphagia. She followed up with yet another mild CVA a couple of months later..........and in the meantime, more and more tasks were being added to her care plan by her ever-vigilant daughters, who spent much of their time complaining to management about what they called "the lousy care that's killing our mother". Naturally, we nurses and aides resented the implication that our unwillingness to ignore our other 28 residents so we could tend to Letha every waking moment was "killing" her. As much as we loved her, there simply weren't enough hours in the shift to fulfill all her daughters' demands, and frankly, she was NINETY......and in bad shape to boot. What did they expect from us, anyhow? Miracles? On a personal level, however, this went far deeper than simple annoyance with a fussy family. I have long been angered by our society's refusal to acknowledge death as a fact of life. I see it every day in the faces of elders whose bodies are still here, but whose minds and memories have long since deserted them........the pain-filled eyes of patients in the late stages of cancer...........the epic waste of limited resources on treatments that merely prolong the inevitable. And in many cases, they endure it all only because their families can't (or won't) let them go. It was obvious that this series of downturns was a signal that Letha was getting tired, and we often talked among ourselves about how we wished her daughters would stop pushing, pushing, pushing and let Nature take its course. ~Continued~ *All names have been changed to protect the privacy of the individuals involved.
  13. jaelpn

    The story is in the soil....

    The first time I met Thelma*, she was rolling down the hallway in her wheelchair, sad deep blue eyes focused on something more than what was ahead of her. She wore a pink sweatsuit, her hair was a mess. I introduced myself, and all she could say was, "I just moved here because my husband died and my family couldn't take care of me anymore." She just moved into an apartment in our assisted living facility, she was upset because she felt like she didn't have a purpose in this world. She lost her husband, her house, and her friends. She would roll her wheelchair in the sunroom, and slowly water the plants. There were around four or five plants that she tended to. A few months had passed, and something just changed in her. She started to put makeup on, she would spritz her "Beautiful" perfume on, and go on down to the sunroom, except this time there were many more plants that she was tending to. This was her sanctuary. She smiled and laughed, and she finally was starting to accept her new life in assisted living. One night, I went to go to one of my male residents room and found a kleenex on his door handle; folded neatly and placed on the handle. I didn't think much of it, and picked it up and handed him the kleenex. He just said, "Oh that silly woman again..." and I just looked at him curiously. He said, "Thelma.... she does this every night. She sprays her perfume on a kleenex, and puts it on my door handle, so that when I come out of my room, it falls on the floor and lets me know that she was thinking about me." ...curiously, I had asked him for the kleenex and sure enough, it smelled just like her "beautiful" perfume. Tears started to form, but I quickly dismissed myself. It's been over a year now since she has moved in. The love story has died, and yet she still tends to those plants. The room is full of beauty, and she makes sure that the plants are watered everyday, so that the room is comforting and beautiful to all those that come and visit. One evening, I had stopped by her room to see how she was doing. She invited me in, and sat me down and told me that she enjoys seeing my face and smile, that I just bring a presence of happiness to her. She told me that when she first moved in, how miserable she was. That she didn't feel like she could ever be happy again without her husband, that she just wanted to stay in her room, but she had quickly found the sunroom. She found that she could still make a difference- that her life story was not over. While I was sitting there in her room, she had showed me her wedding ring and told me to try it on. It fit perfectly! I told her it was beautiful, and that she was such a lucky woman to have had so many years to spend with her husband. I told her that I had been with my boyfriend for nearly two and a half years. She said, "Well what is he waiting for?!...when's he going to ask you?" We laughed, and she put the ring back on her finger, and I could tell by the way her eyes lit up that she was thinking about all the years of love she had spent with her now dearly departed husband. A few days later, as I was leaving I had walked in front of the building, and there Thelma was...sitting in the sunroom. She knocked on the window and said, "Julie, come here for a second!" ...So, I walked over to her, and through the screen she had asked me if James (my boyfriend) had asked me for my hand in marriage yet. I said, "No Thelma....not yet, but maybe someday." She said, "Tell him I said size 7. That is the size of my ring, and it fit you perfectly." I couldn't help but smile. She went back to watering her plants, and as I left, I could tell that she finally found her solace. Our motto for our assisted living community is, "Returning the Love" ... and I think this is a true enough story to put behind the returning the love; not only does she return the love to the caregivers and nurses she encounters, but also to the plants she takes care of and even some of her new friends. The story is in the soil... without the proper nutrients and water- plants can not bloom properly. And without love, friendship and a purpose- our lives would never be the sweet surrender of laughter and happiness that we find in each and every day. *name changed
  14. cav5

    The Journey of Death

    Death, for many nurses, is the enemy. We come to work ready to conquer it or, at the very least beat it back, beat it down for another hour or another day. However, I never felt that way; as a patient, as a family member, or as a nurse. Death was never wanted, never welcomed but neither was it the enemy nor the ultimate loss in a battle of good vs. evil. For, you see, there is no battle with death, not really. It has allowed us to think we have won other battles but it was only a trick of the ego, our ego, as death was never truly in those fights. For, you see, when death has truly come there is no beating it back, there is no winning. In those moments when you know this, when you accept this, I believe nursing and nurses can be at their greatest. It is nurses at the bedside providing palliative care for the patient, comfort care for the families, and much needed resources for everyone involved over the next coming months, days, or years. . Yes, we give meds that make people better; we do treatments that make people well. But, we also give meds and do treatments that make people comfortable and make the days to follow bearable. For me, palliative care was the one job in nursing that made me just a little bit better, both as a nurse and as a person. For those that know me, my cardinal rule of nursing is 'treat each patient as if they were your mother, brother, sister, father'. This is as important during end of life care as it is during the fresh cardiac admit coming in from the ER with his two pages of orders. In my opinion, it is one of the true tests of nursing. How do you react when there is no more "enemy", when there is no more "fight"; When it comes down to just you, the patient, the family, and the realization of a new reality to come. I went into nursing after I became pregnant with my first child. The pregnancy was difficult with lots of complications, office visits, and monitoring. I remember each and every nurse who treated me well and some who treated me poorly, as just "another" 19 year old kid who had no idea what she was doing. I wanted to be one of those "good" nurses who helped people, who saved lives. However, it wasn't until my third child that I came to realize what a great nurse was. I had just had a stillbirth after hours of induction and labor in which everyone knew what the outcome would be. We still waited for the cry, even knowing it was never going to come. I remember the labor, I remember the silence, and I also remember that the nurse always, always said she was going to take my son back to the "nursery". She also advised my family that the baptism should be done quickly, for practical reasons (I was catholic at the time). It was the nurse who gave me my options as far as burial, hospital policies, etc. All I wanted was the last few days to come to an end. However, had it not been for that nurse, I would have nothing but the remembrance of the awful days that followed. Because of her care and resources I have a grave to visit. I have proof that I did indeed have a son and he lived, albeit inside me, on this earth. I went into nursing due to the blessings of life. I learned what true nursing is due to the devastation of death. It is not surprising then that it is the end of life patients that I can remember most vividly after years of leaving the intensive care unit. I remember the father who would not quit seizing and was brain dead on arrival. For a fairly new nurse calling the doctor was, at best, scary and at worst terrifying but that night I didn't care. I called for more ativan, I called for more pain medications, I called for MORE...all through the night. Finally, the doctor at 3:00 in the morning asked me what I really wanted him to do for this man. Wrongly, he thought I had naively hoped that the patient might recover. When I finally admitted that I did not want the son's last memory to be of his father's unending seizing he paused for only a second before I got full orders for a phenytion drip, ativan, and morphine until the desired results were achieved. By then I understood that dying is an individual journey, but death is a family experience. Then, there was the homeless man left frozen in a gutter. On arrival to the ER he had no signs of life. They had managed to resuscitate him enough to have a heartbeat due to multiple drips and good air flow due to a ventilator. For one night we were his only family. We were the last ones to care for a man who had not cared for himself; To make him safe, make him warm, and hopefully take away some of the pain that he must have been carrying. For one night we cared for a broken body in the hopes that we could comfort a shattered soul. Finally, life does tend to loop back to your beginnings. Despite travelling all over the world since leaving the ICU, it was me who made that overseas call to the same ICU after my sister was admitted. I talked to the same nurses whom I had called colleague almost a decade earlier, one of them my mentor. I got the same responses that I had said so many times before, the words we say before the doctor sits down and tells family news that will forever change their life. You know the words. Things like "I think you need to talk to the doctor about that", "I am sorry, truly, talk to the doctor". I heard it in their voices that they were sorry that my 37 year old sister had just been diagnosed with stage IV lung cancer. I heard it on the phone in the ICU, I saw it on the floor of oncology, and I felt it in the presence of the hospice nurse as he faced my family after my sister told him she had been "healed" of her cancer because they had allowed her to leave the hospital. He looked to me for help but I didn't have any, couldn't have any-I was a part of this experience and I just couldn't say what needed to be said. You see, I told that son a decade ago that I, too, believed in miracles. However, for his father to be completely healed it would truly be a miracle. I could tell that to the son when he looked at his seizing father ...but....I just couldn't tell that to my sister, or my mother, or even myself. I still don't believe death is the enemy. I have journeyed with it on more than one occasion and each experience has left me more convinced that it is how we live those journeys, how we travelled each part of that path from beginning to end that defines a part of who we are; whether it be as a patient, as a family member, and most especially as nurse.
  15. nerdtonurse?

    Lessons from a blind man

    The “she” in question was his daughter. And, no, she was not coming. You never know what a person’s past is, or the darkness that might have shadowed a relationship, but the daughter had been adamant that she was not coming and not to call her again. He had no other family. In days when he’d been better, we’d joked and tried to pretend this was just going to be one more hospital stay out of many. But this stay was different, and we both knew it. The first day I had him while he was still on 6 liters, he took my hand and told me, “I want you to know how much I appreciate everything you’ve done for this old man. I’ll pray for you from the other side.” I’d seen the radiology, and I just took his hand and held it, and choked back my tears. Now his head was thrown back, and his mouth in an “O” as he tried to get oxygen into lungs that weren’t able to do anything with it. I listened to lungs so diminished and full of crackles I knew it wouldn’t be long. He opened his eyes and looked at me, too weak to speak. “Mr. Smith, she’s not here yet.” Two hours later, the inevitable happened, and he died. I gently washed his last stool from him, and slipped the catheter out while other nurses removed IV sites, the mask, the SCDs, and other signs of our work until he was once again free of us. We combed his hair back, placed his dentures and propped towels under his chin. I looked at him, and saw how my dad might look on that day, the same big ears, the same Karl Malden-ish nose. I had called the daughter, this time to tell her he had passed away, and she said, “What’s that to me?” and she had slammed the phone down. My gentleman would spend the night in the morgue, and then be sent to county. Whether he would be given a decent burial attended by friends, or wait his year unclaimed before being given a pauper’s funeral, I didn’t know. I tied the tags to his toe, and to the outside of the bag, and the third to his tiny bag of belongings, which we inventoried. There was a pair of shoes, a pair of pants, a t-shirt and flannel shirt, a worn belt and a brown overstuffed wallet. “What’s this doing here, it should have been locked up,” said the charge nurse, who opened it. Inside was a driver’s license, AARP card, all the little clutter that accumulates in a wallet, but then she stopped and said, “oh….” Pictures. There were at least 2 dozen. The firsts were of the patient as a young 20 something, in military uniform, an arm around a young woman, both holding a baby. The baby grew from an infant to a chubby toddler, racing around the yard, then playing with a hoola hoop. One she was about 10, running on the beach, blonde hair flying like a flag. One looked like Christmas morning, another perhaps at a farm or petting zoo, with a donkey eating out of her hand. Then the pictures stopped. There was a newspaper clipping of her high school graduation, another of the daughter’s wedding. The mom’s name was mentioned, my gentleman’s was not. There was a birth announcement for two grandchildren I knew he had never held, also from the paper. The pain and the longing for what could have been washed out of the wallet like a wave, and one of the nurses, pregnant with her first child, burst into tears and fled the room. I reached over and took the picture of my patient swinging his daughter high into the air, both young and happy, and slipped it into his hand, where I secured it with a piece of tape. “She’s here, Mr. Smith. She’s here.” We sent him on that way, holding the picture of his child. Desperately sad, I had barely gotten back from the morgue when my new admission arrived. He was an elderly black man, skin leathery and thick from years of working on the farm, and he was blind. I began my admission questionnaire, explaining my sniffing as allergies, sure that in his blindness my patient would buy my excuse. I listened to his lungs and his chest, thankful that his BP had come down and that he would likely go home in the morning. He spoke of his years farming, split with time in the pulpit. “And, didn’t I pick the two things you can’t do once your eyes fail you? You can’t tell if a crop’s ready, or sickly, or needs fertilizer if you can’t see it, and how do you proclaim the Word if you can’t read it?” I was quickly doing my assessment, and desperate to get off the floor, find a quiet corner, and have a nervous breakdown. Suddenly, he stopped. “Child, give me your hand.” I did, puzzled, and he turned his filmed over eyes directly at me. “What ails you?” That’s all it took. I sat down on the edge of his bed and, feeling like a complete failure as a nurse for weeping, I began to weep. Weep for my dead patient, and the child he still loved. For the daughter who had gone most of her life fatherless, for the grandchildren he was obviously so proud of, yet never held. For the lady down the hall, who thought she was going home, but was going to a nursing home instead. For the teenager who’d tried to commit suicide the prior day, and was now in the twilight land of hypoxic brain injury, never to return. For the stroke victim 2 doors down who was locked in – hideously aware, and unable to do more than blink. I wept for all the countless small sorrows and large tragedies that we see and that we can’t help, can’t fix. Over me, the blind man had dropped his other hand on my head and was praying in the deep, sure and true way of those who have walked this world for decades, solid in faith. He spoke of power and grace and love, and that one of the truest works of mercy is that of caring enough for a stranger to cry for them. The lesson the blind man taught me was that we are all human. We are not nurses; we are women and men, moms and dads, daughters and sons – we are human beings doing work that can wound and maim our souls. And somehow, we are taught that the very humanity that brought us to nursing should be strangled and beat down and hidden away like it is something shameful. It is battered and bruised by the things we see, and we grow calluses over the softest spots so that we aren’t in constant pain. But, blind man saw the truth, and I bless him everyday. The day I can’t care enough to cry for a stranger is the day I need to go do something else.
  16. interleukin

    The Immeasurable Fortitude of Mothers

    After returning from vacation, I was assigned to "Robert", a 24 year-old suffering from septic shock, multi-system organ failure and late-stage muscular dystrophy. He was maxed out on chemical and ventilatory support. In his room, the wasted young man lay in the center of large specialty bed. His angular contracted body was dwarfed by a puffy blue mattress that appeared to be in process of swallowing him whole. During his short life, Robert had been hospitalized multiple times. But this would be his last, his body slowly surrendering to a bacterial juggernaut unconcerned with strong wills or the code of human decency. Alongside the bed sat Robert's mother. She was short, her face drawn. She stood when i introduced myself. A meek smile betrayed none of her accumulated heartache. Her grey eyes hid none of her fatigue. I asked her about Robert's life and she began to talk about the photos that were taped to the room's bulletin board. In one, a frail red-haired little boy wearing water wings was splashing in a backyard pool. In another, he was in a toboggan, wedged between the knees of an adult. With his mother's eyes, he was staring directly into the camera. A third photo showed him in a wheel chair crookedly holding an ice cream cone, ready to take a lick. This was Robert's third day in the ICU. But because the bed was large and Robert's mother so small the only physical contact she could manage was stroking his arm. I left the room in search of the stool we usually keep in the unit. Unable to locate it, I grabbed a heavy box of computer paper and plunked it down at the bedside. "Would you like to kiss your son"? I asked her. I pulled Robert over and then helped his mother onto the packed box. With heartbreaking tenderness, she kissed her son's face. The following day, this mother decided it was time for her son to rest. With him held firmly in her arms, we extubated. The boy passed quietly, finally free from his incarcerating body. Ive been an ICU for 16 years. I am no longer intimidated by clinical complexities or traumatic injuries. To me, they're just variations on themes which oblige me to perform the technical balancing act until a body, hopefully, regains its footing. Today, I am motivated and rewarded by the challenges of assessing and interpreting the behavior of loved ones who suddenly find themselves thrust upon life's razored edge. For me, therein lies the power and privilege of being a nurse.
  17. Currently, I am a nursing student. But, between experiences in a clinical setting as well as my own personal life, I feel like I want to be a hospice nurse. Does anybody have any advice for me regarding this? How does one go about becoming a certified Palliative care nurse? I currently work as a CNA, and I experienced my first death a few days ago. It was really hard for me, as people insisted on drawing blood and other diagnostic tests on a man who was DNR. For the most part, he was incoherent. But, there were a few times when he was clear as day. He didn't want to be poked and prodded anymore. He just wanted to be left alone. He knew he was dying, and he wanted to go on his own terms. I am not normally a hyper-sensitive person. ( in that way) I don't cry over lost patients. But, this guy...I did cry. Nobody was there for him, other than me. I was there when he took his last breath...and I was the one who saw the lone tear in his eye. I was the person who had to tell his nurse that I thought he was dead. I took it upon myself to perform his post-mortem care. I felt it was my responsibility to do so. I was the person who he spent the last hours of his life with. I was the last person he laid eyes on, the last person he talked to, the last person to talk to him. I had to be the one to get him cleaned up and ready. Unfortunately, as the lone CA on shift, that meant neglecting vitals on some other patients. God forbid the nurses take a couple of readings. ......... Not to mention that they told me not to bother. Somebody had to sit with this poor soul. God knows they weren't going to bother. This guy died in pain. He spent hours bleeding out. He was in so much pain. I was NOT going to leave him alone. I knew he was dying, he knew he was dying. I could not, in good conscience, leave him alone to die by himself. My heart made me sit beside him and hold his hand. My heart made me clean him up to the best of my ability. It wasn't easy. I work on a psych floor for elderly patients. Deaths are not a normal occurrence on our floor. This experience has been a profound wake up call for me. He should not have been in so much pain. No one should have been drawing blood. That man should have been allowed to die with dignity, on his own terms. I wish I could tell his kids that he was not alone when he passed. I was there with him. I was holding his hand. I know I am just a lowly CA, but I think his kids would take comfort knowing that someone was there with him when he took his last breath. That he wasn't alone. That someone who cared about him was there with him to the end. I know it's not my place to say such things.
  18. This is Part II of the difficult discussions we must often have with our patients and/or families. This never gets easier and in reality, should it? These discussions should be difficult as they are often the catalyst to pursuing advanced care, resuscitation and/or placing a patient on life support. These are some how to's for discussing these topics. This is a continuation of my last article and these are tips that have worked for me. Some of my patients are homeless and illiterate and drug or alcohol addicted. They need to know that I value them as humans with a medical problem and that I will do everything in my power to help them. I try to use the language and verbage that they give me. If they say "vomicking" or "I fell out" I know what they mean. Conversely, I have patients who are physicians who want to feel in control of their care as much as possible. I explain everything in medicalese and offer as many choices as possible. In either example, my goal is to work WITH the patient for the common goal of the best health attainable. We should be talking with our patients about the "what ifs" that could happen. What happens if we can't get your breathing turned around? What happens if we put you on a ventilator and then find that we can't get you weaned off? What happens if the chemotherapy doesn't get rid of the cancer? And...we should be discussing all of the "what ifs" before they happen if at all possible. For those of us that care for chronically ill patients, we should make a big effort to determine their care wishes and their goals. Do they have a Power of Attorney (POA)? Do we have their phone number? Are they willing and able to act as a POA? This should be discussed at least on a yearly basis as phone numbers and general situations change. Many of our patients use several hospitals. Do the hospitals have shared knowledge or a "bridge" for sharing common information? Do you have access to it and know how to use it? Depending on the hospital system, sometimes you will need to be credentialed at both facilities, sometimes not if there is an already existing information sharing agreement. Try to establish a relationship with family members. For me, I find that when I make a concerted effort to meet the spouse, child or friend who is close to my patient, I already have a basis for any difficult talk that may arise. Its all about advanced planning if at all possible. In addition to asking about POAs on a yearly basis, I also ask about advance directives about every six months and more often if the patient is deteriorating. I realize that I have the advantage of caring for chronically ill patients, thus giving me more time to watch and monitor their overall condition. I also try to be open about end of life care and involve spiritual advisors also if that is appropriate for the situation. Some of my patients are very spiritual and welcome a frank discussion to include the afterlife (or whatever their belief system entails). Others do not. Its all about balance and knowing your patients. What tips can you all share with us to make these discussions easier? Do you have a team that handles this like palliative care. Or are you on your own? Does your physician help out or just give vague details?
  19. TopazLover

    And He Will Die...

    Words that are heard by many family members when a catastrophic event is going on in a bed nearby. The lifeline they have held on so firmly is being cut by a doctor who knows the physiological condition of the loved one in the bed. The doctor walks out. His message has been delivered. He has allowed 30 seconds for questions by the family. They were too stunned to respond except with a quick inhale and the internal la-la-la-la-la of denial throbbing in the head of at least one of the family members. As the tears begin and the sobbing starts the door is quietly closed. Privacy is afforded this family. The family quickly regroups. No, this can't be real. They want to ask questions of that doctor. Only the vapor trail of the doctor remains. The door to the outside world slammed closed behind the MD as he ran so as not to be there when the questions hit. The family scans the surroundings. There are no familiar faces close by. They know they cannot approach just anyone and ask the tough questions. They will be directed to talk with the nurse assigned. Suddenly there is calm in the air. The nurse walks over to the doorway. With a slight smile and with just a hint of sadness showing the nurse takes charge. The important questions are asked. Did the family understand what the doctor said? A quick recital of some of the more important parts are shared. Words like 'brain death', 'incompatible', 'stop heroic efforts', 'no chance' are expressed. More tears. Tears move into sobs and the family tries to stop the flood of emotions. Embarrassment. Shame. Hurt. Fear. Shame? Where did that find its way in? More tears as the family expresses horror that they had not gotten to the hospital sooner. The terror they feel now and the blame they place on themselves for things left undone, unsaid. Thankfully the nurse stays steadfast. Death is not a new thing for the nurse. For the doctor it is always the foe: The challenge to be beaten. But for the nurse death is a reality. Not always the enemy. Not always a friend. But always a possible outcome, a destiny for many who are cared for by the loving hands of the nurse. The nurse does not run out the door. There is no vapor trail to note the exit line. The nurse stands with the family. The family is encouraged to talk about the person. They are encouraged to donate for others. They are offered grace in a time of turmoil. The end of life comes to many under the care of such a nurse. Day after day, hand hold after hug the nurse stands for and with the family. The nurse brings bottles of water, reminds the family that they need to rest, offers chairs and warm blankets so the grieving family members can remain with their loved one and wait until the machinery can be removed, a prayer may be offered, "and he will die" becomes reality. Who comforts that nurse? Who brings the emotional blankets to soothe? Who makes sure dehydration does not set in and add headache to the heart ache suffered with each tough case? Grief by the family can take many forms. Grief by the nurse is often not even recognized.The nurse goes back to do the same thing day after day, always hoping for a good outcome. The toll? Nurses get tired, worn down, seen as cold, unfeeling, uncaring. You watch those babies, children, youth, young and old die day after day you get no sympathy. Not only do people fail to recognize your pain, they laugh about the fact that some nurses could feel that pain. If we cannot support each other in the pain of end of life care then we will die. We will be called burnouts, hard, harsh, and cold. We may still put on our scrubs and we might continue to work until it becomes overwhelming, but lack of support when doing end of life care will end with: The nurse will die. It could be mental health, physical health issues or suicide. Drugs and alcohol take their toll. No matter what we lose a great nurse. That nurse who stood steadfast and supported that family when those terrible words were said needs the same support offered the family. With that support a great hospice nurse can evolve. "And he will die" is no longer a phrase to be feared. It is a part of the life cycle that is faced by the nurse each shift. It is not the foe, the enemy, the horror. It is an opportunity to do what nurses can do. Be present.
  20. littlemammanurse

    A Goodnight Kiss and A Bedtime Story

    I thought I would share this touching story with you. I work on a Palliative/Oncology/General Medicine floor and work mostly nights. We mainly have geriatric patients, but we do have some younger children that are on our floor as well. There is this one special little girl who touched my heart. The nurses on the floor had warned me that she doesn't sleep at night and is constantly ringing on the call bell. It's a busy floor, so I knew that it was going to be a long night. Well, this night, in particular, I was pretty busy, and sure enough, this little girl was ringing on the bell non-stop. No matter what I did she just kept ringing that bell. I finally asked her after the 20th time of ringing the bell why she wasn't sleeping. She has cancer and is in pain, and most of the time she just wants to be readjusted in bed to a more comfortable position. She told me she couldn't sleep. Well big surprise I knew that already. I sat down at the edge of her bed and asked what I could do to help her get to sleep. I asked if she had any nightly rituals that she used to do at home that helped get her to sleep. She told me that her mom would tell her a story and give her a kiss goodnight to get her to sleep. So I told her a story and gave her a kiss goodnight and sure enough the rest of the night she slept and didn't ring the call bell! This continued the next few nights that I had her. I would tell her a story to kiss her goodnight and she would sleep. Well her cancer got worse and a few nights ago she was dying. I was on the floor that night and didn't get her as a patient. Just as she was about to slip away her mom came up to the desk and asked for the nurse that told her daughter stories every night to get her to sleep. The nurses all told her that it was me. I had just finished my rounds and saw her standing at the desk waiting for me. She asked if I could tell her daughter a story even though her daughter had now slipped into a coma. Her mother began to tell me that her daughter loved my stories and before she had slipped into a coma would always ask for me on the night shifts to come and tell her a story. I was busy, but I knew that it would help the patient's mom feel more at peace to give this one last request to her daughter. I walked into the room, sat on the edge of her daughter's bed and began to tell her daughter's favorite story about a princess and a sleeping dragon. As I told the story I held her daughter's hand, and I could see her daughter struggling to breathe. Just as I got to the end of my story I heard her taking her last breath. I got up kissed her on the forehead, like I had usually done and she passed away right after. I was glad that I took that one moment out of my busy night to grant a last request to such a sweet little girl. It was hard, and I cried. These are the moments I love being a nurse!
  21. Right now I have three different residents in three different stages in the process of casting off the human shell that has housed their souls for over eight decades. One of them, Allie*, had been in fairly good shape until the night she had a massive GI bleed and was going into shock while I wrangled with the 911 dispatcher ("She's HOW old? What's her advanced directive say?"). After the EMTs saw for themselves that I wasn't exaggerating---why do they assume we LTC nurses know nothing?---they scooped and ran, and after a few days in the hospital she was returned to us with a DNR order and an inoperable, fast-growing mass in her lower colon that could rebleed at any time. Her family, however, was unwilling to give up, and it wasn't until this past week, when she had a stroke that destroyed her ability to speak and paralyzed half her body, that they finally began to understand that whatever quality of life she had was gone. While they have declined our suggestion to bring in hospice, they agreed to comfort measures such as liquid morphine and stopping unnecessary medications, and they've been coming in every few hours to do mouth care and lotioning. Allie is still with us, and though it's clear to all that she won't be much longer, at least she's surrounded by acceptance and can die in peace. Not so, I'm sorry to say, with another of our ladies, whom I've known since the night she arrived at my assisted living facility four years ago, utterly exhausted from a day of flying across the country with her cat and two suitcases filled to bursting with expensive clothing, hats, and jewelry. Maryann* later followed me to the nursing home, where she has declined slowly but steadily over the past year; now her kidneys are just about gone and her once-sharp sense of humor right along with them. She's been in and out of the hospital now for several months, and each time she returns it's with a diagnosis of "dehydration" and we are once again urged to push fluids, push fluids, push fluids. Well, guess what? Maryann doesn't LIKE to drink fluids. They make her go to the bathroom too often. She also doesn't like to take her meds---too many pills, she says. She's tired of taking pills. She's tired of living. She wants to stop taking all those pills so that she can be with her husband and her cat again. I don't blame her. But Maryann's son, who brought her out here from Philadelphia after his father's death, is having none of it. There is a grandson's wedding coming up in June, he tells us, and "if Mom were in her right mind" she'd want to be around for the event. So we are to encourage/force her to drink at least 2 liters of fluids per day, take all of the 20+ medications she's on PLUS the new ones that were prescribed after her most recent hospital stay. "If she wants to 'go' after the wedding, she can," says the son, "but she really WOULD want to stick around for this. We can't let her die yet, so whatever it takes to keep her going, just do it." All this despite an advanced directive that says no resuscitation, no feeding tubes, not even antibiotics except for "comfort". I want to tell him that this is the most inhumane thing I've ever heard of, that his ideas are so wrong on so many levels that I can't even wrap my mind around it, but I can't. Why? Because this ISN'T the worst thing I've ever seen happen to a resident with a controlling family. That distinction is reserved for the 95-year-old gentleman down the hall whose fate is in the hands of a late-middle-aged couple, neither of whom is related to him by blood. This unfortunate fellow has outlived all but one of his children, who is estranged for unknown reasons; and if he were in his right mind, I think he would be madder than a wet cat at having to live like this. "Grampa" is as demented as they come; his speech is unintelligible, he is combative at times and incontinent ALL the time, he's missing half his right foot due to infection and doesn't know he can't stand up without falling. He has ischemic colitis, CHF, chronic renal failure with a GFR of about 8, degenerative joint disease, osteoporosis.........yet this couple just can't seem to let nature take its course. We've sent Grampa to the ER no fewer than five times this year, despite the belief of facility staff that we are flogging his failing body for absolutely NO useful purpose. I've sent him out for diarrhea that wouldn't stop. I've sent him out for pneumonia. I've sent him out for low BPs, twice. And yesterday I had to send him yet again, this time because he was obtunded AND his BP was in the toilet AND the diarrhea was back. Why? His POA demanded it, despite the fact that he has a DNR order and the paramedics give us hell every time we call about this man. Yes, we all know that "do not resuscitate" doesn't mean "do not treat", but every time he's sent out he winds up being admitted to the hospital for several days on the insistence of the POA. While he's there, he's tied down and force-fed medicines and IV fluids to rehydrate his body; when he returns to us he goes back to swatting at the hands holding a cup or a spoon to his lips. Doesn't anyone understand what he's trying to tell us? I won't even go into the reasons why this is a waste of limited healthcare resources or how selfish it seems to me for families not to let their loved ones go when they fall into hopeless circumstances and life becomes a burden. No, what keeps me awake at night sometimes is the conflict between my job and my ethics, which holds that forcing people to stay alive is as morally wrong as killing them outright via euthanasia. It's not that I would ever impose my personal beliefs on a resident or family, but as a nurse I've seen some of the worst sorts of suffering there is......and not all of it is physical in origin. Some of it is the loss of who the individual was; another large part of it is the loss of independence and dignity. But when those things are combined with medical problems that cause one to feel miserable every day of his or her life, well......would YOU want to live like that? I know I wouldn't. But even though I have an advanced directive (and have threatened my family that I would haunt them forever if they don't let me die when it's my time!), I'm less than confident that my future caregivers will know when to say "we've done enough". They used to call pneumonia the "old man's friend" back in the days before antibiotics. While I wouldn't trade today's technology for yesterday's more realistic approach to end-of-life issues, I wonder sometimes if we as a society have become so arrogant that we keep people alive long past their natural lifespans merely because we can. Just a few thoughts on an evening when I have more quiet time than usual to contemplate. If you've read this far, thanks for hanging in there this long. What are your thoughts? *Names have been changed to protect privacy.
  22. NurseAlwaysNForever

    I'm Leaving You Here

    I had never intended on becoming a nurse, however, that is the direction that God sent me in and I have not regretted it ever since. I loved the nursing home and getting to know all of the patients and their families. I never had grandparents and they all just kind of filled the gap for me. Each of my patients was like an extension to my family. Every time I had a pt that got put on hospice I would get so angry at the MD and would feel that they were giving up on my pt. I didn't want to "let" them just die. How dare they? I just didn't understand the benefit of hospice at that time. After working at the nursing home for a year I had an ethical conflict with the current DON and decided at that time to quit. I submitted my two-week notice and she politely told me that they would not need for me to finish working it out. I went home and balled my eyes out. I felt like I had lost a large portion of my family. I had no idea what I was going to do, where I was going to work, or how I was going to pay my bills. I prayed day in and day out for God to send me in the right direction and vowed to not even apply for a job until I felt that it was the one he wanted me to apply for. After church one Sunday I received a call from a friend of mine who's father was a supervisor at a local hospice and she informed me that he was very interested in hiring me. I told her I would think about it, and I did. I felt a very strong urge to do it, but couldn't help but think that God must be laughing at the time. Me, do hospice? Was he crazy? I couldn't fight the urge and did apply for the job. They gave me a lengthy test full of questions that I had no clue how to answer. Miraculously, I only missed a few. I was hired and went through the 3 days of orientation before I was assigned my caseload. My first hospice pt was a Lutheran minister in his 50's with Brain CA and the only warning I got was that he would try to convert me. I arrived at his home, rang the doorbell and waited patiently for an answer. I was so nervous. What did I say to this man who was dying? How did I talk to him? Do people realize how often they use the words die or kill me in a conversation.? "Oh, I could just die" or "That kills me." What if I slipped up and said it and he got offended. What if I made him sad? At that moment the door was answered by a middle-aged man with wire-rimmed glasses. I introduced myself and he invited me in. I will call him Joe. Joe offered me a seat on his sectional and he sat down as well. He didn't even look sick really. I explained I had to get his vital signs and ask him a few questions. He allowed this and everything was in normal range. We shook hands and I started to leave. Joe touched me on the shoulder and said, "You know I'm dying and I know I'm dying. It's okay if we talk about it." I apologized and explained that I just didn't really know what to say and that I was sorry that he and his family were having to go through this. His only reply was a hug and then with a grin, he said, " Don't feel sorry for me I feel sorry for you. I'm leaving you here." In that moment I realized that he was right. Mr. Joe lived for six months. During that time he declined very slowly at first. It started with mild confusion and forgetfulness, to not even being able to recall his wife's name, even when she sat right in front of him. Mr. Joe never lost his faith though. I told him happy Easter before the holiday. He explained he would be having the real Easter in Heaven with God when he passed. How could a man have such strong faith to not remember his wife's name who sat beside him, but still remember such strong things about the Lord, who he'd never laid eyes upon? A month before Joe died he became bedridden and was unable to speak. We would talk to him at length. He even got to where he could barely open his mouth and swallow his food. He was transported to the local hospital for his last few days. His family was more comfortable with the thought of him passing there. His wife never left his side. When we were waiting for him to be moved to his floor I bent down and said "Joe, when you get up there you put in a good word with the man upstairs for me. I need all the help I can get." He smiled and spoke for the first time in over a month and told me he would. Mr. Joe died the next day with a smile on his face and all I could think was, "You lucky son of a gun." Talk about a change of heart. I know Joe was put in my life for a reason and Hospice is my passion!
  23. molly.hershman

    Death and All His Friends

    I was 16 years old when I saw death for the first time. I was working in a small emergency room, and they brought an old man in who had had a heart attack while out canoeing with his wife. There were chest compressions, quiet sobs from his wife, the grim silence as the doctor stepped away from the patient...and it was all over. I will never forget how in the moment of death, the man almost seemed to deflate. Like something more than his breath had left him. His essence, his soul, his very life had left him. In what seemed like only seconds after, the hospital staff asked me to "clean him up" before the funeral home staff came for him. They left me alone in the room with him. What once had been a man only minutes before was now a corpse. I remember being scared, worried that he was going to somehow jerk or move and still be alive, somehow. He almost looked fake on the cot. I went home and cried for hours. When I worked in a different emergency room years later, I started seeing death all the time. The older woman whose daughter begged alongside her bed for her mother to just please, please stay alive. The 17-year-old who committed suicide with shoelaces, whose parents asked us to leave the lights on for him when they left because "he had always been scared of the dark". The car accident victims, the old women whose families were ready to let them go, the people who had heart attacks in their prime. The 26-year-old with no past medical history who dropped dead while playing volleyball with his girlfriend. That was the only time I ever cried at work: his mother and father had collapsed at the bedside, and his girlfriend had continuously screamed 'please don't leave me here, don't leave me here, come back come back come back, I love you" until the doctor told her he was gone. Permanently. The one thing I hate about working in healthcare is that in some ways, it seems easier to deal with death each day, because it is there quietly in every corner. It is the enemy, but it is also THERE. Lurking. Present. Taunting with its nearness, and yet not very understood. It's the person no one invited to the party, yet he found his way in. And I hate that. Actually, 'easier' is not the word to describe how I deal with death now as a nursing student. But it's different than how it used to be. I am more numb to it than I was before. More hardened. I think it's a defense mechanism, but I don't know. I don't ever want to someone who is insensitive to the tragedy of death, in any of its forms. But how as a nurse do you stay strong, so you don't break with each loss, but still vulnerable, so you never lose your sense of compassion?
  24. Death is commonplace to me. As a former ICU nurse and now acute care nurse practitioner, I dare say I have seen hundreds of people die. I consider it a sacred act to be there at the time of a patient's passing. Shared that precious moment with family, friends, or perhaps with just the patient themselves. While not a religious man I consider death a part of life. Acceptance of death is also a part of life. I consider it one of the most important jobs to give acceptance to family and friends. And at times to the patients as well. At times there is no more that can be done for my patients but to allow them to rest. But what of those left behind? The motorcycle accident victim was my first patient. A young man, he had the world in the palm of his hand. A tragic accident stole him from his fiance, family, and his future. He would have changed the world. I'm sure of it. And despite that he died. In those last minutes in the ICU before he was wheeled to the operating room to take the organs that would change 7 other lives, I sat with his fiance and cried. 5 foot 10, 220 pounds I wept for a man I had never met. I felt the pain of his young fiance. Of the family they would never create. The memories they would never build. The arguments over toast and unmade beds and clothes left on the floor that they would never have. It was there that I learned how we can make the passing easier for family and friends by being present, sharing the moments, Making a difference. In the end she thanked me with a hug and a smile, and I knew she would be ok. Another day; another patient. His family gathered around him in the dark ICU room. Afraid to touch him, they stood like statues staring at the monitor on the wall. Perplexed I walked in and asked them a question. Would anyone like to hold his hand? They looked at me as if I just shared the winning lotto numbers. We can do that, they asked? Of course you can. I lowered the side rail and his wife sat in a chair and grabbed his hand. I asked if anyone had a story to share. Something embarrassing would do. Something he would like to hear and laugh about in these final minutes. Of course there was one. Or two. Maybe ten. By the time he passed, there was laughter, tears, and acceptance bellowing from the room. Some of it from me. This family shared their intimacy with me and it allowed them to let go. It also allowed the patient to know they would be ok without him and that he could finally move on. Death seems such a taboo topic to many of the nurses I have met. I see so many nurses huddled outside the room, not wanting to bother the family, frustrated, angry, yet keeping those emotions bottled up inside. I believe this is a disservice to keep the emotion inside. Loved ones need help accepting the horrific idea that their loved one is leaving them. Whether the patient is 20, 40, or 99 doesn't matter. They are leaving someone, somewhere, behind. And it's not fair. So who are we to make it harder for everyone to accept by not being there? We are nurses. Game-changers. Earth-shakers. We are the voice of the voiceless in the middle of the night. I tell families all the time that death is just the next step. It's a process. And they should help their family member or friend get through it. Tell stories, hold hands, laugh, cry, sing, pray, tell jokes or horrible stories, in the room, in front of the patient. Dying patients need to know their family is there, prepared for what comes next. That it's ok to move on. Patients need to know that the ones they are leaving behind will be ok. The bullet hole in my sleeve is a badge worn with honor. It is a hole put there by the hundreds of death I've seen. It reminds me that I have a small window to make a difference in those last hours. A small window of time to plant the first seeds of acceptance. Acceptance of finality, that tomorrow will still come, that life will go on for those left behind. I will never sew that hole closed because I dare not forget the power I have as a nurse. Of being the voice of my patients. Of making a difference. I dare you to do the same.
  25. Occasionally, a patient in our care in the Critical Care Unit (CCU) is expected to die imminently no matter what we do. Others may have had a good chance of recovery if admitted to the Critical Care Unit, but then no bed is available for this new patient. Limited resources impact on CCU admissions. Situations in the CCU are often fluid, the medical condition of each of the patients may be stable, changed or perhaps hopeless. The rapid pace of unchecked technological advances enables prolonging life by maintaining some patients on a ventilator even for years even where prognosis is poor or guarded, some even with 'silent' Do Not Resuscitate [DNR] orders. There may be no clear policy on DNR existing in any Kenyan hospital as yet. This dilemma often occurs in the Critical Care Unit. Profound ethical questions confront the CCU personnel as they watch and wait helplessly. Apart from the relatives the critical care primary nurse bears the greatest psychological trauma. Its depressing and stressful to see, manage or care for the brain dead patient. The society has become less prepared for death and has come to rely on high tech medicine to work miracles...ACLS has become one of the techno age's primary end -of -life rituals, but it falls short of filing the gap left by the loss of life affirming community and family bonding ceremonies... Adds Borgatti Joan an ethics consultant in an article First Do No Harm that family experience of death of a loved one ought to be more binding for their family than disintegrating. 'Though technology has improved the quality of life for many people, it can also be burdensome, and its use at a patient's end of life is particularly distressing for many nurses', remarked Urlich Connie, author of Nursing Ethics In Everyday Practice. CASE STUDY ZX (not her real name), a 56 year female patient has been ventilator dependent by tracheostomy in a Kenyan public hospital. She is a retired civil servant, married and a mother of 3 children. She was admitted with ascending paralysis which started on the lower limbs progressively to affect respiratory muscles. Could not feed, move or breath without help (mechanical ventilator) .Working diagnosis of Gullaine Barre Syndrome (GBS) or its variants [never became conclusive]. Went in and out of depression many times, was managed by the psychiatric with counseling and antidepressants without much improvement. At one point after one year she summoned her three children to the bedside. Patient was only able to move the eyes. Not possible to ascertain what exactly she communicated to them. Around the same time, a memorial service was held in CCU, a joint effort between CCU staff and the relatives. The opinion of experts from three medical disciplines; neurosurgery, anesthesia and internal medicine (physicians) was that the condition was irreversible; it was only expected to deteriorate until death. That is, she wound never be able to live without total life support with ventilation, nasogastric tube feeding, turning and cleaning. ZX was very close to the CCU staff, they knew her likes and tastes; she was fond of pediatric patients who got admitted the CCU bed next to hers. She had been moved through all the six CCU beds slots at different times of her stay. Her cognitive functions remained intact most of the time. She made friends even in that state e.g. whenever a staff went for annual leave one desire they had was 'to come back and find ZX still alive'. She was resilient and could pull through odd and ends circumstances including multiple drug resistant organisms in her spectrum etc. A silent attempt for 'less aggressive care' was contemplated in a conference to discuss way forward. The family was divided on this; however they consulted their lawyer who constrained them against seeking to terminate life. At times stress levels could get very high among the nursing staff on advocacy and primary nursing. Nursing care was performed professionally-the patient was suctioned, put back on ventilator, bathed, fed, turned, and her dressings were done. A written order was issued by hospital management to resume full support. Efforts were even made for fundraising for a portable mechanical ventilator to use at home. ZX went into deep coma 3 months to her death after 1 year 4 months in CCU she succumbed, possibly due to complications like hospital acquired infection. She had accrued a Hospital Bill of nearly Ksh 3 Million (US$37,500). A support group was founded in her honour. This case is comparable to Terry Tchiavo and Richard Rudd only that these two had given advanced directives on what should happen in case they ended up in vegetative state while ZX (above) had not given any such directives. Anecdotal evidence also shows that many Kenyans don't give advance directives or living wills. Conclusion There will probably be more situations like these in Kenya. There is no Law or guidelines in Kenya on the issue, therefore ethical issues and dilemmas are inevitable. Health Care providers ought to seek out resources early, care and support the carers as they strife towards a positive and dignified outcome for the patient. The European and American cases quoted in the text though setting precedence for our courts are only of persuasive not binding authority so our courts can ignore them if they wish.Ethical rules do not have the weight of the law, but may be relied upon by the courts as guidelines to determine whether a health care professional has acted unprofessionally in litigation. The Ministry of Medical Services in collaboration with professional bodies like Nursing Council of Kenya and their legal advisers should legislate (subsidiary legislation) on this matter urgently to issue pragmatic policy guidelines to safeguard the health care providers. References Donchin Yoel, The Intensive care Unit May Be Harmful to Your Health Bogner S. Marilyn, 2004: Misadventures in Health Care -Inside Stories, Lawrence Erlbaum Associates Herbert Vander Lugt, 1981:A Matter of Life and Death, Radio Bible class,USA.33-43 Campion Catherine, 1998 Death Rites for the Techno Age, Nursing spectrum ,Vol.2, No.15, http://nursingspectrum.com Borgatti Joan Urlich, Connie, 2012: Nursing Ethics In Everyday Practice, Sigma Theta Tau Intl http://digg.com/News/Science/Terry 'Between Life And Death,' BBC television documentary, 13th July 2010 http://bbc.co.uk/