After being off for a few days, I went back to work at my cover-all ICU. I had the typical two, vented patients, who were very much fluff and turns.
Around 9 pm on my first night back, a twenty-something-year-old male from the ER arrives. The ER nurse gave our nurse report, stating the patient was breathing a little fast. We are all thinking 25-30 breaths a minute, sounds reasonable. Finally, the patient arrives, and we hook him up to our monitors and get him settled. But the guy is breathing 50 times a minute and satting 85% on a 100% bipap.
He didn’t look good. I got down on one knee and stroked this guy's hair, and told him that he was in the ICU and we would take care of him.
He seemed to understand but was terrified. While holding his hand I told him that he needed to focus on his breathing; we needed to get a new IV in him so we could get him some medicine to relax. I also told him that once he was calm, we would bring his partner back to see him.
This patient was rapidly declining—he was in ARDS and soon to be in septic shock. Because he was not calming down, we told him that he needed to be intubated. He was scared and got a little combative, but in no way do I blame him.
Finally, we got the OK to intubate and it all proceeded rapidly. Once he settled down, his partner came back. My charge nurse discussed with him the possibility of contacting the family. He said that the patient didn't want the family contacted, but he was going to do the right thing and call them.
Within a few days, the patient was still on CRRT but not doing so well. The partner had been kicked out by the brother, which made me sad. That partner had been there every night at his bedside, keeping him company, talking to him, caring for him. Yet he was kicked out for doing the right thing.
But the patient was assigned an amazing nurse. She had him on 4 different pressor drips, and by the end of the night would add one more while managing CRRT and another patient. The patient was paralyzed and rapidly declining, but this nurse was determined to get the partner to say his goodbye to the patient. She managed those drips like a well-played Beethoven sonata; she worked hard to keep the patient alive.
Finally, at 4am, she sneaked the partner past security (with the help of our charge nurse and a caring security officer), the family, and everyone else who didn't want him there, to say his goodbye.
After sneaking the partner out, within 45 minutes the patient died.
Some people question whether people really wait for their loved ones; after tonight I believe they do. I'm still very young in my career but that night I learned a lot about what I want. I want to be like that nurse—and when I'm dying I want to have that nurse.
She is not the perfect nurse, because the perfect nurse would not get involved with family issues. But those imperfections make her perfect to me. I never thought I would be affected.
Your thoughts?
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October 2nd, 2008 at 11:06 am
I am a nursing student and I like to think that when I become a nurse, I would do the same thing that that nurse did. It breaks my heart when the patients’ wants conflict with the families’ wants and the patient has very little say because of their condition.
October 2nd, 2008 at 11:08 am
Awesome. As a CCRN myself, I’ve done the same thing many times. Sometimes you have to break the rules to do the right thing for your patient. At the end of the day, nobody will fault you for it.
-Rachele-
October 2nd, 2008 at 11:22 am
That nurse did the right thing. And I think nurses have to get involved with the family in a way.The partner did the right thing and called the family. The nurse did the right thing and helped the patient and partner say good bye. I have been a nurse for 30+ years and I have ‘broken’ rules on behalf of the patinet more often than I can count..I do not regret a one. We must keep the patient as our main focus….that is why we are nurses and not administrators or insurance execs. Advocacy is the thing that counts.
October 2nd, 2008 at 11:25 am
I can believe that these two were so linked that they needed the act of saying goodbye. But I had one older lady who was expected to stay alive until her eldest son flew in from his life in Holland. I was angry that, not only was he not there for his mom, but he was supposed to control her death. This was the need of the family- his sisters- not the patient. There was no way to communicate this without being harmful.
October 2nd, 2008 at 11:35 am
Thank you so much for that story. Unfortunately, some health care providers tiptoe around possibly controversial situations. I believe, every nurse MUST be an LGBT (Lesbian, Gay, Bisexual, Transgender) ally; if our goal is to provide optimal care, we cannot have our own prejudices involved in the care. This story reminds us that first and foremost, the nurse is a patient advocate, and can truly impact a patient’s healthy life and/or peaceful death.
October 2nd, 2008 at 12:34 pm
Yana
Lets not turn this into a political item by saying we MUST be advocates for any special groups. We need to be advocates for all groups no matter what their beliefs, this story just happened to involve a partner, that you assume to be LGBorT. It could very well have been a heterosexual who was banned from the room. Please do not assume such things.
October 2nd, 2008 at 2:03 pm
Carl,
I understand your concern, however before I jumped to any conclusions, I followed the pronoun the author used: “He was kicked out…”
My comment was by no means a political statement. You are correct to say that we need to be advocates or all groups; I was only highlighting the fact that a nurse (or any health care provider) should not pick which groups to advocate for.
October 3rd, 2008 at 12:14 am
I’m a male nurse (I wrote this) and I think that it’s not important to be so much LGBT advocates because it might not be what we believe in, instead we should look at each case individually and do what is fair regardless of our beliefs. We are fortunate to be spectators in the conflicts of others, at times we’ll be mediators, and at time we might be judges. We have to be impartial to do what our heart says is best for the patient. There are laws and “by the book” answers to every question but that’s not real life. A lot of new nurses don’t realize that a lot of times what we do is not by the book, but by what’s right.
October 5th, 2008 at 1:08 am
I’m proud of all nurses that are able to realize that beyond a patient’s medical condition is their human condition. It’s the ability to realize this that sets a great nurse apart from a warm body with a license, in my opinion. I’m especially proud and hopeful after reading this story, because as a lesbian in a state with no laws and protections for me, I’d be heartbroken if there was no one with the guts and the heart to advocate on my behalf and allow for my human condition.
I don’t feel any special interest group or minority is any more or less deserving of good nursing care. Advocacy is a part of our job as much as fulfilling policy or abiding laws. My experience has taught me, if anything, that the most difficult part of my job will always be in managing the grey areas and not in abiding the black and white. Kudos to the nurse that recognized a vast grey area and acted on behalf of her patient. And kudos to the author for realizing he was witnessing a tiny moment of greatness in this mixed up world of tragedy and heart ache. May we all have the guts to provide what is needed based on whom it is needed for and not based on needs of our own.
October 5th, 2008 at 10:24 pm
I had a similar experience. I am a RN, but when my dad was on his death bed his last words were to see my daughter, his only grandchild he wanted to say his goodby. The nurses on the unit would not let her in, she was only 7 years old, I understand the rules but my dad could not talk and that was the words he saved his strength for. I felt betrayed by my fellow nurses and sad for my dad and my daughter. He was not even in an ICU he was on the med srg floor. I always try to act on behalf of my patient. That day made me forvever respect my patients wishes. As nurses we need to have the guts to stand up for our patients and the families that love them.
October 30th, 2008 at 9:23 am
I totally applaud that nurse!!! Speaking as a Hospice nurse, Yes these patients do wait for that “someone”. I have seen patients hold out until that person has been there to have closure…I have also had patients that have been unresponsive and hanging by a thin thread, and the family cant understand what is holding them here…So I ask them, is there anyone who cannot be here…Most of the time yes is the answer…I tell them to call that person, put the phone to the patients ear and let them talk. Most of the time within a few minutes that patient passes. I have been witness to many deaths and take pride that I have followed my heart and my patients wishes. I love my job and wouldnt want any other job…I help those pass gently into another stage in life, I help families stuggle with those choices…talk to them and tell them they might not agree with the choices that someone makes, but it is their life and whether we like it or not, they love that person…out of respect for their loved one, their partner needs to be there too! If you put it in that way sometimes they realize what needs to be done…Not always, but most of the time.
After having my best friend (grandma) on hospice, that is when I decided I wanted to be that nurse! Now I am!!
Sometimes rules have to be broken!
Stephanie, Hospice RN
December 29th, 2008 at 6:41 am
I don’t think that there is such a thing as the “perfect nurse”. We are all human beings, who makes choices and mistakes and live with the consequences of both. Personally, I commend what your “amazing nurse” did for this patient. It was compassionate and caring at a time when it was truly needed. I think, sometimes, we lose sight of both those qualities. We get burnt out quickly in this profession and in that process, misplace what our role really is. A caretaker, yes, but also an advocate and an ally for those who have no or limited voice in life and while dying.
Kudos to this nurse and to you for sharing your story.
December 30th, 2008 at 2:13 am
I was my father’s caretaker during the first two months of my nursing job, and those happened to be my dad’s last two months on earth. He had advanced lung ca that metastasized to his bones, all over his body, and finally his bladder. our hospice nurse was great, but I did his main round the clock care w the assistance of our family. He hung around for two days, breathing at 44-50 bpm, not being able to speak or swallow his last day. I gave him roxanol and atropine every few hours for his pain and secretions. He seemed so determined, but we knew it was time. my aunt, mother, and I (separately) had the ‘it’s ok to let go, we’ll miss you but we’ll be ok because you won’t hurt anymore, we love you” talk with him and he left us that night. Care for other people has a huge, powerful impact on a dying person’s will. I will always believe that.
June 27th, 2009 at 6:40 pm
God bless this nurse.
I feel that patient’s desires should override the wants of the family. Perhaps extra care should be taken for those who are confused, but for an adult with a clear mind and desire like this patient, why should they be treated as children? And who is to say if the person even consents to the family’s involvement? Obviously this patient didn’t if he didn’t want his family contacted.
I’m starting nursing school in the fall..and I will remember this story..Thanks for posting.