Monday, May 17, 2010

Good Lord, let the man die already!

Before you read this post....I must warn you. My perspective on life and death has been masterfully warped by my job. I see people die often enough to have been relatively desensitized to it. Sometimes I'm surprised with myself and it's sad, and sometimes I'm just plain surprised, "Whoa, the guy in bed 13 coded and died yesterday? Yikes."

As we speak, there is a patient on our unit who has been here for...mmm I'd say about five months. This man's history for the past couple of years is full of, "Stroke in '08, right sided paraplegia, dysphagia, aphasia, pulmonary embolism in '09 complicated by severe GI infection" etc. Seriously the list goes on and on and on.

This man is trached, vented, has a drain coming out of every orifice, (except maybe his mouth) cannot talk, cannot eat except through a PEG tube and with TPN. He has bacteria growing in his blood, urine and stool. He has contractures so severe that he cannot straighten his arms or move on his own at all. He has virtually no muscle mass left in his body and his skin is so fragile that he has hundreds of little skin tears all over his arms, legs and back. We have to change his dressings multiple times a day because his arms just weep serous fluid continuously. And even with that he still manages to soak through to his sheets, of which we have to change frequently as well.

His wife is significantly younger....a May-December romance, if you will. His son looks honestly like he is slightly younger than her (step-mother). Both of them visit every day, sitting at his bedside, talking to him and treating him as if it's any other day the family sat down to watch some TV together. They see him in the deteriorating, painful mess that he is in and for months have decided to (still) make him a FULL CODE. This means that we do anything necessary to keep this man alive. CPR, drugs etc.

Every day I go in for unit report and Bed 8 rolls a round and we all hear that familiar name. "Still a full code." reports the charge nurse.

"You've GOT to be KIDDING me?" I blurt out.

That poor man. I've had many conversations with his family and they insist that this is how he wanted it. He wanted them to fight as long as they could to keep him alive.
Ok, fair enough....maybe, just maybe (which I actually don't believe) he wanted them to do everything possible to save his life. But is this what he had in mind when he thought of living?
Slowly and painfully wasting away, soaking in your own bodily fluids, depending on a machine for your every breath and heart beat?
I doubt it. I can't help but shake my head every time I see him, and it makes me want to go home and fill out my advance directive right now.

I understand that losing someone is incredibly hard but isn't it harder to see them suffer so much? And for what? A few extra months of painfully, laying in an ICU while your disillusioned wife talks to you and sings you nursery rhymes? (Yes, she sings him nursery rhymes) That is not is torture.
Unfortunately, our opinions don't matter. If that's what the family wants, then that's what happens.
At the end of the day all we can do as nurses, is give the best care we possibly can to a dying man.

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