My life's calling?

I'm not sure if this occurs in every nurses life but I believe there is a time when you realize what you were meant to do in life. Nursing hands down is my life's calling, but I think I've found a more specific destiny. I want to educate the world on end of life care.

Last night when I worked in the ICU an ABC (Act before code aka Rapid response) was called to the floor. I went along and it was a older woman who was struggling to breathe. They believe she has severe lung disease and has been in the hospital for 2 weeks now. As the patient is struggling to breathe the ABC team is initiating interventions. The necessary step was intubation. The patient was tired of struggling to breathe but did not want any treatment. As she finally agrees to the procedure the team leaves to prepare and I'm left in the room with her. I explained what was going to happen and question her about her feelings on what was going on. Overall she was very distressed and in my opinion "gave in" to what the team wanted her to do.

I held her hand and comforter her, assured her that she would not be awake or in any distress and that this would procedure would allow her body to heal and rest. She seemed to still be uneasy with the decision, which was hard. I began to tear up and explained to her that I can understand how frightening this must be, and that she would be in good hands with us in the ICU.

We called her daughter and explained the situation. She didn't live in town and agreed that intubation would be best and she was on her way. We then transferred her to our unit and intubated her. Her daughter arrived with her husband and they visited the patient after she was intubated and comfortable. They then left to head home because it was late and she appeared comfortable. About 2 hours later the patient coded.

During the code I performed chest compressions. This poor woman had a very frail chest and the required strength for compressions was not much. After 3 minutes I switched out. I asked her nurse if we should call the daughter and discuss terminating the code. She agreed. We called the daughter and she said "Do what ever you can for as long as you think is necessary".

What kind of help is that? Her chart had stated that changing the patients code status had been discussed a few days ago but no decisions had been made. Therefor CPR continued. As my next turn approached to perform compressions I stepped up and began, the patients chest was sunken in. You could no longer feel the ribs but what may presumably have been her back. After 1 minute I had to excuse myself from the situation.

After we resumed a rhythm she maintained it for a few minutes and we discovered she was in PEA (pulseless electrical activity) and resumed CPR. Having been personal friends with the ER physician responding to the code I reminded him that the family had said to terminate when we felt it was over. He joked and thanked me for being "the conscience on his back". He ended the code.

A few minutes later the family arrived. I brought them into the ICU and the first thing the daughter said in a matter of fact tone was," I don't want to see her, I'm just here to sign any paperwork". No tears, no distress, she was very much at peace with what happened. Her husband on the other hand was not. His eyes were bloodshot and tears were filling up. I reassured him that I also had been in this same situation and told him that she was very peaceful with the situation and I explained to him that I talked to her and held her hand prior to the intubation. He told me the story of her illness and it seemed ever so familiar.

The family thanked us endlessly for being so kind and that they were very gracious for all of our work. After they left I had to excuse myself from the unit. Everything was all to familiar and I couldn't control my emotions. After some "therapeutic communication" with my friend (another nurse) I resumed work. Reflecting on the situation all I could have wanted to change was the manner in which we coded her.

What 80 year old woman with such co-morbidities who had been hospitalized for weeks needs to be coded? Have you ever seen any patient over the age of 65 recover with any quality of life from a code?  I haven't! As I spoke to my friend we discussed the alternative of dying as you "gasp for breaths", I debated that it doesn't have to be that way. Palliative care is a beautiful thing. This collaborative team works together and uses medicines and therapies to make death painless, peaceful, and with dignity.

How many nurses out there actually know the facts about palliative care? Would you feel comfortable advocating to your patients and their family to choose an end of life care that would allow them to be freed from unnecessary testing, medicines, and treatments?

I believe my mission is to learn, practice, and educate others about Palliative care, the importance of advance directives, and discussing that "difficult conversation" with your family. I had a professor during my Med/Surg rotation who was ever so adamant about these things and taught us about "End of Life Care" and I'm thankful for that. It is my mission to continue her teachings but to take them to the next step.

I'm not a nurse yet, but I'm passionate about this. It's never to early to start working on your life's mission and I plan on starting now.