She was a tiny slip of a woman in her seventies. At four foot something she weighed just about 80 lbs. A heavy smoker for most of her life she spent her days attached to the oxygen machine. She fell from her bed during my shift fracturing her hip. Surgery was not recommended. The decision was made to change her level of intervention. No heroic measures were to be taken.
The ensuing weeks were painful. I found them to be incredibly frustrating. The nurses refused to stay on top of her pain management. There was no regular dosing of pain meds. They would wait until she was nearly frantic and inconsolable before administering anything. Then finally giving just an ativan.
I was working nights at the time. At the start of each shift I would immediately have to give pain meds so that she would be able to sleep. Still able to communicate, we would often have brief conversations before I would tuck her in for the night.
Then came the fateful night. I could immediately tell that she was in decline though she was still responsive. A check of the vitals confirmed my fears. P 140, BP 175/114, oxygen saturation of 64%, resps 38. This was the occurrence of another underlying cause. It was not the slipping away that was expected for the end of her life.
A call to the Dr. was quickly made. Send her immediately to the hospital. Though the hospital was just a short hallway away, we were an attached facility, it was required that we still call an ambulance. The paramedics showed up a short 10 minutes later. In this time, she had changed. No longer responsive, her pupils huge, and agonal respirations. The decision was made not to transport her. Quickly, quickly, the family was informed. Her daughter came in tears. Minutes later her spirit left her body. I gave the family time before knocking gently. The daughter, in denial, kept asking "Are you sure she's gone?" "Yes" was my response accompanied with a hug.
She was gone, but she had made her departure memorable.
This made me cry. It's so sad that she was treated that way. (It also reminded me of my great-aunt, who died after falling and breaking her hip. She was in the hospital for several weeks before finally passing, but we knew that the broken hip was the beginning of the end.) Someone once commented that doctors and health care facitilies don't know how to handle pain management - that euthanasia wouldn't be such an issue if we had decent palliative care. This story makes that much more poignant. She could have had some restful, pain-free last weeks with her family around her before passing.
ReplyDeleteBonnie, I'm sorry to hear about your great-aunt. It's very common that hip breaks are a precursor to death. Hopefully her passing was more peaceful. In all my experiences with death, excepting this one incidence, the palliative care had been very good. In fact I'd be inclined to say that in most cases there has been an abundance of meds available and given. It tears at one's hear to see such suffering. I only worked very briefly at this particular facility. There were many gross lapses in care that I couldn't abide to see.
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