End of Life
In my job as an Emergency Department nurse, the hardest thing isn’t always when we lose a patient. It’s when we try too hard to prevent that very occurrence. It happens all too often in Emergency Departments and Intensive Care Units. An elderly person is trying to let go, but the family loves them too much to accept it.
It is heartbreaking to watch. It’s agonizing knowing that despite the family’s efforts to prolong the life that is slipping away, they will soon encounter the same grief they are trying to avoid. That’s where the real tragedy is. The body eventually gives up, the heart stops beating, the mind says “enough is enough,” and the person finally rests in peace.
This lovely woman I had the honor of caring for was profoundly sick and had been suffering for some time. She had just been released from our hospital only a few days ago. Her family brought her back in stating she “just isn’t herself,” complaining of substantial weakness, pain, and changes in her breathing. Her body was being taken over by a systemic infection that was killing her–and quickly. Her vital signs were declining, her weakness was increasing, and she knew she was dying. The family was told, with our sincerest compassion, to again consider changing her code status. We discussed the options, whether to make her as comfortable as possible should her condition deteriorate further or to do everything imaginable in the event her body gave up. They were educated on the process of CPR, including rough chest compressions and invasive endotracheal tubes. We talked about the possibility of broken ribs, and the chance that their beloved may never come off of the ventilator. The patient herself looked me in the eye and said, “This all has to stop. I don’t want to feel like this anymore.”
Yet, we continued to poke, prod, catheterize, medicate and lay her on hard CT scan tables. We rolled her from side-to-side, moved her in different beds and exposed her to countless strangers. Her time on this Earth was not being spent resting or cherishing time with family. It was being spent in a cold hospital room with endless beeping, poking, wires and catheters. She wasn’t looking through old photo albums with her grandchildren. She was looking at her own heart rhythm on an incessantly beeping monitor.
The doctors place the orders, but it is the nurse who has to carry them out. It’s the nurse who has to do the poking, touching and inserting. It’s the nurse whose hand the patient holds and says they’ve had enough. It’s the nurse who brings extra blankets and pillows, any small measure of comfort to make this just a little bit easier. It’s the nurse who brings the family coffee and assures them we’re doing everything we can. It’s the nurse who educates them on what “that blinking number is” and “why that machine keeps beeping.” It’s the nurse who explains why the patient needs two intravenous lines instead of one and why we have to draw so much blood.
As someone who loves her own family very much, I absolutely felt for her family, but I felt for my patient a little bit more. She gave me a certain look when I explained to her I would be shoving a swab in her nostril to check for the flu, one that I will never forget. She laughed about “different ways to torture people,” and I kindly told her I wish I didn’t have to–and I meant it. The least of her concerns was the flu, and she knew it. The look in her eyes told me she understood, but she would let this go on for her family.
As nurses we hope our patients get better, we strive to restore them and return them home good as new. Our entire careers are spent trying to fix people. But with patients like this, sometimes it’s better if they don’t get better. Sometimes it’s better if they rest.