The Patient I Failed

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existent, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent. Nurses Relations Article

She knew what she wanted.

She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.

So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

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"I do not wish my heart to be restarted through usage of any chemical, mechanical or physical intervention..."

Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.

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"I do not want any external device to be used to maintain my respiration if my body is incapable of sustaining it on its own."

The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.

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"I wish to die a peaceful, natural death."

She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.

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"I do not wish artificial means of nutrition to be used, such as nasogastric tubes or a PEG tube."

Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.

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"I wish nature to take its course, with only medication to prevent pain and suffering."

The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."

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"Allow me the dignity we give to beloved pets. Let me die in peace."

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existent, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.

Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.

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"Thank you in advance for helping me in the last moments of my life to have a gentle, peaceful passing."

She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.

And so was mine.

The-Patient-I-Failed.pdf

This is so true, so heartbreaking and I have had similar cases too.

I can't push enough that the public is educated, that everyone should walk through an ICU or LTAC.

That somehow we can help push education, preventative medicine and that not everyone believes that this is Greys Anatomy and that there is a miracle fix for every problem.

My heart goes out to all the nurses out there who have had these patients and these nights/days.

Been there multiple times. Wrenches your heart every time

Very well said and it is the sad truth

Specializes in critical care.

we do this almost every frgn week in my ICU, disgusting, sickening and demoralising......

Specializes in ICU CCU PACU.

This is exactly why I left ICU many years ago.. I didn't become a nurse to torture old people for a living !! Luckily over the last decades it has improved, more discussion of code status, no coding unwitnessed arrests on the floors. I was fortunate to be a nurse and had influence over my siblings when it was my parents time to die, they both died comfortably in the nursing homes they lived in surrounded by family and care givers that loved them. Canada has the beginnings of Right to Death legislation. I pray it is better when my time comes.

How can a notarized living will be ignored? This is heart breaking

Specializes in Medical ICU, Psych (OP & IP).

Wow! A REAL story! Been there! Heartbreaking, especially not respecting the lady's wishes and also NOT allowing sedatives or pain meds!?! I think that is very selfish of her daughter! As Nurses, sometimes all we can do is make our patients as comfortable as possible.

Very well written!

That is my biggest fear, that I will end up like some of my patients: bed ridden, half concious, suffering for months before finally being allowed to die... I'm always very uncomfortable when I perform some procedures on a patient that in my opinion should be left to die in peace. It seems barbaric, unnecessary and makes me feel guilty.

When I first started in nursing, events like this were common place, as DNRs did not exist. We were so relieved with the advent of DNRs, onlybto be forced into situations like this one. Horrible. I have threatened my adult children mightily with haunting if they do this to me! Hopefully that will remove any guilt they may have over letting me die!

if I had a dollar for every time I heard "yes, we have advanced directives, but I am not ready to lose them"......I have only been an ICU nurse for five months. I tell every patient - makes sure your POA is someone who is strong enough to honor your wishes when you lose your voice and sometimes, that is not your spouse or child.

Beautiful! Even though I haven't had the privilege of working as a nurse yet, I can't imagine how you felt. You did not fail her, her daughter and physician did. Bless your soul.