Sunday, June 8, 2014

when a nurse has to do what a doctor shoulda done

The doctors signed out for the day, a lovely warm Sunday evening with clear blue skies. The attending, who had promised to come back later, decided he wouldn't be returning after all. The cross cover team didn't know the patient, and besides, they were stuck in a room placing a difficult line.

It all fell to me to address the family's concerns and questions regarding the end of their loved one's life, and the removal of his life support. They had made him a full DNR, do-not-escalate care just yesterday. His daughter had panic attacks so bad this morning, when she realized he would not survive the day, that she retched and shook and had to go to the ED herself.

I have often participated in, or even led, these types of discussions. I have never held a family meeting to discuss end-of-life care all by myself. What choice did I have, though? They were ready to let him go, but they didn't know how. They didn't know what to expect or how they would survive it. They didn't know if they could even utter the words that would lead to the push of certain buttons, the end of his life support, the withdrawal of all that kept him alive.

I gave them that permission. I took away that awful choice. I told them that he had lost consciousness days ago, his body had made a decision for all of us. I told them that the doctors had already made the decision that everything that could possibly be done for him had been done. We could keep him going for another day, perhaps, on his current support. Or we could withdraw it and let him slip away peacefully in the next few hours.

I described what would happen to his vital signs. His breathing would quicken, and then slow. His heart rate would go through a variety of rates and rhythms, slow down, and stop. His blood pressure would drop quickly to nothing, as would his oxygen levels. He had already lost consciousness, and he would slip even farther from this world. I described that what we could do to keep him comfortable. They all looked at each other, nodded, and said yes. Let's let him go.

I reported all of this to the cross-cover team. I just needed them to enter the orders. I paged the attending, who still chose not to come in even though he had built a relationship with this family over the last week. I had just met them this morning. Nevertheless, I assured them that their emotions were ok. I said it was ok to cry, or not to cry. It was ok to stay in the room with him, or to leave. There was no right way, and no wrong way.

I was surprised that they chose to say goodbye and to wait outside of the unit. I stayed with him, holding his hand and rubbing his head, representing the Mother that we all call out to in our times of need. I hummed to him and sometimes sang. The family sometimes came in to kiss him and tell him they loved him. Ultimately, they were not there when he passed. I alone was there as his heart beat its final beat. I alone witnessed his exit from this world. And I alone went to the family to express my condolences, and to hug them.

The daughter said to me, through shaky tears, "thank you for being with him when we couldn't be".

This is the greatest work I do, that I've ever done.

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