death

Nurses always say how nurses are the worst patients. One may think this to be silly since nurses can relate to the work, however it has proven to be true more often than not. Emotions run high in the hospital and having a nurse either as a patient or a controlling family member often proves this statement to be true. From every safety step to every decision, the off-shift nurse at the bedside watches the primary nurse’s every move. And when the patient is actively dying, the nurse family member is even harder to handle.

Watching a patient decline, converting them to comfort measures, and switching them to hospice is one of the many tough aspects of nursing. When this patient is a family member, the decisions become harder to make as the wishes of the family conflict with the wishes of the patient and/or the patient’s best plan of care.

I recently had a patient for weeks who originally presented with an ileus and GI bleed. She was NPO for two weeks and connected to an NGT with suction. Throughout the stay her bowels began to function, while her kidneys began to fail. She became sicker and sicker by the day until it did not seem like she would survive the weekend.

She was originally having full conversations and working with PT, then quickly progressed to 1-2 word sentences and was using all of her energy to breathe. Her daughter was a nurse and was active in her plan of care. Throughout this decline, she ordered every lab and test to be completed even if it did not seem to be in the best interest of the patient. Her mother appeared to be actively dying and the daughter stated how she knew in her brain that what she was ordering was probably irrational, however her heart could not let go.

One shift the patient woke up enough when the doctor and daughter were communicating to clearly state her wishes. I will never forget this moment. It was as if she took all of her energy to tell her family that it was okay. She looked at her daughter and said, “Please don’t cry. It is okay. I am ready to go home.”

Everyone in the room started to tear up- daughter, MD, and me included. The patient had the biggest smile on her face. This brought comfort, closure, and the next steps in the plan of care.

When many of the previous nurses complained about the controlling daughter, it is moments like these to make me take a step back and empathize with her feelings. All she was trying to do was ensure that we were providing the best care and holding onto any last hope to prolong her mother’s life. Anybody would react this way, not just nurses.