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.
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.
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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