Death….
A 94 year old patient of mine was struggling to breathe. He had aspirated earlier in the day. He was full code. Prior to intubation, both the Doctor and the Respiratory Therapist described the procedure to him and asked if he wanted to be placed on a ventilator to help him breathe with more ease. He finally came to the decison to declare himself DNR/DNI and decided against intubation. At about 3am, he was had wheezing and was gasping for air. His O2 sats remained 95% but he was definitely in distress. He was placed on bi-pap with a full face mask. This comfort measure didn’t help and made the patient more agitated. So, the bi-pap was discontinued. Shortly thereafter, the patient’s skin became clammy and was starting to mottle. The Nurse’s were trying to predict time of death. The patient was not experienceing Cheynne-stokes breathing; nor were agonal breaths apparent…..just the wheezy, watery sounding breath that is often associated with aspiration pneumonia. I really didn’t think the patient would die. Although there were significant signs that he would pass, I thought it would be later in the morning after shift change; and, I didn’t agree with any of the Nurse’s time parameters. In my 15 years as a C.N.A. I have seen hundreds of patients with the same symptoms live from days longer to weeks longer…so I was surprised that this patient died — especially since the family present expected more family from out of State to arrive later in the moring to say their good-byes to him. I guess the signifant lesson for me is that a prediciton of death is a 50-50 statistic…ultimately, a patient will die when he or she is ready. I am grateful that we didn’t prolong his life and cause any further stress or pain in an attempt to do so. He was able to pass peacefully with his wife and a few of those he loved holding his hand.
December 23,2008 at 18:34
I really enjoyed this post. It is very sad that patients who have little to no change of recovery will have family members prolong their life, etc., so it is good that that is patient didn’t want a full code status.
It’s pretty sad that he passed so soon, but I believe that He has a plan for all of us and not a single person on earth knows when someone is going to pass. Like you, I’ve seen hundreds of people die and I’ll admit that I’m pretty good at guessing…but sometimes you never know.
That is nice that he was able to die in the hands of his loved ones. I can’t imagine what it would be like to lose a relative or friend so close to Christmas. It must be just terrible.
December 26,2008 at 18:34
This experience with death totally opened my eyes. It must be horrific to loose someone loved around the holidays. I was humbled; and, inspired. The family insisted they help with post mortem cares…one of my favorite things to do, simply because I feel spiritually connected with the deceased and put a lot of love, respect and care into preparing the body after death. For me, this ritual is a way to pay homage to many different belief systems, life styles, personas and is a beautiful act of caring for my fellow man. I was humbled because the family, not being Health Care professionals, desired to help me with this very special task. Instead of fearing the body sans a life force, they revered it. They were loving and gentle and were able to tell me about the life of the one they loved. I felt this brought closure and some peace to a very sad moment. I was inspired because they were so pleased with the results of my care to their loved one, even though the body was merely a minute representation of the man they lost. I want to always take time and care for those that pass while under the light of my care….I want to always have love in my heart for my fellow man. I want to always try to come from a place of understanding…even when there are evident differences. I want to provide exemplary care…even when my patient has died.