Advance Directives - AKA Living Wills - power of attorney - my thoughts on these

For ethics I have to read two positions on this. Funny thing is is that I have personal experience with this - outside of my role as a nurse.

About 3-4 years ago my mom's good friend Jane (not her real name) - her husband Joe (again not a real name) was walking about 15 minutes from home to go to the local coffee shop (Tim Horton's for us Canadians) where he would meet up with his chums for a morning pick-me-up. He reached the traffic light, pressed the button and when told to cross he did so. Unfortunately at the same time was a young girl who went through the (green for her) light and struck Joe. He was thrown about 15-20 feet and landed in a snow bank. EMS showed up and rushed him to the local hospital. He was stabilized and was discovered to have a massive head injury that required immediate surgery. We live in a (smallish - approx. 75, 000 pop) community that does not have a brain surgeon so he was air lifted to the closest center that could perform this - happened to be in the US. So there he went. Well his wife was notified and off she went to the US to be with her husband. She permitted them to do brain surgery and he was intubated (naturally) and was ventilated for his surgery. The surgery went according to plan and he was brought back to the ICU. He was touch and go for several days and when they tried to take him out of the medically induced coma he would not regain consciousness. He was in an actual coma. He remained this way for several weeks. When he finally DID come out of the coma he was found to have major brain trauma which stripped him of his ability to function - approx. 25% of what he was previously. It took him almost 2 years to be able to even slightly talk (remembered how to curse though which is hilarious) but he had a feeding tube and ended up also needing a catheter. He was wheelchair bound and required support 24 hours a day. He was put into a nursing home for this care but his family also provided for him additional care during the day hours so that his therapists could work with him more personally and often and TRY to regain some function. Then he started to get complications upon complications. This inevitably caused his death. During some part of this his wife was notified that she was NOT allowed to make decisions in regards to his health OR expenses because they had had NOT created a power of attorney, living will or advance directives and so someone else had to make these decisions PLUS she had to go to court in order to get these right given to her (as it should have been).

Because I've seen this and what Jane and Joe had to go through - from this side - and seeing what patients and their families have to go through when these things aren't put into place..... as well as when they are (it's wonderful when they have been). I would like to make it known what I would want or not want.... husband and I tend to disagree on some of it. He would like me to be kept alive (on a ventilator and everything else) so that he could be with me. I on the other hand would NOT want to be kept alive if I were to be incompacitated or diagnosed brain dead.

I had a conversation with my BFF about some of these things and we talked about scenarios because I told her in no uncertain terms that I would NOT want a tracheostomy. Well she made me realize that I would ONLY want it if it could come out - and I would only allow it for 30 days (ever seen the episode of Grey's anatomy - 30 days and that's all I get - if you can't figure it out by then I'm being taking off support) then take it out and if I live then i live - if not I die and I'm ok with that. Clearly I wasn't meant to live.

Now the ONLY time I want to be on a ventilator and kept alive is if I were pregnant and the fetus could be viable and NORMAL (no cerebral palsy due to hypoxemia) then keep me alive until I could "give birth" then take me off life support.

Now if I were expected to live but have some deficits - if I could be expected to be at least 75% of who I was previously (mental faculty wise) then do extradinary measures. If I need antibiotics - please give - I completely agree with them. Don't give him a G/J or any other kind of tube to extend my life. I see enough of this at work and do NOT agree with it. I WANT to be able to drink and eat the "normal" way and if I would die if I didn't have a tube going into my body then that's not the way I would want to live. Again if it's longer then 30 days - let me die! When it comes to tests - do them, do as many as you can to try to figure out what's wrong with me and try to fix it - I'm ok with that - I like tests, it makes treatment easier and WAAAY more effective. When it comes to CPR it's a bit trickier - inately I agree with CPR. However, the longer that CPR is done, the less likely it is that mental faculties will be back to 100% so really, would I want extended CPR?! I suppose I will have to ask a doctor about this to truely know what my answer is to this one. I agree 100% with dialysis and pain medication - I think these things are totally important. I can't think of other things that should be included but I will totally update these kinds of things as I learn and see more.

I think MORE people should put it in writing what they want. And try to think of ANY and ALL kinds of situations.

Back to normal and hitting it hard - so hard I cried

So I'm back at work, back to my usual schedule. This week I started off with 6 shifts in a row. Monday and Tuesday were day shifts and the other 4 are evenings. And let me tell you something, I HATE DAY SHIFTS!!!!!!!!!!!! Especially Mondays!

So ya, monday mornings suck!!! I knew it would totally suck but I wasn't prepared for the suckiness of my shift! I had a trach pt who was due for a barrium swallow test, to check and see if she was swallowing properly and to see what thickness the fluid had to be to prevent aspiration. And in our hospital at least, ALL trach pt's MUST be accompanied by a nurse for the ENTIRE procedure/test. So I ended up being off the floor for 2 1/2 hrs - which put me behind like CRAAAAAAAAZY. I came back to the unit to find out that the nurse that I gave report to had done NOTHING for my other pt's. So when I get back I'm running around like a chicken with it's head cut off. While I was gone one of my other pt's went for a liver biopsy and when she came back (just before I returned) and had to have vital signs done like she was a surgical pt (so Q30 min X4 then Q1hr X2 and so on) and of course the nurse hadn't done VS for her so I had to do that one. The nurse hadn't done my meds while I was gone either so I had to get those done, and answer the call bells that were continuously going off. My trach pt also had diarrhea so I was CONSTANTLY going in there. I just couldn't catch a break, and was getting NO help from my colleagues. I also didn't have my break so when things settle down a sec (at 1400hrs), I spoke with my two other nurses who were relieving each other for breaks, just to find out that neither of those two while I was gone went for a break - which they really should have! So here I am expected to NOT have a break... not a fat chance in hell let me tell ya!

So I finally got a hold of my charge nurse to explain things and she told me to try to find another nurse on the floor to relieve me... so of course THAT took more time... to find out that there wasn't a nurse who could cover me! By the time I had all that information and I talked to the charge nurse it was 15 min later (because I had to track down all the other nurses) who said that she would cover my patients so that I could go for break. Later I find out she gave my patients to one of the girls who wouldn't cover me (the two nurses in my area who didn't do their breaks while I was gone) and they didn't do ANYTHING for my pts while I was gone. Hell I didn't even sit down my entire shift except while on break, I didn't even get ANY charting done!

Therefore when I handed my pt load to the next nurse at 1530hrs she acted like I did NOTHING all day and just slacked off which is complete bullshit. The good thing is at least the charge nurse had my back and knew what my day was like. But the nurse's attitude totally affected me and when I was done my shift I had to stay and do my charting for the entire shift since I didn't get to and it took me TWO hours to get that all done because of all the crap I had to chart about. I started to cry while doing my shift because I was completely overwhelmed by the suckiness of my shift and the way the nurse treated me like I hadn't done anything and was leaving it all for her. Thankfully I talked to the charge nurse to explain what happened and she calmed me down, letting me know that I had done my best with what I had to deal with that shift.

The next day was better but still craziness and my evening shifts I have a completely different set of pts but they're just as demanding and draining..... ah the life of a nurse!!!