Monday, May 16, 2011

Making Peace

My favorite patient died on May 1st. I discovered this on Saturday night about 4 a.m. after I finished writing he and his sweet wife a little note to say hello. I went to look up his address and had the wind knocked out of me by the word deceased on his facepage.

He was 83 years old and had been diagnosed with a form of lung cancer over the winter. He had a short course of treatment, lost his hair, lost a little weight, otherwise he did ok. At the end of his treatment though his doctors recommend he do 25 radiation treatments "Just to be sure." He wasn't happy about it. He didn't want to do it, but at 83 he was used to the doctors knowing what they were talking about and so he resigned himself to doing the treatments.

But he also looked to me and the other nurses who cared for him to confirm that he should do it. Now, I sit here feeling like a traitor to him and his precious wife. I feel like I gave him the company line, when what I should have said was, "Well you are 83 years old and you have had chemo and if you don't want to do the radiation just tell them no and make peace with your decision."

But I didn't. I said something like,"Well if the doctors think this will give you the best chance at survival you should go ahead and do it." So, his life ended on a ventilator, in an Intensive Care Unit, with pneumonitis and pneumonia likely brought on at least in part by the damn radiation treatments and here I sit, complicit in the crime.

No, I didn't kill him-but did I do enough to make sure he knew the decision was his and not the doctor's? Not his wife's Not his cancer's or his grandchildren's or his priest's. The decision to endure radiation treatments should not have been accompanied by the external pressure of his healthcare providers-we should have given him all the details, respected his choices, and let him go home for 6 months, a year, or a decade.

But we didn't, he got pushed by all of us into radiation, and now he's dead.

The day I accepted by original hospice nursing position I was working an overnight shift in a San Antonio ICU and the patient was an 80 year old man who had been "found down" in his nursing home, and got "brought back" before anyone checked to see if he had a DNR. As luck would have it, he did. But by the time anyone saw it the poor SOB had been shocked, intubated, and was now spending his last miserable freaking days on a ventilator being continuously dialyzed, and that night every time I suctioned secretions from his lungs I chanted to myself, "This is why I am going to hospice, this is why I am going to hospice...."

And I did. I worked in Hospice for close to three years with adults and children and it was rewarding and challenging and I loved it-but between remarriage and two deaths at home on hospice I had begun to feel like everyday was "Take your sickle to work day" and I needed a change. So I came back to the medical and surgical side of things and there isn't a day that goes by where I do not find myself torn between telling people what they want to hear, what they need to hear, and what I can responsibly tell them as a part of their healthcare team.

This time I didn't do it right and now I am left with my grief, my conscience, and the hope that I will do better next time. The next time you are a patient remember that the people prescribing and providing your care are human too and therefore your care is inherently flawed. 

Clinically he should have had the radiation treatments, but realistically, an 83 year old man with a 50% survival rate after chemotherapy should have been allowed to go home and read the paper and flirt with his wife. Next time I hope I err more on the side of flirtation than radiation.

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