Thursday, April 4, 2013

Good Article from website

When Nurses Cry

  1. As nurses, we have an awesome responsibility and privilege to make a positive difference in the lives of patients and families that we care for in sometimes unexpected and almost unbearable life and death experiences. In certain situations, expressing genuine emotion can be a sincere way to provide emotional support.

Friday, February 15, 2013

"The Patient I Failed"

                       Shared from written by "nerdtonurse cited below

She knew what she wanted.

She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.

So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

"I do not wish my heart to be restarted through usage of any
chemical, mechanical or physical intervention..."

Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.

"I do not want any external device to be used to maintain my
respiration if my body is incapable of sustaining it on its

The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.

"I wish to die a peaceful, natural death."

She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.

"I do not wish artificial means of nutrition to be used, such as
nasogastric tubes or a PEG tube."

Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.

"I wish nature to take its course, with only medication to prevent
pain and suffering."

The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."

"Allow me the dignity we give to beloved pets. Let me die in peace."

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent. 

Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.

"Thank you in advance for helping me in the last moments of my life
to have a gentle, peaceful passing."

She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.

And so was mine.

APA Style Citation

nerdtonurse?. (Aug 29, '08). The Patient I Failed. Retrieved Friday, Feb 15, 2013, from

Tuesday, July 31, 2012

In the Sanctuary

     Sunday mornings were always challenging when my son was a toddler. The crying would begin as we walked back to the church nursery, and though his class was filled with toys and friends and people who would provide loving care for him, his separation from me would cause stress, fear and sadness. But I left him. 
     As I worshiped in the adjoining sanctuary I felt I was in the presence of the Lord. I was at peace and I was where I was supposed to be. I knew that my son was missing me, but our time apart would be short. I looked forward to the day he would be old enough to come with me into the sanctuary and we would stand before the Lord together. 
     I was reminded of these emotions years later when I lost my dad. I was the crying child while he had stepped into God's sanctuary in heaven. At times when I think " I will never see him again" I am reminded that he is where he should be and when the time is right I will join him there.  I have shared this analogy on occasion and hope it brings comfort.

Friday, June 1, 2012

Taking off your nurse's cap

    I felt an advantage being a nurse, acting as my mothers advocate as her advanced dementia required her being a LTC facility resident.  I was her daughter and loved her, and part of that love was monitoring her care, reviewing her medication orders, labs and watching for skin breakdown, fall risks, etc.  I was involved with her care plan and acted as her primary contact and power of attorney. I explained her medical issues to my siblings. I knew her medical history better than anyone.
     I had a history of caring for my mom since my fathers death 10 years before.  My father's last words to me being "take care of your mother". And so I did. I moved her near me and then in with my family  until her dementia made it unsafe for her to ever be alone. I worked full time on a telemetry unit, night shift and my husband a hospital pharmacist. I visited her frequently in LTC and took her to all doctor's appointments.
      I understood when it was time for hospice care and explained it to my brother and sister.   My way of demonstrating love to my mother did not change when she was actively dying. I spoke to her, held her and brushed her hair, but I also assisted in turning her, fixing her pillows, listened to her heart and lung sounds and asked for heel protectors etc. I helped bathe her because I had been doing so for years.
   The hospice social worker admonished me for being a nurse instead of a daughter, and told me I should let others be the nurse now. He told me it was time to "take off my nurse's cap" and just be a daughter. This went against the grain for me.  I don't think I was being the control freak nurse/daughter. ( We have all dealt with those before) I tried to explain that providing care to my mother was how I loved her.  I felt self conscious asking about her vital signs or medication doses after that.  After she passed I relented and let the nursing techs bathe her. Often I have thought back and wished I had bathed her that last time.
   Isn't it possible to be a good daughter and still think like a nurse?  Was my behavior any different than any other caregivers?  How do you separate the roles?