A last breath, without hospice

My autistic daughter’s writing tutor was explaining to her the basics of writing. He explained that all things come in three’s: the beginning, the middle, and the end. He went on to explain even more simply: “we are born, we live, we die”. While he was trying to make his point regarding writing, it reminded me of how much we, as a society, are on-board with birth and life, yet we are so very uncomfortable with the last stage of life, that is, death.

This week, one of my patients’s, an older gentleman with lung cancer, came into the emergency department because he began to spit up blood and was short of breath. In fact, he had a great number of medical problems in addition to his terminal lung cancer. Initially, just oxygen and a breathing treatment helped him to feel better. Then, he began to cough up blood; his lungs were audibly filling with fluid, his color turned gray, and he was struggling to breath.

Just before this, I was speaking to him and his family about hospice services. His family wanted hospice, comfort based services meant for those who have about six months to live.  Yet, they had no idea how to even get such services. While I explained that we can arrange them here at the hospital, it made me wonder why his doctor had not even discussed this with him and his family.

What changes can be done

Where do we drop the ball on end of life care? We drop the ball so many times, in so many ways. In this case, the patient’s doctor should have been openly discussing this patient’s very limited options with him and his family. His doctor should then have suggested hospice as a way to make this gentleman as comfortable as possible and to provide support for his family. Yet, the doctor did not. Was he too busy? Was he just too uncomfortable about openly discussing death?

Sadly, although we did admit this man and begin arranging hospice services, he barely made it through the night and then he passed away. I think he was made as comfortable as possible on his last day of life. Yet, we could have done better for him and his family. We need to open up communication on so many different levels. We need to ensure that all healthcare providers are comfortable and knowledgeable with end of life options. Then, those of us in healthcare need to share this information with patients and families proactively, giving them time to process this information, to ask questions, to accept when death is near, and to become empowered to ensure that all is done to make their loved one comfortable and cared for in those last moments, days, weeks, and even months.

Welcome to my world

Hi. I am an ER nurse, actually a RN, certified in emergency nursing. I love my job, every day, sometimes every hour or even every minute is different. There are times when I comfort, times when I administer life saving medications, times when I use paddles or pads to jump start a patient's heart from a life ending to life saving rhythm.

Yet, there are times, too many times, when I must perform aggressive life saving treatments to a patient who is dying. This is why I am writing this blog. Instead of providing comfort care to someone who is at the end of his or her life, perhaps because of a terminal illness but more often simply because that person's life is at an end due to advanced age and all the many medical problems that can no longer provide this person with any sort of quality of life.

Too many television shows such as ER have led people to believe that just by entering the emergency room of a hospital, even a level one trauma center where I work, will somehow magically transform a person who is at the end of life into an entirely new person, one without the many medical problems that brought him or her there.

We owe those whom we love the opportunity to be comfortable at the end of his or her life. We can do that. In fact, as a nurse I am obligated under the nurses "Code of Ethics" to do just that. But, families instead choose to make decisions that prolong that dying person's life. Really, sadly, that person then is poked and prodded with many tubes and interventions until finally the family is ready.

I will share with you stories, my stories or more aptly, the stories of those with whom I come in contact with every day. For example, an elderly man with lung cancer that had spread to his other organs came in unresponsive. He was so thin and gaunt, he could not even close his mouth, he had an audible "death rattle" - because he was so weak and near death he could not even cough to move any of his secretions. Did we make him comfortable so that he could pass on? Well, no we did not .... not until we were able to secure THREE physicians who agreed that indeed this man was dying. In the meantime, he received one aggressive treatment after another....by me. This is not why I became a nurse.

More to come.