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A difficult morning....
Mar. 18th, 2015 06:00 pmI admitted someone to the hospital yesterday afternoon, after a heart attack, and sadly, not her first. This gentle lady has multiple organ systems in bad shape due to underlying disease that I will not go into here, other than to say the cause was something genetic.
I had admitted her to the hospital last month, at which time she said to her adult daughter that she was dying. The daughter pooh-poohed what she was saying at the time, and I rather firmly said to the younger woman to take what her mother was saying seriously, that given her underlying disease at some point in the not to distant future, she would say that again and she would be correct. My comment was a wake up call for her. It laid some serious groundwork for the decisions her family made last night regarding just how invasive to be with her care. After a consult with the cardiologist on call, I had the palliative care people see her and the family. Their decision was to forgo any major heroics and to sign DNR orders. Did I mention the woman's mother was including in this decision-making? The patient is several years my junior, not that time has been kind to her.
Despite my trying to get her whole family to go home last night, her husband and daughter remained at her bedside, each dozing in an easy chair. When I got there this morning, they had changed shifts, with the two of them going home to get some sleep, and her son, plus a family friend taking up the vigil at the bedside.
While the patient was comfortable and in no pain, she was also clearly declining; her labs were significantly worse and she was no longer conscious. The palliative service had been in to see her and had discussed both hospice and comfort care. However they had not ordered them, her son deferring that decision until I arrived, or until his father had awakened. After speaking with me, her son asked me to write comfort care orders. I had just finished writing those orders when her RN came out of her room to ask me to look at her. In the 30 minutes I had taken to write her note and her orders, she had quietly and peacefully passed from this plane of existence. Her son had just walked out to stretch his legs for 5 minutes. The family friend sat there in silence, a solitary tear wending its way down her cheek.
It fell to me, first to break the news to her son and once he had calmed enough, to then call her daughter and her widower, to break it to them. I was still there dealing with more paperwork when they got back to the hospital.
While I'm at ease with the care I gave her, and grateful her passing was not a long, drawn-out, and painful experience for her, I don't handle the death of someone, particularly someone younger than I, with any ease.
I had admitted her to the hospital last month, at which time she said to her adult daughter that she was dying. The daughter pooh-poohed what she was saying at the time, and I rather firmly said to the younger woman to take what her mother was saying seriously, that given her underlying disease at some point in the not to distant future, she would say that again and she would be correct. My comment was a wake up call for her. It laid some serious groundwork for the decisions her family made last night regarding just how invasive to be with her care. After a consult with the cardiologist on call, I had the palliative care people see her and the family. Their decision was to forgo any major heroics and to sign DNR orders. Did I mention the woman's mother was including in this decision-making? The patient is several years my junior, not that time has been kind to her.
Despite my trying to get her whole family to go home last night, her husband and daughter remained at her bedside, each dozing in an easy chair. When I got there this morning, they had changed shifts, with the two of them going home to get some sleep, and her son, plus a family friend taking up the vigil at the bedside.
While the patient was comfortable and in no pain, she was also clearly declining; her labs were significantly worse and she was no longer conscious. The palliative service had been in to see her and had discussed both hospice and comfort care. However they had not ordered them, her son deferring that decision until I arrived, or until his father had awakened. After speaking with me, her son asked me to write comfort care orders. I had just finished writing those orders when her RN came out of her room to ask me to look at her. In the 30 minutes I had taken to write her note and her orders, she had quietly and peacefully passed from this plane of existence. Her son had just walked out to stretch his legs for 5 minutes. The family friend sat there in silence, a solitary tear wending its way down her cheek.
It fell to me, first to break the news to her son and once he had calmed enough, to then call her daughter and her widower, to break it to them. I was still there dealing with more paperwork when they got back to the hospital.
While I'm at ease with the care I gave her, and grateful her passing was not a long, drawn-out, and painful experience for her, I don't handle the death of someone, particularly someone younger than I, with any ease.
