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February 17, 2016

This is the 100th Blog Post on SMYS. Guest Blog by Cherie Ulmer-Mulvey

By | end of life, Nursing | No Comments

This stethoscope was last used at 5:50am on Friday, February 12, 2016. It was used to pronounce the mom of my best friend of 36 years.
It was never mine but it was used by her husband for a very long time…through a diagnosis of class IV cardiac failure, through a heart transplant and for the last 10 years, through her diagnosis of Alzheimer’s.
After it was used to pronounce her, her husband told me to keep it, that he has no use for it anymore. I tried to explain to him that I had my own stethoscope. He told me that I have to use this stethoscope one more time in my life and I immediately knew what he meant. He winked at me and walked away. steth
I have known this man for 36 years, he has yelled at me, punished me (not my dad) and always been who he is and we have been known to lock horns more than once. I sat and prayed with him that morning and cried with him too… These were things I never thought I would do with him.
We buried my best friend’s mom today and today…
I am Showing You My Stethoscope with pride and pain and tears but most of all with LOVE…




Thank you, Cherie for reminding us what that Stethoscope sees. Witnessing the life, the death, the joy, the pain and the everything.

That is who we are.

That is nursing.

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A Nursing Story – with ZdoggMD props (not a fangirl post, Dogg)

By | Advocacy, Education, end of life | 2 Comments

When I was a fairly new nurse, I had the patient who would change nursing for me forever.

Most of us can say that….but read on.

I was working in SICU, and I was caring for a very elderly lady (upper 90’s) after abdominal surgery. She was one of those super healthy 90+ folks.  She still drove.  Sharp as a tack, and a sweetheart!

Even as a new nurse, that last part chilled me.  The sweet ones always had the worst luck.

The surgery was routine, but she became hypotensive on the floor.  The transfer was initially appropriate.  She had a DNR in place, but we all know that does not mean ‘do not treat’.  She was septic, of course. We did all of the ‘ICU Magic’ and she soon had a central line, pressors, and our (rudimentary at that time) sepsis protocol in place.  She could still consent to these things, but cautioned us that she didn’t want to be on a ventilator for any reason.  

Her husband died without ever coming off the vent 15 years earlier.

Her children visited; all seven who were still alive.  She outlived two of them.  Her oldest daughter was her medical power of attorney.  During the family conference, she held her mother’s hand and agreed with her when she indicated she did not want to be put on a ventilator for any reason.  2011-02-18-047_DyingProhibited

She was placed on BiPap, her organs were shutting down, and was no longer able to consent when a well-meaning first-year doc suggested intubation as a temporary measure.  Alarm bells chimed in my cranium.  I gently suggested to both the physician and the daughter (separately) that intubation was rarely a short-term fix for a woman this ill and this old. I also reminded both of them that this lady was absolutely against this, and had stated it repeatedly.  

I had three days off.

When I returned, Granny was on a vent and pressors, had a rectal tube, NG, art line, and foley catheter.  We couldn’t really sedate her because she was so hypotensive, and she would fight the restraints, pull out the tubes, and roll around in her own feces. Granny, remember her? The lady who didn’t want all of this? She had ICU psychosis, multi-organ failure, and I wanted to stick a 14 gauge IV catheter into my own eyes to kill the pain I felt just looking at her. Her daughter decided she “Wasn’t giving up on her, because she is a fighter” She made her a full code. futile

Eventually, a doc decided enough was enough and told the family that simply nothing else could be done.  When they pulled that ETT, the family stood around absolutely bewildered, and angry that no one told them that granny wouldn’t get better before ‘All of this started’. 

She gasped like a fish until she died.

And nursing changed for me, forever.  

Granny, I am sorry I didn’t advocate harder for you with your daughter.  I will feel the pain I caused you by my inaction forever.

Thanks to ZDoggMD for helping us talk about futile care and why we should make AD’s ironclad with his song  Ain’t the Way to Die.  <—click




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