From the earliest days of nursing school, when we were taught never to become "too involved" with our patients, we nurses find ourselves balancing precariously on the gossamer thread that separates caring for people and caring about them.
OK, so I'm a little jaded after having been a med/surg nurse for awhile and seen a lot of noncompliant medical patients, addicts and alcoholics returning for their umpteenth detox, and the usual assortment of frail, sickly, demented elderly patients whose families won't give up no matter how poor their loved one's quality of life.
And then there are patients like this one.
Twenty-nine-year-old female with four children, a husband who just got deported to Mexico, and an advanced case of cervical cancer with distant metastases to the bones, liver, pelvic organs, stomach, and now possibly the brain. She is hospitalized now for acute renal failure with a BUN in the 200s and creatinine nearing 20. She is still a full code, but in her few lucid moments she must know that her prognosis is terminal; all the operative options have been done, and she's had all the radiation and chemo her failing organs can handle. Essentially she is out of options and has a month to live if she can get dialysis, but only a few days if not.
She lies in bed with her eyes closed, the butterfly-yellow prayer shawl given her by the parish nurse spread over her wasted flesh. She does not complaining about pain or anything else. She also does not eat, drink, get up and walk around, or ask for anything. Her mother, who is my age or a couple of years older, is in almost constant attendance while her children, who range in age from 1 1/2 to 10, play on the other bed and dance around the room, seemingly oblivious to the fact that she is leaving them very soon, no matter what anyone does to try to save her. They do not know that even our strongest weapons are powerless against the enemy, that the battle was lost long before it began in earnest.
This suffering soul is the patient who gets to me, the one whose silent anguish makes me feel petty for ever thinking I was in pain or going through hard times. She has so many things to think about, so many decisions to make, and so little time. Why can't her husband be here, the one who should make her last days a little easier and give their children a stable home when she takes her final journey? Why must these children be split up at a time when they need each other the most---the two eldest to their grandmother's, while the two youngest must go to foster care? And why, oh why, is this girl dying in a hospital bed when she should be raising her babies, finding out what she wants from life, and looking forward to the future with eyes undimmed by pain?
This is the patient who will haunt my dreams, tonight and for nights to come. There should be answers for her. I am outraged because there are none. And as I work with her, I scream silently at the unfairness of it all.
This is the patient who breaks my heart. Who is yours?
I took care of a woman in a ltc that had ALS. She was in her 50's and was unable to move from the neck down. She could still feel everything. A wrinkle in the sheets, an itchy nose or a foot positioned wrong. She drove everyone nuts. I found that if you took a few extra minutes to make sure the sheets weren't bunched, the radio on a station she liked, (instead of one the staff wanted to listen too) and scratch her nose she didn't yell as often. I found out that she had been a concert piano player and loved music. She spent most of her time in her room. Her family had the legal status to determine if she was dnr or not. She said often that she wished they would just let her go. She frequently had pnuemonia and they wanted it treated even if it meant putting her in the hospital. When I left there she was unable to swallow and move her head at all. The family insisted that they put in a G-tube. I often wonder how much longer they forced her to stay alive. I can't imagine what it's like to be some of these peole with diseases like these.
dinkymouse
182 Posts
I took care of a woman in a ltc that had ALS. She was in her 50's and was unable to move from the neck down. She could still feel everything. A wrinkle in the sheets, an itchy nose or a foot positioned wrong. She drove everyone nuts. I found that if you took a few extra minutes to make sure the sheets weren't bunched, the radio on a station she liked, (instead of one the staff wanted to listen too) and scratch her nose she didn't yell as often. I found out that she had been a concert piano player and loved music. She spent most of her time in her room. Her family had the legal status to determine if she was dnr or not. She said often that she wished they would just let her go. She frequently had pnuemonia and they wanted it treated even if it meant putting her in the hospital. When I left there she was unable to swallow and move her head at all. The family insisted that they put in a G-tube. I often wonder how much longer they forced her to stay alive. I can't imagine what it's like to be some of these peole with diseases like these.