Monday, May 3, 2010

A rant

This is going to be a bitchy post.

I normally don't talk smack about people (aside from residents and administrators, who are obviously exempt from this, and just from their job description, need to be heckled occasionally), but I feel the need to express some anger and frustration - and that, I will do now, with you dear reader. I think that most professions generally protect their own. Unless someone is a total jackass; teachers, lawyers, doctors, and nurses will give one another the benefit of the doubt. Publicly broadcasting someones incompetence is a politician's job, and not mine, but, with discretion- I will share this complaint.

OK, yes, I talk about death a lot, and I promised only a few more posts (a lie), and here is another one. Not particularly about death, but more about dying and dignity, and not the political hot potato kind. Dying with dignity to me means: not dying alone, not being a carnival show, having privacy, being comfortable, and having an intuitive person watching over you. Some nurses and doctors get this, and some are fucking oblivious. In the ICU this is a scary/sad thing. I believe that for many nurses, when a patient dies, there is a big difference in care when they are alone, rather than with family present. This goes for physicians/nosey med students too. When there is no family we are more likely to poke and prod, take random blood pressures, talk about how pissed we are at our spouses, and gossip about hospital drama. I know that I am less sensitive when there is only my sedated or stuperous patient - but the key is that I KNOW I am not being delicate at that moment - when under it all, I still am in touch with the current of the room, the patient, and my role as advocate. I can get right back there, where often times I don't know if some other nurses can feel it at all.

I had an event the other day where a new orientee was being trained by and older, very experienced nurse. The patient was placed on comfort care over the phone by their DPOA. The family opted out/was not able to be present for his death, (Granted, he probably had a colorful life, any may not have been the most angelic character, as his ending diagnosis was Hep C and alcoholism) and he was going to die alone. We all knew this, and shortly before I came on shift, his medical care transitioned to comfort rather than cure. I was to assume his care four hours later at 8pm, and in the meantime I was the floating helper nurse. (I will admit that I did remark: "Christ, another trip to the God-damned morgue, fucking great.") (I am not a saint). I went by his room a couple times and noticed that his door was wide open, revealing the bright yellow, bloated form that he had taken. Making sure he had soft music in the background, I shut the door gently each time, only to find it wide open again later. I hear the two nurses in charge of him wondering aloud why is oxygen levels are so high, they thought he would die so much sooner. The new nurse was eagerly watching his monitor for cardiac changes, oohing and gasping when he would have a sinus pause or a bout of arrhythmias. This is pretty cool for a little while, but after a while got annoying, especially when I noticed that his blood pressure cuff kept going off, showing a BP of 30s/20s. I asked why they were taking his blood pressure, and they couldn't give me a good answer. I said "The guy is on comfort care, give him a break!" They said they would stop it, and I let it go - with an eyeroll, and a meaningful look at the nurse next to me. Finally, 8pm comes.

I am the charge nurse and also have this guy. After I make the rounds, I go into his room. I see this man alone, fairly obtunded, with all the bells and whistles attached to him. I call the covering doctor for a morphine drip, which all my comfort patients receive, even for a small dose per hour (which you had better do for me too). I take off all of his extra leads, his BP cuff, his oxygen monitor, and I wash his face. I notice that his oxygen is blaring 6 liters in his nose, and turn him down to 1 liter per minute (No wonder his sats were so high!! (dumbasses)). I hang out with him for a while, swaying to Kid Rock after I change it to the country station, since he is obviously not smooth jazz.

All of this should have been done before me. I notice that after he had been placed on comfort care, his vitals were still written down every fifteen minutes for the next two hours. This irritates me.

Soon his heart rate slows and I go into his room. I stand next to him and sing him a song as he dies.

I took him to the morgue with the goofy escort guy (It was swell. Yeah right, the morgue sucks. I should get paid hundreds of dollars an hour when I have to go there and shove bodies around). Whatever.

I pulled the nurses aside individually the next day and told them that this was not the way to do comfort care and that I was upset about the way that this patient had been treated. They both bristled and made excuses, and I know that we are not on our game all of the time, so I am letting it go now. However, if I am in that bed, please give me a different nurse.

This is a rant really saying that an expected death should be as peaceful as possible, and that the care of the patient shouldn't be lessened if they end up dying without friends or family present. They should have a sensitive hand stroke their hair, and someone there to dream a little of the good person that they were.

So I will leave you with the song I sang, by a lovely woman named Joules who lived on Lopez - I think my guy liked it.

My clothes are ragged and torn,
you know as sure as your born,
that they've been loved and worn for many years.
And from the mud on my toes,
to the way my hair grows,
I see that everyone knows I'm living free.

Cause living free is the only life for me.
Yeah living free is the only way I'm gonna be.

Some see the dirt on my hands
and they just can't understand
how I can live on the land, but that's OK.
I tried my hand at their schools,
but they was acting like fools,
restricting life with dumb rules,
that's not for me.

Cause living free is the only life for me.
Yeah living free is the only way I'm gonna be.

(Jazzy ending)


  1. Thank you for being with him Lisa - it is an honor to be with a person when they pass and not enough people/nurses realize what an important part of their job that is to be there. The two most important days of our lives are the day we are born and the day we die. Neither of which should we be alone ('course the first would be difficult to be alone... hummm) Anyway... you're right - it should have been done BEFORE you! I promise to make sure you have a happy dose of MSO4, if every that time comes, if you'll do the same for me - let's hope that is not ANY time soon! Don't change the way you are - and thank you for not letting him die alone or in silence. Mel

  2. I can only wish for a conscious and loving nurse like you to be by my side when my time comes. Thank you Lisa. I miss you. You are in my heart and my mind all the time. You inspire me! Thea

  3. WOW! Lisa that moved me when you told me & now that I read your posting... I LOVE YOU! Thank you for helping people! It truly is a honor and a blessing. Way to be on your game!

  4. Amazing post. Where I work...most of our patients die with HCV, ETOH abuse and are often alone. Your rant sounds like many I have had as well, not about the nurses as much but residents, interns etc. Im so glad I found your blog, it's a great read!

  5. Beautifully written. Some of my most fulfilling moments as a nurse have been facilitating a peaceful death for someone. (that sounds weird but it's true)