Lately on our unit we've had an increase in the amount of deaths. Now I understand that eveyone has to die, heck we don't live in the age of the bible/torah/quran and live to be 800 yrs+
That being said, we've also had people on our unit who are DNR (do not resuscitate) who I can't help myself in thinking that many of these people I would rather see die... but only because IMO they are suffering.
The last shift I worked was one such case - I had a patient who's not very old - I'd say youngish, on TPN (since like 2001/02), was severely emaciated, had several comorbidities and had been in and out of units (whenever he gets readmitted he gets put back on our unit for some reason - totally unrelated to the fact that our unit is for neuro pts) for like a year+.
During this last admittance, he suddenly started vomitting blood EVERYWHERE and had to have an emergency scope to have varices in his stomach banded/cauterized. When he returned back to us, he required like 6-10 units of blood, plasma, IV fluids, etc...
To see him, he was CLEARLY suffering - and I'm thankful that he passed because you could see that not only was he suffering, but so was his family.
Another pt we've had on our unit is an older patient who is also a DNR, tho has late stage dementia. She's been on our unit for several months I think and recently became a DNR, the family was in denial about her condition for so long. This woman moans CONSTANTLY, is completely delirious and is VERY difficult to take care of, emotionally and psychologically because there's nothing that we can do to settle her. Even super strong anti psychotics don't touch her. She's REALLY difficult to feed or get her to drink and therefore she's starving herself. At least with the DNR in place, we don't have to give her a feeding tube. I'm hoping that she's passed, her family is having such a hard time seeing her waste away, physically and psychologically. They cry almost every time they come to visit but know that a DNR is the best thing to do. Thank goodness!!!
We have another lady on our unit who's on restraints because she has a neuro disorder that causes these involuntary movements. Now, in our province, no LTC (long term care) facility will take a pt with restraints, and therefore must stay with us in the hospital. This family, tho will not make her a DNR. I don't understand why, or maybe the Dr hasn't talked/pushed the family into making her a DNR. It's not like this lady's condition is going to improve, it'll only get worse! It's a terminal disorder. And I certainly don't want to be pushing down on this lady's chest when the time comes that her brain is going to deteriorate to the point where she stops breathing and I have to call a code on her, because she isn't a DNR. SOOO frustrating. I am surprised tho that this family comes to the hospital DAILY - for lunch or for dinner and personally feed her. It astonishes me because you think that that would eventually fade.
My question to you folk out there.... have you ever thought about delaying calling a code on someone who should VERY obviously SHOULD be a code????
Showing posts with label suffering. Show all posts
Showing posts with label suffering. Show all posts
Thursday, August 23, 2012
Thursday, August 9, 2012
Death & Dying - what I learned
I was working the other week, and one of my co workers had a patient who had been going downhill. It was such a sad story - the husband and wife came to Canada from out east to visit their children and the husband had a stroke and the wife forced her husband to come to my hospital. He of course was admitted. Now of course when ppl go on holiday they don't (always) think to get health insurance so now that they're at my hospital, there's no way to pay for the care and so the hospital goes after the children's ability to pay.
During grand rounds I learn that this person has been going through cycles since coming to the hospital - that his doctor had been trying to make him healthy enough so that he could get on a plane to go back to his parent country. Unfortunately, he would get well for about a week and then would start to spike a temperature and would have to be held up and begin a round of antibiotics, and that would be the cycle. It was like EVERY time he was well enough to get a clean enough bill of health as is required by airlines to allow sick ppl onto their airplanes, he would spike another temp and wouldn't be able to go back.
The shift I worked, I was told by the nurse taking care of him that he wasn't doing well, his BP was REALLY poor but his O2 was alright, but that he didn't look good. Thankfully the family had made him DNR so at least if things went awry we wouldn't have to pound on this poor patient's chest to revive him and keep him alive for longer than he needs to be.
The nurse came out and explained that she thought he would die during that particular shift and felt that there wasn't anything that could be done to alleviate any suffering. She called the on-call doc, who just happened to be one of my favorite docs and he ordered some dilaudid for him and some scopolamine as this med dries up secretions and the "death rattle" is less so the family isn't as upset by it.
The doc agreed that he was in the final throes of dying and that it wouldn't be long before he died. I was talking to the doctor and a couple of the other nurses when the wife comes out to the nursing station speaking Hindi - a language that not enough of us speak but we did have a couple of ppl on at that time and we pulled one of them (the male of the two) to translate as the wife was trying to speak to the doctor and pull him back into the patient room. Now when we pulled the male nurse to translate the face he was making was hilarious and it was almost as though he had NO idea why we were grabbing him and it was hilarious so I laughed.
I found out when the doc came back to the station was that her husband had just breathed his last breath and was coming out to indicate this.
I felt soooooooooooo bad that one of the last things that this woman may remember will be laughing when her pain was excrutiating. I am not someone who enjoys seeing another person in pain. I wish I coudl have spoken the language with enough fluency to apologize for any pain that I may have inadvertently causing her.
Morale of the story - get health insurance whenever you travel, you never know what's going to happen and you really do need to be covered. And never laugh at ANY point in time if someone is dying on your unit, because it may be perceived in another manner in which you meant it. ESPECIALLY if someone speaks another language. They have NO idea why you're laughing, and nothing is funny when your loved one is dying.
During grand rounds I learn that this person has been going through cycles since coming to the hospital - that his doctor had been trying to make him healthy enough so that he could get on a plane to go back to his parent country. Unfortunately, he would get well for about a week and then would start to spike a temperature and would have to be held up and begin a round of antibiotics, and that would be the cycle. It was like EVERY time he was well enough to get a clean enough bill of health as is required by airlines to allow sick ppl onto their airplanes, he would spike another temp and wouldn't be able to go back.
The shift I worked, I was told by the nurse taking care of him that he wasn't doing well, his BP was REALLY poor but his O2 was alright, but that he didn't look good. Thankfully the family had made him DNR so at least if things went awry we wouldn't have to pound on this poor patient's chest to revive him and keep him alive for longer than he needs to be.
The nurse came out and explained that she thought he would die during that particular shift and felt that there wasn't anything that could be done to alleviate any suffering. She called the on-call doc, who just happened to be one of my favorite docs and he ordered some dilaudid for him and some scopolamine as this med dries up secretions and the "death rattle" is less so the family isn't as upset by it.
The doc agreed that he was in the final throes of dying and that it wouldn't be long before he died. I was talking to the doctor and a couple of the other nurses when the wife comes out to the nursing station speaking Hindi - a language that not enough of us speak but we did have a couple of ppl on at that time and we pulled one of them (the male of the two) to translate as the wife was trying to speak to the doctor and pull him back into the patient room. Now when we pulled the male nurse to translate the face he was making was hilarious and it was almost as though he had NO idea why we were grabbing him and it was hilarious so I laughed.
I found out when the doc came back to the station was that her husband had just breathed his last breath and was coming out to indicate this.
I felt soooooooooooo bad that one of the last things that this woman may remember will be laughing when her pain was excrutiating. I am not someone who enjoys seeing another person in pain. I wish I coudl have spoken the language with enough fluency to apologize for any pain that I may have inadvertently causing her.
Morale of the story - get health insurance whenever you travel, you never know what's going to happen and you really do need to be covered. And never laugh at ANY point in time if someone is dying on your unit, because it may be perceived in another manner in which you meant it. ESPECIALLY if someone speaks another language. They have NO idea why you're laughing, and nothing is funny when your loved one is dying.
Thursday, December 8, 2011
What nurses talk about....
At the end of my shift last night, a bunch of us nurses gathered to talk about a couple of things.... we talked about one of the new hire nurses (got hired at the same time as I) experiences and how it differs from the veteran nurses experiences - more like what one would do vs. what another would do.
The situation was this.... if you did a bladder scan on a patient because they were complaining about fullness and pain - found that there was a substantial amount that was being retained, would you do a straight in and out THEN call the Dr for the order OR would you call the Dr, report the finding and request an in & out, also, what would you do if a Dr refused it....
Veteran nurse said that she would NOT have waited for a Dr's order, would have done the in & out and called the Dr for the order - neglecting that policy indicates otherwise... and even said that she didn't care if she got fired for it because it was in pt's best interest.
Newbie nurses (I included) - have called Dr's for such FIRST - but this is seen as us not having a back bone.
So what would YOU do?
When I have called Dr's for in & out's, I have already done a bladder scan and feel that information is a girl's best friend. I think it's like arming yourself for when questions get asked. Now, if I had a pt who required an in & out but a physician was refusing to give one (did happen to that newbie btw), I think I would go to the unit leader/charge nurse to speak about it, since having the leader on your side is like arming yourself - it's peer review and support. I know that the nurses on my unit support one another, and their patients - and ultimately would do what's best for the patient. Even if that means going against a Dr.
The newbie kept paging that Dr. for several HOURS, probably not realizing that the other option available to him was to do the in & out without the order and that one could be obtained later from the MRP (most responsible physician).
We also talked about our past patients and where they are... one of the nurses generally checks out various units within the hospital, as some of our patients end up on rehab units, we like to know if they're still there or not...
Last night this nurse revealed that one of our patients.... the one I told this blogging world about - the woman with the MASSIVE CVA (AKA stroke). Turns out that she aspirated at home - from the family trying to feed her! And she was back in ICU, intubated and STILL not a DNR (Do not resuscitate)... it amazes me, truely astonishes me that a family would WANT to watch someone suffer. If that was MY family member, I would NOT want my family member to be a full code if they are going to have crappy quality of life. If they can barely move, can barely communicate, and are entirely dependent on others for EVERYTHING, and that the family isn't all that interested in learning to take care of this family member.
It's crappy when people keep a loved one around for THEIR need, not caring about how it is for their family member. I guess this is something that I will learn to live with, because there is NOTHING I can do about it.
The situation was this.... if you did a bladder scan on a patient because they were complaining about fullness and pain - found that there was a substantial amount that was being retained, would you do a straight in and out THEN call the Dr for the order OR would you call the Dr, report the finding and request an in & out, also, what would you do if a Dr refused it....
Veteran nurse said that she would NOT have waited for a Dr's order, would have done the in & out and called the Dr for the order - neglecting that policy indicates otherwise... and even said that she didn't care if she got fired for it because it was in pt's best interest.
Newbie nurses (I included) - have called Dr's for such FIRST - but this is seen as us not having a back bone.
So what would YOU do?
When I have called Dr's for in & out's, I have already done a bladder scan and feel that information is a girl's best friend. I think it's like arming yourself for when questions get asked. Now, if I had a pt who required an in & out but a physician was refusing to give one (did happen to that newbie btw), I think I would go to the unit leader/charge nurse to speak about it, since having the leader on your side is like arming yourself - it's peer review and support. I know that the nurses on my unit support one another, and their patients - and ultimately would do what's best for the patient. Even if that means going against a Dr.
The newbie kept paging that Dr. for several HOURS, probably not realizing that the other option available to him was to do the in & out without the order and that one could be obtained later from the MRP (most responsible physician).
We also talked about our past patients and where they are... one of the nurses generally checks out various units within the hospital, as some of our patients end up on rehab units, we like to know if they're still there or not...
Last night this nurse revealed that one of our patients.... the one I told this blogging world about - the woman with the MASSIVE CVA (AKA stroke). Turns out that she aspirated at home - from the family trying to feed her! And she was back in ICU, intubated and STILL not a DNR (Do not resuscitate)... it amazes me, truely astonishes me that a family would WANT to watch someone suffer. If that was MY family member, I would NOT want my family member to be a full code if they are going to have crappy quality of life. If they can barely move, can barely communicate, and are entirely dependent on others for EVERYTHING, and that the family isn't all that interested in learning to take care of this family member.
It's crappy when people keep a loved one around for THEIR need, not caring about how it is for their family member. I guess this is something that I will learn to live with, because there is NOTHING I can do about it.
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