I'm a big William Faulkner fan. Have been since we read his novel As I Lay Dying my freshman year. But that's not what this post is about.
Earlier this week at work we had a patient who was actively dying. Being around things like this is just part of working in an ICU. Being around things like this is just a part of nursing in general I guess. Nursing is all about beginnings and endings, and we only hope we make a difference and affect the things that happen in the middle.
The patient was being cared for by a nurse I don't normally associate with when I'm at work. You see, there are extern-friendly nurses, and then there are...well, the others. I'm only lucky to be in complete control over when I work, as well as who I work with when I choose to be at my job.
Sometime in the course of the day, the patient started to brady down. She dropped into the 40s, and since this particular nurse's stunning communication skills meant that she declined to inform the rest of the unit her patient was actively dying and was a DNR, several of us showed up inside the patient room ready to code the patient.
The patient was an old woman with a mane of beautiful white hair. With her face turned toward the window and head half-raised to heaven, the look in her eyes made it easy to tell she wasn't long for this world. At her side she had a brace of sturdy Southern sons who had each clearly gotten something in their eyes judging from the tears that wet their cheeks.
Beat by beat her heart rate climbed back into the 60s and the heavenly escort was waved off for only a touch-and-go for the time being. We all left the room and continued on with our day.
A couple of hours later, her pressures on the monitor started to dip precariously low--80s over 40s. When I got into the room I cycled the cuff again, and she was 70s over 30s. Her sons were not in the room. I hustled across to the nurse's other patient room and informed her that her patient's pressures were bottoming out.
She shrugged and said, "She's a DNR."
After I scooped my jaw up off the floor, I asked, "Where's the family? They aren't in the room?"
"I sent them out because visiting hours were over. Say, can you help me pull this patient up?"
I'm ashamed to say that I *did* help her pull the patient up in bed. I should have given her a death star glare, turned on my heel and marched right back to the dying patient's room.
But as soon as I was free, I did go into the room. I pulled up a chair, and sat down next to the patient.
And then I took her hand and quietly explained, "Ma'am, you can't let go just yet."
"Your sons aren't here just now," I whispered, "I'm so sorry, but they'll be back soon to see you off. Please hold on a little longer."
And she did.
When I came in the next morning, she was gone. Apparently shortly after shift change the night nurse brought the family back in, and the patient was gone within the hour.
I'm not saying that anything I did had anything to do with that. And I'm not saying that the nurse's other patient's care wasn't important. I don't know that in the practical sense that anything else could have happened.
But I do know this: As I Lay Dying, I don't want it to be in an empty room accompanied only by ringing monitor alarms.
I'd want someone to be there.
Awesome.
ReplyDeleteI have goosebumps here.
I am so pleased you have learned this, because it is such a huge component to nursing. I am so incredibly bothered when nurses write off those with DNR's. It's like they no longer are valid people. Shame on those nurses.
I'll have you know that there is science behind what you witnessed. And from experience, I've seen patients hold off until their loved ones give verbal permission for them to go. It's incredible.
Good for you. I'm giving you a virtual pat on the back.
I can't believe that nurse sent the family home because of the end of "visiting hours". That is not only inflexible but unforgivable. Thank goodness you were there. Having been at the bedside of many dying patient, and also those who came back to tell about it....they know and they hear... and from what I have been told....they can see too. I strongly believe she held on because of what you told her....
ReplyDeleteFor the sake of clarity, the nurse didn't send the family home, but to the waiting room. And our visiting hours are intermittent throughout the day, so they would have been allowed back in a few hours. However, this doesn't take away from the fact that our policy specifically states that if a patient is actively dying, the rules don't apply.
ReplyDeletenice. we had a similar thing. a patient came in, mets everywhere, brady, hypotensive, unresponsive, DNR, blah, blah. we were waiting for a daughter, and when she showed up, she told the patient that he couldn't go, his dad wasn't there yet. patient became normotensive, heart sped up, responded 'okay,' with eyes wide open and waited until said family member showed up so he could pass in the presence of loved ones.
ReplyDeleteso i say......good job.
that OTHER nurse however.......grrr......
he/she should remember that karma never forgets.
Beautiful post. I'm glad you were there.
ReplyDeleteThis nurse sounds like a lot of the nurses I often see in clinicals and wonder why they even went into nursing in the first place. I don't know if it's burnout, the overworked and underpaid mentality or what. Whatever it is, I hope it's not contagious. As the next generation of nurses, I hope we never get to the point of writing off DNR patients, patients with chronic pain, or any of the other less-than-caring versions of nurses I have witnessed thus far.