The Patient I Failed
Aug 29, 2008 written by nerdtonurse?


She knew what she wanted.

She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.

So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

"I do not wish my heart to be restarted through usage of any
chemical, mechanical or physical intervention..."

Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.

"I do not want any external device to be used to maintain my
respiration if my body is incapable of sustaining it on its
own."

The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.

"I wish to die a peaceful, natural death."

She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.

"I do not wish artificial means of nutrition to be used, such as
nasogastric tubes or a PEG tube."

Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.

"I wish nature to take its course, with only medication to prevent
pain and suffering."

The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."

"Allow me the dignity we give to beloved pets. Let me die in peace."

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.

Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.

"Thank you in advance for helping me in the last moments of my life
to have a gentle, peaceful passing."

She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.

And so was mine.

Loraine signs off at7:31 PM.

This period of MC is unique.
-Im in isolation for a long period.
-a pt passed away, i had no time to say goodbye.
-I've sent in my letter of resignation. Finally i had the guts to. And a gd excuse to not be giving it to them personally.
-I slept in between almost all my medicine doses.
-Russian Red becomes one of my fav artists. Cigarette has one of the best tunes.

Loraine signs off at10:12 PM.

Shift work is actually less mundane. Waking up early isn't something I have to do on all weekdays, and I get to do whatever I like, go wherever I want to go after work after a morning shift and not be stuck in a jam. The shorter working hours each day allows the mind to rest earlier, and so I wont be drained so easily.

I feel like gg shopping tonight. To shop for clothes, working shoes, etc. But i feel like staying in to read too. Well, the good thing is, I am spoilt for choices, and not tied down to being able to not choose at all.

")

Loraine signs off at4:49 PM.

While I wish to have my hands on the latest iphone, I do feel that now I want it more than before after knowing that Jobs has passed on. I want to be part of that legacy. Yup, just by buying another of his Apple gadgets. I know, it's like... superficial, but i want to have a taste of what it feels like to have a lifestyle made more convenient.

And we all know that children (I'm especially more empathetic towards them) are dying on the other side of the globe. Many of us including myself, really should be ashamed of ourselves for neglecting their most basic needs even, while attempting to merely up our conveniences by just a small glitch.

Loraine signs off at11:48 AM.

Spontaneity

Dont be too systematic and have an itinerary all the time. Having a fixed schedule is boring, well at least for me. I like to be on-the-go. Just like it in Australia. Accommodations were not booked before hand. We only checked for availability on the spot. Risky, but hey, it's fun. :) And just like going for a camp tmr. Time to pack again! :)

But tt's just for myself. If my partner suddenly has a change of plans and does not inform me earlier, i may be quite upset! Still, I like pleasant surprises.

I realised that the Australia trip costs more than $2000! I estimated it to be ard $1500, but boy, how wrong I was!

Im looking forward to the church camp tmr. Praying for good weather! :)

Loraine signs off at8:55 PM.

Post Australia trip

hello there once again. Being a rather introvert, i need my personal time and so im back home, in my room, spending time alone. Having spent some crazy time with my sis and bro-in-law, with much emotional ups and downs, i chose to spend the rest of my saturday resorted back to my cosy room (with lots of unpacking and packing to do still).

Alright, so even though ive targeted 2 days, just 2 days to complete all the unpacking, packing, calling, doing up my resume, applying job at ktph, after my return from australia, i hvnt met it. I guess I just want to do things at a slow pace. Basically, to chill, now that ive got loads of time in my hands.

And since ive got loads of time, i should do sth about it right? Of course, so that was exactly what id planned to do. To call up the driving school to book a date for advance theory test on monday, attend a christian musical w eileen and have dinner w her before that, give flute lesson on sat at 4pm, and in between, maybe uhm... provide help to those who are needy?

And that reminds me of what Uncle Jeff said yesterday during cell. He said a lot, but one thing that i remembered very clearly was "my time is God's time". Since my time is given by God, i should do things that are pleasing to Him, and for Him. Well, that;s my interpretation.

Loraine signs off at9:27 PM.

Last 10minutes in Deegloo...

The movers will be coming at 1pm, it's now 12.50pm. I can't believe it. THAT'S IT! three years have passed and it's time to say goodbye to this place. This room D304 that I had called home for the last 2 years. (I stayed in E305 in my first year.)

And so it's almost time to go,
oh how I long to stay here for one more night.
But it's not going to happen,
For it is sure time to leave this place.

Loraine signs off at12:50 PM.