Hard decisions

So I've been meaning to write something on my blog for a few weeks about an interesting experience that I had at work. I really love my job. Even though Chad could be surprised to hear that. Cause I tend to complain about all the bad at the time when I get home after my 12 hour shifts.

But to understand the situation, I have to go back to when I was in nursing school. Most of you know that I went to Rick College for nursing school, which was one of the greatest blessings in my life. Not only did I get accepted to such a great nursing program, but I was able to be taught about the spiritual side of healing as well. In class we were always bombarded with the idea of nurses becoming an "advocate" for patients. This is kind of an interesting idea, cause I had never really heard this term, except in reference to our Savior being an advocate for us with the Father. Which in turn makes nurses pretty amazing by comparison.

So in my career there have been a few instances when I have felt a challenge sometimes to be able to become an advocate for a patient, whether is was just to motivate myself to do everything I knew the patient needed from me, when I was busy to making sure the patient and family have all the questions answered about up coming procedures or treatments.

So not too long ago I was able to care for a patient that was in the hospital with liver cirrhosis. This man was very sick and had severe ascites (fluid that builds up in abdominal cavity). I have taken care of a few patients in my career that have had similar severity of ascites and am very sad to say that they don't end up living very long or having much quality of life. This guy had recently had a paracentesis (using a needle to drain the fluid from the abdominal cavity) where they took of about 3 liters of fluid a few months prior to this admission to the hospital. Doctors do this to make the patient more comfortable. This helps the patients because it allows them to breath easier. Eventually the fluid comes back though. This is exactly what had happened to this man. He had eventually got sicker and sicker until he didn't want to eat any more at home and difficulty breathing and ended up with pneumonia.

It was a very long stay for this patient the their family. The patient's nutrition had been poor for so long that he would get bed sores on any area he layed on for more than 1 hour. It was a struggle for our nursing staff to even change the patient's position enough to try to avoid getting more bedsores, let alone to get them to heal. The patient finally got a short term feeding tube that went down his nose into his stomache. This helped alot with his strength, but the patient just wasn't getting better over all.

The most difficult part was that the wife and daughter really wanted to take the patient home after this stay. I really felt like this was not a realistic expectation. But after many conversations with the family I realized that the Doctor had not given them any reason to think that the patient wouldn't get better.
I know that several nurses had talked to them about a Do Not Resuscitate order. This is where when a person's heart and respirations stop, we let them pass on without using CPR and other medical interventions to bring them back. These allow someone to die with dignity and not the disaster that seems to happen when you bring someone back that has no quality of life to begin with. It was very appropriate for this man, which all the nursing staff could see would never have quality life again.

After a couple weeks the doctor finally told the wife that they needed to look into nursing home placement. This was a very internal struggle for her because her husband had said that he never wanted to go to a nursing home. Because he had said this, the daughter was totally against it and was determined to come help care for him at home. (Also the daughter didn't want us or the wife to discuss any of the test results or treatments in the room around the patient, because she thought he would give up if he knew the prognosis. This was totally not appropriate in my opinion) But I feel like the wife was more realistic about the matter. I felt even going to a nursing home was suicide too. Even us at the hospital with all the staff, we couldn't keep his skin from breaking down. I know that nursing homes don't have as great of staffing ratios as we do. The other things is that this man was 6 foot 3 inches tall, and even though he was emaciated, he still weighed a lot. I just couldn't see this daughter and wife even moving him in a hospital bed that helps some.

So with all this happening I felt like the doctor was not being straight forward with the family. What kind of outlook had he let them have? When I called to get a better idea what he thought the outlook would be, I realized that he even had a very unrealistic idea and didn't even mention the fact that he'd probably die from the liver failure.

So then I had to make a decision do I just stand by what the doctor says, or do I really tell this family what is most likely to happen....
Kind of an ethical decision. I didn't want to undermine the doctors education and say that I knew better, but I didn't think he was being realistic or up front with this family. It was so hard.

I ended up talking with the wife about exactly what the doctor had said could happen, and then ended telling her that my experiences with liver failure never turned out as good as the doctor was stating. I encouraged her to help us take care of the patient to get an idea of what would be demanded of them once the patient was at home. She was very overwhelmed with the repositioning and the flushing of the feeding tube and using the pump for the feeding tube. Really it would be overwhelming for most people. I felt that the wife was being realistic and decided that the nursing home would be the best bet. But then she had to deal with the daughter who felt that she wasn't making the right choice. What a struggle for this family. Something that really wretched at my heart strings. That night I went home and cried as I shared some of the emotion I was feeling dealing with all of these issues.

The craziest part of all of this is that I was there the day they transferred this man to the nursing home and I really felt like this was the best decision. But then I heard that the next day this man died. Things like this happen and make me wonder if I had done the right thing. What a hard thing. I thank heaven that I don't have to deal with this every day of my life.. But even though I do.. I get the opportunity to help patients and their family through some very big life changing events so better than others. It also makes me thankful for religious beliefs that help to have peace with the big decisions of life and death.