So last night at work, I began to realize that sometimes nursing
equates working in a hotel...not just any hotel but obviously the
Marriott hotel.
The night started out rough because we were
short one tech with lots of busy patients. The call lights were
unending. One would ring and of course five others would go off at the
same time...that in itself was unbearable, but then it got worse.
One
of my patients was a sweet older man who had been diagnosed with liver
cancer. Up until five months ago he had been running 3 miles, lifting
weights, and swimming 100 laps a day. Then he lost 40 lbs in three
months and became very weak. His primary doctor had urged him to come
to the hospital ASAP, but he refused until after Thanksgiving so he
could be with his family.
When I admitted him, I remember
thinking...this is one patient I would take home with me...he's so sweet
and adorable. His family at the bedside, two sons, were very nice and
polite. They stayed long enough to answer any questions and to ensure
their father settled in for the night. (The first night with this
patient was a breeze, he slept all night and didn't need a thing...my
favorite patients).
This night his two daughters were at his
bedside. And I could tell from the beginning they were going to make
sure my night was a long difficult one. The first daughter introduced
herself. "I'm Dr. _________ and I want to talk about the plan of
care." I politely answered all of her questions (even though some of
them I had to go find the answers). Next she demanded that his zofran
be increased to 4mg every 4 hrs instead of every 6 hrs. I told her I
would have to call the Dr but I would go ahead and bring in the dose
that was due. She rudely commented, "Yeah you should do that".
I
got his zofran adjusted and brought in his dose. When I got into the
room and offered it to the patient, he refused it. The daughters of
course jumped all over him to take it...when he still refused, I told
him that it was okay and i didn't have to give it to him...well let me
tell you...the daughters definately did not like that..."He does need it
and you WILL give it to him right now!" I calmly explained that I
could not give it to him unless he was the one who said he needed it.
The daughter looked at him and finally convinced him to take the med.
As
soon as I left the room, I felt the daughter on my heels. "I am his
legal Power of Attorney and I want to read the doctor's notes tonight
right now!" I explained to her that I was not able to give those to her
and she would have to go to medical record with the Power of Attorney
paper. She was definately not happy about that.
I managed to
make it three steps away when she started asking me about a private room
and if there was anyway they could have one... I explained that I would
put in the order, but it was not a guarantee that they would get
one...but that I would do what I could.
What she said next just
totally astounded me. "Can we put another sleeping chair in the room
and shove the other patients bed up against the wall?" WHAT!!!!!
"Uhm...no
we can't do that...but i can either get you a list of hotels nearby or I
can make a sleeper chair for you in the waiting room". After printing
off the list of hotels, she decided that none of them were good enough
for her, and she wanted the waiting room (Uhm...if the hotels aren't
good enough...you choose the waiting room...what????)
The tech and
I went and found a reclining chair and rearranged the waiting room to
make up the bed. As she enters the room, she says "No No, can you move
the chair so I can see the tv, and then tilt the tv so I can see it
better". (Okay at this point I was having a really hard time in not
saying something nasty especially since she was still running around
barefoot, after i gave her some socks...I mean really who does
that!!!!).
I thought that once she fell asleep it would be better,
but no she decided she was going to stay up all night and make demand
after demand. Made for a very long night.
When I returned the
next night...this patient was no longer there, but the stories the day
nurses told me...complaining about meal trays, dumping meal trays onto
the OTHER patient in the room, demanding to see the dr right now...then
complaining about the meal tray to her, demanding a private room an hour
ago, and then of course just being rather demanding of the techs and
nurses.
So to close this out...I'm gonna still a quote from one
of my work friends "I pulled into what I thought was the hospital
parking garage tonight but apparently to some people, it's the Marriott
with an all night buffet".
Sunday, November 25, 2012
Thursday, November 22, 2012
Do Something!!!! Please!!!!
I know that I have written quite a few articles on patients coding or declining...but unfortunately that is a sad part of the job. (This time it didn't happen on my wing or any of my patients...no one can blame "Crash" this time).
It was 0715 one morning. I had to take a quick break from report to grab a paper towel. As I entered the hallway, I saw two residents enter the room of a patient on the wing straight across from mine. Within 10 secs, I saw the Assistance please light go off. I quickly yelled at my techs and the other nurses on my wing and we took off running. One of the techs stopped to grab the crash cart along the way. As I went running pass the clerk's desk I told her to call a code. As we entered the room, we saw the patient laying in the bed with a nasty bluish gray color. He wasn't breathing and the continuous pulse ox was not picking up a pulse or an O2 sat. The residents were just standing there with a scared look on their faces.
I pretty much jumped onto the bed and the patient and started chest compressions. The other nurse quickly checked for a pulse, and went to grab the ambu bag. Of course there was no ambu bag or suction set up in the room. Two other nurses quickly started looking for a vein to put in an 18 gauge IV.
The whole time, we are all looking at each other wondering where Rapid response, respirtory and other doctors were. Since I work on an acute care floor, we are not allowed to push medications during a code, either the doctors or rapid can do that...and since the two residents in the room, were not responding to our yells to do something...we were kinda stuck in a hard spot.
We continued chest compressions, ambu bagging (we had to run and find one), started three IVs (three nurses all at once got them at once) and freaking out for fifteen minutes before everyone else started showing up. (Although from the moment I did my first chest compression, I knew the patient was not going to make it, due to all the fluid that was coming out of his nose, mouth, and ears).
Once rapid showed up and took control they were able to get the residents into motion but only by telling them step by step directions. We continued coding the patient for another 30 minutes, because no one wanted to admit this was one that we could not save. However, the attending eventually called it and night shift ended their shift on a depressing note. It's definitely a difficult thing when we are reminded that sometimes there is nothing we can do, no matter how hard we try.
It was 0715 one morning. I had to take a quick break from report to grab a paper towel. As I entered the hallway, I saw two residents enter the room of a patient on the wing straight across from mine. Within 10 secs, I saw the Assistance please light go off. I quickly yelled at my techs and the other nurses on my wing and we took off running. One of the techs stopped to grab the crash cart along the way. As I went running pass the clerk's desk I told her to call a code. As we entered the room, we saw the patient laying in the bed with a nasty bluish gray color. He wasn't breathing and the continuous pulse ox was not picking up a pulse or an O2 sat. The residents were just standing there with a scared look on their faces.
I pretty much jumped onto the bed and the patient and started chest compressions. The other nurse quickly checked for a pulse, and went to grab the ambu bag. Of course there was no ambu bag or suction set up in the room. Two other nurses quickly started looking for a vein to put in an 18 gauge IV.
The whole time, we are all looking at each other wondering where Rapid response, respirtory and other doctors were. Since I work on an acute care floor, we are not allowed to push medications during a code, either the doctors or rapid can do that...and since the two residents in the room, were not responding to our yells to do something...we were kinda stuck in a hard spot.
We continued chest compressions, ambu bagging (we had to run and find one), started three IVs (three nurses all at once got them at once) and freaking out for fifteen minutes before everyone else started showing up. (Although from the moment I did my first chest compression, I knew the patient was not going to make it, due to all the fluid that was coming out of his nose, mouth, and ears).
Once rapid showed up and took control they were able to get the residents into motion but only by telling them step by step directions. We continued coding the patient for another 30 minutes, because no one wanted to admit this was one that we could not save. However, the attending eventually called it and night shift ended their shift on a depressing note. It's definitely a difficult thing when we are reminded that sometimes there is nothing we can do, no matter how hard we try.
Friday, November 16, 2012
Just Another Night
Oh the things my co-workers can tease me for…I swear…so the newest joke on me is…I have a thing for old
men. Well at least that’s what my
co-workers say after tonight…the night I will almost definitely never
forget.
One of my patients tonight (actually one of my preceptee’s patients) was an adorable 88 year old who was here for cystocele surgery. She was adorable…as was her husband, who was so attentive he never left her side.
The night started off busy with two direct admits back to back (with one of them being a surprise because the day nurse forgot to give us report so we had no idea he was coming until he just showed up). But we made it a point to check on the other patient every hour.
She had a catheter in place and was on a PCA pump (now really, this was a disaster just waiting to happen but you know that’s the fun in it, I guess).
We managed to handle the two direct admits pretty well which is actually harder to do then it sounds…and by midnight we were pretty much caught up and in a good spot. But then trouble began.
The first sign of trouble occurred at about 0200. When I checked on the patient she was wide awake, her husband sleeping in the recliner next to the bed. She gave me a really strange look, and if I would have only known what that look meant…I might have just walked right back out of the room without bothering her.
“Are you having any pain?” Well of course her response was not what I expected. “Why the hell would I be in pain!!!!!???” “Um…because you just…um…had surgery…and I was just um…just wondering”
“No, I’m not in pain…but I need to use the bathroom…right now!!!!”
I did a quick check of the catheter, which appeared to be draining, and I’m sure I sounded pretty confused, “You have a catheter, do you feel like you need to urinate?”
“Umm…No,…I need to do the other thing. You know the stinky thing”. I suggested maybe using a bedpan or even a bedside commode, but the patient was not going to have any of that…”Young lady…I am not too old to go to the bathroom…Now help me get there.”
I assisted her to the bathroom…regretting that decision from the moment I got her up…she was very unbalanced on her feet, and about took us both to the ground a few times before we made it. Not the brightest idea I’ve ever had.
The second I got her to the toilet and she sat down…she yelled “GET OUT!!! NOW!!!”
Now I’m all about giving privacy…but when it comes to unsteady 88 year old women, especially one on narcotics, unsupervised in the bathroom…I’m not that stupid. Then the IV pump at the bedside started to go off…so I did the only thing I could think of. I told her to stay sitting, closed the door just enough to give privacy and ran to the bedside to fix the pump. Suddenly, I heard the bathroom door slam. I quickly turned to the husband. “Please tell me that was you?!”
He shook his head.
I ran to the door and tried to turn the handle. It was locked!! Of course…Wait…Our bathroom doors lock????!!!! “Sweetie are you okay?”
Nothing, it was completely quiet in the bathroom. So I acted like a little child. I knocked on the door, when that didn’t work…I pounded on the door…and when that didn’t work…I pounded on the door and screamed her name…still NOTHING.
All my yelling brought about the rest of my co-workers. When they saw what was going on…they all looked at me and said…”The bathroom doors lock???!!!” I tried to stay calm…but man I was about ready to kill them… “Uh no they don’t lock…I’m just standing here like an idiot beating up the door!”
I started to do something as a nurse you shouldn’t ever do…I started to panic…and it takes a lot to make me panic.
I dropped to the floor and laid my face on the cold, germ-infested floor. I could see a gown, but nothing else on the floor…well that’s good…she hasn’t fallen at least…has she!!!!???
I called environmental services and security. Minutes later, they showed up and looked at me and said… “I didn’t know those doors locked”.
Oh great…now what in the world am I supposed to do. I grabbed my scissors and attempted what I later found out looked really funny. I attempted to pick the lock…of course my scissors didn’t work.
As I’m trying to play petty theft, I start to hear the husband going crazy. “Helen…I mean it you need to come back here. You need to leave those tigers alone!!! Now I said come here. Those bears are going to get you and then you will be sorry!”
Uhm…What in the world?
The husband is pacing around the room…when we try to reorient him, he looks at me. “Who the blast are you…and what did you do with my pickle?”
(Now any other time, this would have been pretty entertaining…but at that moment…I could have strangled him and everyone else)
The tech helped him over to the bed to sit down. I returned to pounding on the door and screaming my patient’s name. Of course, still no answer. I just knew that my patient was on the other side of that door…dead.
The husband was on the bed trying to punch the tech in the head…and was cussing and swearing up a storm at him. And of course, all of the other patients were going crazy on their call bells, IV pumps were beeping and doctors were wanting to speak with me. So this is what it feels like to suffocate and almost die from stress.
Then in the midst of all the chaos, a patient from another room, just happened to be walking down the hallway, and he poked his head in wanting to see what all the excitement was.
Just about that time…the bathroom door opened. Everyone…the husband, the techs, myself, the two other nurses, the security guard, the HOA, the environmental services person and of course the other patient all crowded into the bathroom to see what had happened to the patient.
And there stood the patient, butt-naked, holding her arms in the air, pumping with victory. She had pulled out her PICC line (of course), and disconnected her catheter from its drainage bag. The bag was above her head in her left hand, and the catheter was hanging straight down, streaming urine. There was blood and urine everywhere.
I am absolutely sure, we were all standing there with our mouths wide open…not exactly believing what we were seeing. She slowly lowered her arns, and then raised her finger and pointed at me. “Get her away from me, she is trying to kill me.” UM…EXCUSE ME…WHAT!!!!
I saw everyone trying not to laugh and failing miserably.
“Please call the police, I would like to report an attempted murder.” She said, glaring at me.
Everyone looked at me…I didn’t know whether to laugh, cry or to scream. “What…um…what…uh…I’m not trying to kill you”, is all I could say.
“You thought I was asleep…but I tricked you…I was only pretending. I heard you…You and my husband…I heard you both. You are plotting to kill me so you can run off together.”
The almost 90 year old man looked at me and whispered, “I’m so sorry”. I did my best to smile back at him. I will never live this down. .
My preceptee took over, getting her back to bed, dressed, new catheter, new IV, and removed the PCA, while of course I had the privilege of calling the doctor at 0400. She was really nice…of course after she laughed hard core at me. OMG…really…and then the teasing started. “Alicia, you never mentioned that you have a thing for 90 year old men…I didn’t know you had a grandpa complex.” And so it begins…yet again.
One of my patients tonight (actually one of my preceptee’s patients) was an adorable 88 year old who was here for cystocele surgery. She was adorable…as was her husband, who was so attentive he never left her side.
The night started off busy with two direct admits back to back (with one of them being a surprise because the day nurse forgot to give us report so we had no idea he was coming until he just showed up). But we made it a point to check on the other patient every hour.
She had a catheter in place and was on a PCA pump (now really, this was a disaster just waiting to happen but you know that’s the fun in it, I guess).
We managed to handle the two direct admits pretty well which is actually harder to do then it sounds…and by midnight we were pretty much caught up and in a good spot. But then trouble began.
The first sign of trouble occurred at about 0200. When I checked on the patient she was wide awake, her husband sleeping in the recliner next to the bed. She gave me a really strange look, and if I would have only known what that look meant…I might have just walked right back out of the room without bothering her.
“Are you having any pain?” Well of course her response was not what I expected. “Why the hell would I be in pain!!!!!???” “Um…because you just…um…had surgery…and I was just um…just wondering”
“No, I’m not in pain…but I need to use the bathroom…right now!!!!”
I did a quick check of the catheter, which appeared to be draining, and I’m sure I sounded pretty confused, “You have a catheter, do you feel like you need to urinate?”
“Umm…No,…I need to do the other thing. You know the stinky thing”. I suggested maybe using a bedpan or even a bedside commode, but the patient was not going to have any of that…”Young lady…I am not too old to go to the bathroom…Now help me get there.”
I assisted her to the bathroom…regretting that decision from the moment I got her up…she was very unbalanced on her feet, and about took us both to the ground a few times before we made it. Not the brightest idea I’ve ever had.
The second I got her to the toilet and she sat down…she yelled “GET OUT!!! NOW!!!”
Now I’m all about giving privacy…but when it comes to unsteady 88 year old women, especially one on narcotics, unsupervised in the bathroom…I’m not that stupid. Then the IV pump at the bedside started to go off…so I did the only thing I could think of. I told her to stay sitting, closed the door just enough to give privacy and ran to the bedside to fix the pump. Suddenly, I heard the bathroom door slam. I quickly turned to the husband. “Please tell me that was you?!”
He shook his head.
I ran to the door and tried to turn the handle. It was locked!! Of course…Wait…Our bathroom doors lock????!!!! “Sweetie are you okay?”
Nothing, it was completely quiet in the bathroom. So I acted like a little child. I knocked on the door, when that didn’t work…I pounded on the door…and when that didn’t work…I pounded on the door and screamed her name…still NOTHING.
All my yelling brought about the rest of my co-workers. When they saw what was going on…they all looked at me and said…”The bathroom doors lock???!!!” I tried to stay calm…but man I was about ready to kill them… “Uh no they don’t lock…I’m just standing here like an idiot beating up the door!”
I started to do something as a nurse you shouldn’t ever do…I started to panic…and it takes a lot to make me panic.
I dropped to the floor and laid my face on the cold, germ-infested floor. I could see a gown, but nothing else on the floor…well that’s good…she hasn’t fallen at least…has she!!!!???
I called environmental services and security. Minutes later, they showed up and looked at me and said… “I didn’t know those doors locked”.
Oh great…now what in the world am I supposed to do. I grabbed my scissors and attempted what I later found out looked really funny. I attempted to pick the lock…of course my scissors didn’t work.
As I’m trying to play petty theft, I start to hear the husband going crazy. “Helen…I mean it you need to come back here. You need to leave those tigers alone!!! Now I said come here. Those bears are going to get you and then you will be sorry!”
Uhm…What in the world?
The husband is pacing around the room…when we try to reorient him, he looks at me. “Who the blast are you…and what did you do with my pickle?”
(Now any other time, this would have been pretty entertaining…but at that moment…I could have strangled him and everyone else)
The tech helped him over to the bed to sit down. I returned to pounding on the door and screaming my patient’s name. Of course, still no answer. I just knew that my patient was on the other side of that door…dead.
The husband was on the bed trying to punch the tech in the head…and was cussing and swearing up a storm at him. And of course, all of the other patients were going crazy on their call bells, IV pumps were beeping and doctors were wanting to speak with me. So this is what it feels like to suffocate and almost die from stress.
Then in the midst of all the chaos, a patient from another room, just happened to be walking down the hallway, and he poked his head in wanting to see what all the excitement was.
Just about that time…the bathroom door opened. Everyone…the husband, the techs, myself, the two other nurses, the security guard, the HOA, the environmental services person and of course the other patient all crowded into the bathroom to see what had happened to the patient.
And there stood the patient, butt-naked, holding her arms in the air, pumping with victory. She had pulled out her PICC line (of course), and disconnected her catheter from its drainage bag. The bag was above her head in her left hand, and the catheter was hanging straight down, streaming urine. There was blood and urine everywhere.
I am absolutely sure, we were all standing there with our mouths wide open…not exactly believing what we were seeing. She slowly lowered her arns, and then raised her finger and pointed at me. “Get her away from me, she is trying to kill me.” UM…EXCUSE ME…WHAT!!!!
I saw everyone trying not to laugh and failing miserably.
“Please call the police, I would like to report an attempted murder.” She said, glaring at me.
Everyone looked at me…I didn’t know whether to laugh, cry or to scream. “What…um…what…uh…I’m not trying to kill you”, is all I could say.
“You thought I was asleep…but I tricked you…I was only pretending. I heard you…You and my husband…I heard you both. You are plotting to kill me so you can run off together.”
The almost 90 year old man looked at me and whispered, “I’m so sorry”. I did my best to smile back at him. I will never live this down. .
My preceptee took over, getting her back to bed, dressed, new catheter, new IV, and removed the PCA, while of course I had the privilege of calling the doctor at 0400. She was really nice…of course after she laughed hard core at me. OMG…really…and then the teasing started. “Alicia, you never mentioned that you have a thing for 90 year old men…I didn’t know you had a grandpa complex.” And so it begins…yet again.
Sunday, November 11, 2012
How About Some Dancin?
Every now and then I will have a patient that makes such a difference
in my life that I will never forget them (sometimes this is not a good
thing, but others its a great thing).
It was a busy night from the get go. And then one of my patients decides that he is going to be difficult and go septic. Since this is not a good thing, and usually requires a lot of extra monitoring, these patients are usually moved off of our floor. However, this night, the doctors had decided to leave the patient here. He was stable for the most part. Sure he had a dobhoff tube, and was very jaundice but he was in great moods.
The tech and I went in to clean the patient up. As we were in there we quickly discovered what a character this patient was. He very quickly joined in with our banter and was picking on us. He asked me to go dancing and was flirting with the tech. Next thing, we knew he was romancing both of us by singing us Robert Stewart songs. He was actually a pretty good singer (or as good as anyone could be with a tube going down the back of their throat). The night passed quickly with him being a tease and a flirt.
However, when I came in the next night, I knew that he was not feeling well at all. He was not his joking self and would barely say a word at all. I convinced the doctors that he needed to be moved to a higher acuity. The doctors wanted a CAT scan before they moved him. The patient was too afraid to go by himself so I asked the tech to go with him. When he returned to the floor, it was time to transfer him to the other unit. It was rough because when he realized he was leaving us, he started to cry and didn't want to go.
Over the next couple of weeks, the tech and I went to visit him on the other floor. It was super cute because every time, we came to visit he would get this huge grin and start to sing us more songs. It was great to see him improving. He finally improved enough to go home, and the night before he left I went to see him for one last visit. He was in the best mood I had ever seen him in. He of course sang me a few songs and of course flirted and teased. He reminded me that I owed him some dancing. I laughed and said "Well you never know". He grinned and said that he would never forget me.
It was great to feel so appreciated. It was also amazing knowing that I had made such a difference in this patient's life while he was here at the hospital. Every time I hear a Rob Stewart song now, it makes me think of him and his positive attitude while he was here.
It was a busy night from the get go. And then one of my patients decides that he is going to be difficult and go septic. Since this is not a good thing, and usually requires a lot of extra monitoring, these patients are usually moved off of our floor. However, this night, the doctors had decided to leave the patient here. He was stable for the most part. Sure he had a dobhoff tube, and was very jaundice but he was in great moods.
The tech and I went in to clean the patient up. As we were in there we quickly discovered what a character this patient was. He very quickly joined in with our banter and was picking on us. He asked me to go dancing and was flirting with the tech. Next thing, we knew he was romancing both of us by singing us Robert Stewart songs. He was actually a pretty good singer (or as good as anyone could be with a tube going down the back of their throat). The night passed quickly with him being a tease and a flirt.
However, when I came in the next night, I knew that he was not feeling well at all. He was not his joking self and would barely say a word at all. I convinced the doctors that he needed to be moved to a higher acuity. The doctors wanted a CAT scan before they moved him. The patient was too afraid to go by himself so I asked the tech to go with him. When he returned to the floor, it was time to transfer him to the other unit. It was rough because when he realized he was leaving us, he started to cry and didn't want to go.
Over the next couple of weeks, the tech and I went to visit him on the other floor. It was super cute because every time, we came to visit he would get this huge grin and start to sing us more songs. It was great to see him improving. He finally improved enough to go home, and the night before he left I went to see him for one last visit. He was in the best mood I had ever seen him in. He of course sang me a few songs and of course flirted and teased. He reminded me that I owed him some dancing. I laughed and said "Well you never know". He grinned and said that he would never forget me.
It was great to feel so appreciated. It was also amazing knowing that I had made such a difference in this patient's life while he was here at the hospital. Every time I hear a Rob Stewart song now, it makes me think of him and his positive attitude while he was here.
Wednesday, November 7, 2012
Nursing Ethics
So this past week has gotten me thinking about nursing school and
when we talked about nursing ethics and the role of a nurse. We were
informed that we would see many ethical issues and we would not always
agree with the way things were handled in the practice. To make this
easier on us to decide whether something was ethical or if it was our
own personal biases and feelings making us feel uneasy, we were taught
about the different principles of nursing ethics: autonomy, veracity,
justice, non-maleficence, fidelity, paternalism and beneficence to name a
few.
Of course I have faced many issues where I wondered if nursing ethics or medical ethics were being forgotten, but none quit like this one patient I cared for this week.
She was an elderly lady who was in with a bad prognosis. She was dying of cancer...stage IV. There was nothing else that could be down and in fact the treatment was only prolonging her misery. She was alert and oriented during the day, but at night she experienced sun-downers and would quite often forget where she was and have to be re-oriented.
Her family was great and took turns in a rotating schedule staying by her side at all most all times. However, they felt that she should not be told the truth of her condition. They did not want her to know that she was dying and that the treatment was not helping. They ordered the doctors and nurses to not say a word about the prognosis and in fact to tell her that she was getting better. The doctors tended to agree saying "she's confused anyway so what difference does it make...she's not aware of what is going on".
I was very disturbed by the response of the doctors because I knew from first hand expierence that the patient was in fact mentating and did know what was going on around her, thanks to many great conversations.
One night while I was in the room doing a dressing change, the patient asked me, "I'm dying aren't I? This is the end, I can feel it." I looked up at the daughter and had to make a decision quickly about how I was going to answer it.
I'm not usually one to beat around the bush, or not be direct when a patient asks me a question but I knew that I had to tread carefully with this answer. I looked her in the eye and told her something like "Well honey, you know your body and mind better then anyone else, and many times, the feelings we get are our mind's way of telling us the truth about our health." She sighed and nodded her head.
Her daughter walked out of the room, and while I finished the dressing change, we made small talk. When I left the room, the daughter was waiting for me, with a very unhappy look on her face. She immediately began to say how it was inappropriate for me to tell her mother that and i had no right. I looked at her and said, "Your mother knows more then you think...she knows that you aren't telling her the truth...she also knows that you guys love her very much and it's hard for you...but what you guys are forgetting is that...by not telling her and not letting her decide to quit the care...you guys have managed to take away the dignity of your mother." She looked at me and nodded and said she hadn't thought of it like that. She went and called the rest of her family. Within an hr, she came back and asked for the doctors to come in and talk to her mother.
I was happy to see that the patient was finally able to know the complete truth of her situation. The next morning the patient had decided to go home, and spend the remainder of her days with her family. She was incredibly happy and at peace with her prognosis and her decision. It made my day.
Of course I have faced many issues where I wondered if nursing ethics or medical ethics were being forgotten, but none quit like this one patient I cared for this week.
She was an elderly lady who was in with a bad prognosis. She was dying of cancer...stage IV. There was nothing else that could be down and in fact the treatment was only prolonging her misery. She was alert and oriented during the day, but at night she experienced sun-downers and would quite often forget where she was and have to be re-oriented.
Her family was great and took turns in a rotating schedule staying by her side at all most all times. However, they felt that she should not be told the truth of her condition. They did not want her to know that she was dying and that the treatment was not helping. They ordered the doctors and nurses to not say a word about the prognosis and in fact to tell her that she was getting better. The doctors tended to agree saying "she's confused anyway so what difference does it make...she's not aware of what is going on".
I was very disturbed by the response of the doctors because I knew from first hand expierence that the patient was in fact mentating and did know what was going on around her, thanks to many great conversations.
One night while I was in the room doing a dressing change, the patient asked me, "I'm dying aren't I? This is the end, I can feel it." I looked up at the daughter and had to make a decision quickly about how I was going to answer it.
I'm not usually one to beat around the bush, or not be direct when a patient asks me a question but I knew that I had to tread carefully with this answer. I looked her in the eye and told her something like "Well honey, you know your body and mind better then anyone else, and many times, the feelings we get are our mind's way of telling us the truth about our health." She sighed and nodded her head.
Her daughter walked out of the room, and while I finished the dressing change, we made small talk. When I left the room, the daughter was waiting for me, with a very unhappy look on her face. She immediately began to say how it was inappropriate for me to tell her mother that and i had no right. I looked at her and said, "Your mother knows more then you think...she knows that you aren't telling her the truth...she also knows that you guys love her very much and it's hard for you...but what you guys are forgetting is that...by not telling her and not letting her decide to quit the care...you guys have managed to take away the dignity of your mother." She looked at me and nodded and said she hadn't thought of it like that. She went and called the rest of her family. Within an hr, she came back and asked for the doctors to come in and talk to her mother.
I was happy to see that the patient was finally able to know the complete truth of her situation. The next morning the patient had decided to go home, and spend the remainder of her days with her family. She was incredibly happy and at peace with her prognosis and her decision. It made my day.
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