Credit: Nurse.org
As I lay dying…
In my travels, Pax and I (Pax is my service dog) went to visit the gang on the old ward and have coffee and deliver an apple crisp the hubby made to a couple of friends. For real these 2 kept me laughing and held me up when I was struggling in school. It is fun to sit and reminisce about the old days of killing myself as a floor nurse in hopes of delivering high-quality care to my patients. I know I sound like buzzwords for a hospital chain and customer care (It is not). I had always believed in high-quality care before some corporate genius made it a buzz kill…err word.
While I was visiting the unit, there was a patient who is very, very old and is dying a slow death. Like many of our very old patients in this country, we do everything to prolong life. Why? No seriously, why?
The patient in question is still a full-code in his late 90s. Which means that if his heart stops, they want us to do every heroic thing to save him. That means CPR which will compress his sternum 2-2 1/2 inches. We will insert a tube in his throat to assist him in breathing. We will deliver 400 joules of electricity if his heart is beating funny to try and restart a “normal” rhythm. If you have watched any television drama about emergency rooms or ICU…this is far worse (see the picture, that is what the aftermath looks like). If you have done CPR, you know that feeling as you are starting compressions when the sternum and ribs break on the frail elderly with an almost nauseating snap. You work just like they were younger all the while knowing that death is a far better outcome than lying in a hospital bed.
You are left in a pair of depends, being turned every 2 hours and changed more frequently due to your incontinence and the insistence that you be hydrated. So who did this to you? Why your family, of course. They told the internal medicine service that they wanted them to “save your life” and make it so you can go back to the Nursing home where they mostly ignore you and visit you when they “have the time.” So here you lay a full code, in pain constantly moaning hoping that your someone understands that you need something for the pain or even something as simple as why me. He is in enough pain that they are afraid to give him too much morphine as it will suppress his respiratory drive and ultimately cause his demise.
We ignore a person’s wishes. We should have well-documented wishes (even in our 20s) about how many heroic measures should be allowed before they let you go. Without this, when you are in the worst distress, people you love are afraid just to let you go. I know, I have been in this circumstance as a family member and as a provider. It is the toughest thing you will ever do. When I approach having to deal with this personally and professionally. I always quote a line from Dostoyevsky’s Crime and Punishment (yeah I have really read it):
“I read about a man condemned to death saying or thinking, an hour before his death, that if he had to live somewhere high up on a cliffside, on a ledge so narrow that there was room only for his two feet- and with the abyss, the ocean, eternal darkness, eternal solitude, eternal storm all around him- and had to stay like that, on a square foot of space, an entire lifetime, a thousand years, an eternity- it would be better to live so than to die right now! Only to live, to live, to live! To live, no matter how- only to live!”
I get it, and I think you do too. We would rather stand in a torment of life than face what is next. This patient may not be feeling this sentiment, but I can bet a month’s salary that there is at least one family member who feels this way and is sure that this person should live at all costs. I get it. The person laying in that bed is your father, grandfather, brother, friend. You remember them bouncing you on their knee, going on a hike, picking apples, or just sitting and listening to stories about life when he was a kid and how he used to hike and pick apples in the same orchard and how much he truly enjoyed it and how different it was…
Yes, it is tough, and there is no way to sugarcoat the truth. To everything, there is a season, and a time to every purpose under the heaven: A time to be born, and a time to die; (Ecclesiastes 3:1-2). Bet you didn’t expect a bible quote, but there it is…and it fits. It may just be time for him to go. There are many things we as providers can and can’t do, and the biggest of these is prolong life when the body is no longer able to sustain it.
As I was walking back to my ward, I thought, I hope my family does not do that to me. As much as I want to live and enjoy life, he does not have much enjoyment.
Have a great day and be the kind of person your dog thinks you are.