Petty thoughts on Pettiness...

So I was talking with one of my online friends tonight (<3 Nikki) about some of the things I get frustrated with. There's a lot of pettiness that people make big deals out of. I'm kinda getting fed up with petty stuff. I'm needing to distance myself from any high school bullshit drama right now.

It's been feeling like nursing-home-central at work this past week. Yesterday I nearly cried; it was such a difficult day. Today, thankfully was a much better day, but I still had a rough crowd of patients.

I had 3 goals today:
1)Stay awake.
2)Don't Cry.
3)Keep 311 alive
till 7pm.
I was pretty successful in my goals.
I shed tears,
but they were tears of laughter.

So, without being all HIPAA-y... let's talk about 311. She's been riding on my mind a lot. Little old lady. When I say old, I mean OLD. Nearly pushing a century. Sick. Aspiration pneumonia, and breathing like shit. Also (+) for MRSA in Nares, Urine, and Blood. She's completely septic. She's not going to get better. She WILL die; there's no question about that in anyone's mind. To me, it's just a matter of when and how she dies.

The poor lady was "with it" completely until the last couple days. Last night she mostly became nonresponsive. She moans, cries, and panics when she's moved or touched. She's edemetous, with hands swollen and puffy like the Stay-Puff Marshmellow Man. Her skin is tight, splotchy, and bruised to all hell. She's incontinent of stool, and on so many antibiotics, she's got heavy diarrhea. She needs to be turned regularly, because she cannot move on her own. She carries the smell of the dying- even after a bath. She's had agonal breathing, in an attempt to get more air in. I've suctioned her several times. She panics, moans, and sometimes pleads, "no..please no". Suctioning isn't pleasant, but it often opens a clogged airway. It's what needs to be done to sustain life. She is a DNR.

DNR. Do not Resucitate. It doesn't mean do not treat. So treating the illness is what we continue to do. We pump her with antibiotics. We turn her regularly to keep her skin on her bottom intact. We poke her swollen hands & arms with needles repeatedly, looking for veins to draw blood samples for her daily labs. When her IV site blows, we put a tourniquet on, and start a new IV. We feed her through a tube that goes directly into her stomach. ...If she stops breathing, we cannot help her. But in the meantime, we are obligated to continue to treat her, doing everything in our power to prevent her from getting to the point where she stops breathing. This is where it hurts. She is going to die. It is certain that she will not be able to survive all these ailments that are attacking her.

Sometimes the treatment is just as bad as the disease. If it were me at that age & level of sickness, I would want to be left alone. Give me oxygen to help me breathe comfortably, and high doses of Morphine. Spare the IV antibiotics, that sting going in the veins, and give diarrhea. Quit poking for lab values.. why keep score on a battle that's a sure loss? Just be kind, and keep me comfortable.

Comfortable. That's what I would like to see my patient be. What I talked about above..that's Comfort Measures. Keep a patient comfortable before their "celestial transfer." You don't hasten their death, and you don't treat them; you just keep them comfortable, so that they can die peacefully. I talked to the attending doctor about getting this woman's status changed from DNR to Comfort Measures this weekend. The MD tried to get in touch with the patient's children. (The children, by the way, live less than 2 hours from the hospital, and have yet to be seen on the unit - another issue that just further upsets me!) The MD explained her grave condition, and they said that they "need more time" before they decide whether or not they want to withdraw treatment.

It breaks my heart. Please allow me to stop torturing this woman!! Allow me to stop poking her with needles. Allow me to let her lay in peace. Allow me to give her large doses of painkillers. Allow this woman to finish her final days on this earth comfortably.

*sigh* guess that's what's weighing heavy on my mind. It's not that I try to trivialize some other problems that others might be having, but I guess everything else just seems so petty, in perspective. I've spent my weekend torturing a woman, because that's what I'm legally obligated to do. But in my heart of hearts, I know that she needs & deserves to be left comfortable so that she can leave this world in a peaceful non-traumatic manner.

::continuing to put effort into not crying::