MY PATIENT WISHED TO LIVE, BUT …




MY PATIENT WISHED TO LIVE, BUT …

By Ioana Caranica, RN, MSN

In July of 2019, I cared for a male patient with gastrointestinal bleeding for two days in a row. He was full code, alert and oriented. He had refused Do Not Resuscitate and Comfort Measures orders. He wished to live, to return to his family. However, there was no treatment initiated for his condition by the intensivist.
The patient and his family were under the impression that appropriate treatment was being provided.
The following day, the patient started to decompensate. He became short of breath, cyanotic, and hypotensive. I notified the intensivist, who came to see the patient. He stated, “The patient is very sick,” but initiated no treatment. The patient had only a peripheral intravenous access. I asked for a central line, oxygen orders, etc. I received no orders. I informed the charge nurse, but she was not concerned either. She went about doing her duties. My patient was dying and there was no sense of urgency.
I informed the charge nurse, “I am going up the chain of command.” She told the intensivist what I had said. Only after I initiated the chain of command process did the Intensivist insert a central line. A Code Blue was called within minutes. The patient was resuscitated, and treatment finally started, but too late. The patient passed away a day later.
I have witnessed many cases in which hospital physicians have decided the fate of patients they deemed to be a waste of resources or lives not worth living. Families trust doctors, but this trust is frequently betrayed. The culture of death has deeply infiltrated our healthcare system. We all must be aware of this and prepare ourselves to be advocates for the medically vulnerable.

Definitions:
Comfort Measures: a term often used to mean the administration of increasingly frequent and larger dosages of powerful pain medications while providing no life-sustaining or life-saving care and treatment.
Decompensate: the inability of an organ or system (e.g., the circulatory system) to continue to adequately function.
Cyanotic: the skin and/or mucous membranes have a blue or purple color due to a lack of oxygen.
Hypotensive: lowered blood pressure.
Intensivist: a physician who provides special care for critically ill patients.
Peripheral intravenous access: a catheter inserted in the vein that allows for safe administration of medications, fluids, etc.
Central line: a tube placed in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly, which is particularly important in intensive care.



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