Through the back door

kaylie1, MSN, RN, NP

We had just finished our Monday morning hospice report. As a group, we routinely meet for 30 minutes on Monday morning to share admissions and deaths over the weekend. I was preparing my schedule for the day, still thinking of a patient that had just passed away over the weekend. I thought to myself, its pretty cool to be able to help others make the transition through death. It is often nursing care at its most basic-comfort care.

This is when the call came into the office to my supervisor-"Sue." She was a bit distraught saying that the caller was the daughter of a patient screaming in the background with pain. Sue had assured me that as soon as the order for the morphine was signed off by the attending, that I would be able to pick it, and the rest of the comfort kit, up from the pharmacy.

Quickly, I hurried out the door and into my car. I was on my way. I entered the address on the GPS and wasn't really sure how far away it was. I knew that the patient was to be admitted for Cancer, although I wasn't sure what type of Cancer or about the source of pain. I assumed she was dying as any other patient on hospice, but for the pain to be this severe, maybe it was more terminal. I just didn't know how I would be able to help, especially without the comfort kit and/or the morphine.

About 10 minutes down the road, I received a call from Sue. She wanted to know if I was almost there. She said if the Dr. could hear the patient screaming on the phone, then he would be more likely to sign the order. The Dr. was still working on it. Sue was getting ready to follow up once again with him.

Arriving at the home, the daughter "Lisa" met me in the driveway. "Did you bring the morphine?" I responded, "No ..I'm sorry, we are still working on that. Is it OK if I go ahead and see her?" She said, " Sure go up these stairs into the back door." So I ran up the stairs and entered the room of a screaming woman lying in bed. Looking directly into her eyes, I said, "where is your pain?" The patient motioned with her eyes and said in a weak voice, "down there," only to start screaming again. I asked the daughter if she was constipated to which she said "maybe." I replied, "Would you mind if I just check, I mean I know we just met?"

With the daughter's assistance, I turned the patient to the side and with rectal check started disimpacting the patient. After a few balls of hard stool, the patient stopped screaming. The daughter's response was, "You really came in the back door more than once, didn't you?" Not sure she ever used the morphine or comfort kit, but I had later picked it up at the pharmacy and brought it back to her in case she needed it.

I phoned the office to speak directly with Sue and said, "The pain is gone. It turned out she was impacted, and I just disimpacted her." Sue's response was, "Thank God!"

The patient died the next morning. She just needed to be comfortable.

As a nurse I had the unique opportunity to relieve the suffering of another person that I had just met. Entering the back door in more ways than one says something pretty special about their confidence in me as a nurse. I am proud to say that I directly relieved her suffering and helped her make it along her journey.

Through the back door

About kaylie1, MSN, RN, NP

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