During my first shift of this week, I discovered a new appreciation for hospice nurses. I started my shift with 2 patients- the first was a 79-year-old female who was chronically ill with CHF and related respiratory issues; she had been back and forth between the ICU and the telemetry unit over the past month. She had been planning for discharge when she coded on telemetry; she was transferred back to the ICU on a ventilator and multiple drips.
Through that evening, the nurse kept having to increase the amount of vasoactive medications she was on and shortly after the start of my shift that next morning, she was maxed out on multiple medications (vasopressin, epinephrine, levophed, neosynephrine, and dopamine). Her daughter arrived at 0800 and we discussed the fact that her mom probably would not make it through the day no matter what else we tried to do (there’s already so much damage being done to the body on that amount of medication).
We waited for her brother (the patient’s son) to arrive, and after he did, they informed me that they wanted to withdraw life support and let her die peacefully, as they knew she would not want to live like this. After talking to physicians, I turned off all the IV medication and her blood pressure quickly dropped. We then removed her breathing tube, and shortly after, her heart stopped.
My second patient that morning was a 50-year-old man who had a severe pneumonia. He had lung surgery 3 weeks prior to try and alleviate some of the problems, but we continuously had trouble getting his oxygen levels to an acceptable level. He was a DNR due to other health issues he was facing and we were trying to transfer him to a hospice facility that afternoon to live out his final days/weeks in a more comfortable environment.
That morning, the admitting nurse from the hospice facility came in to get all of the information she needed, meet the patient and his family, and arrange transport from the hospital. As we were finishing up all the transfer paperwork early in the afternoon, the patient began to show signs of quickly declining health. His heart rate jumped into the 160s, his respiratory rate jumped into the 40s, and he became very lethargic. His dying wish (as he had told me earlier that morning) was to be able to see his dog before he died, which was a benefit of going to the hospice facility, because they would allow his dog to be there.
But, seeing his declining health, I had a gut feeling that he would not survive the ambulance ride (as they could not provide the same amount of respiratory support, via BiPap at 100% FiO2 that we were provided in the ICU). I talked to the admitting hospice nurse and the patient’s significant other and we decided to have a friend go and get the dog and bring it to the hospital. The dog arrived and was placed upon the patient’s bed, and instantaneously, his heart rate dropped into the 60s and an aura of calm surrounded him. He quietly passed away.
As much as I know in my heart that both of these patients needed to pass away, that they are leaving behind the pain they were experiencing, it is so painful to see their family members going through their own world of pain. After a patient passes away, or sometimes during the dying process, family members have a tendency to share stories, usually happy stories, of the loved one’s life.
Those stories make me happy to know that they lived a full life, completed by those around them. But, these stories make me internalize the reality that is in front of me- it reminds me that this could happen to anyone at anytime. It makes me cherish my loved ones that much more and want to make each day more meaningful than the one before.