A Hospice patient...This has never before been a big thought for me. If a patient was a hospice patient as a CNA, I helped the nurse turn the patient, bring the family coffee and kept the patient comfortable. It's a whole other world when you are the RN in charge. I knew the day would come eventually. The thing about when this day hit, it was during one of my worst weekends when I was dealing with personal issues. When I came to work trying to fight tears from my own downs, they let me know I'd be taking our patient on hospice care...The nurse who assigned me to that patient selected me personally because she thought I would do a really great job with the patient and family. I appreciate her intent, but it was the last thing I wanted to take on that day. I headed into it. I saw my other three patients first and saved the hospice patient for last. I knew I'd want to spend some time in there making sure the patient was comfortable and talking with the family. I wanted to not be rushed. I walked into the room and my heart dropped. Here was a gentleman that two days ago was alert and oriented, a walking, talking gentleman who came in for a UTI. Here he laid pretty much unconscious with a tearful, concerned looking daughter next to his bed side. Something in me kept me together and all I could think to myself was "God are you testing me right now?" It seemed unreal and hard. I spent probably about half an hour in there taking care of the patient (repositioning, hygiene, pain medication) and trying my best to talk to the family. They kept on asking "how much time do we have left" and I wasn't sure. Sometimes we get feelings when we see some specific signs and symptoms, but I wasn't able to give an accurate estimate. I called the MD to update them when she got the chance and the family went home. A while later I got the phone call from the wife. I could hear the sadness in her voice when she explained to me for 15 minutes how to care for her husband, what he likes to eat, what he doesn't like, which ear to talk into because his hearing is the best in that ear...and so on. It was probably one of the saddest conversation but also one of the sweetest listening to this woman who had been married to him for half a century explain to me how to take care of her husband. It was then I decided being the RN taking care of a patient in this condition was not only hard to see, to be extremely conscientious of every move and word was draining and to be the point of contact for each arriving family member was extremely hard. Later that night a nephew and his wife arrived to spend time with the patient. I knew they had arrived because as they leaned on the bed to kiss my patient, they accidentally set off a bed alarm that was placed on a bed. We set these in the hospital to alarm us if a patient who is at high risk to fall , tries to get out of bed without staff in the room. This patient didn't need a bed alarm. His body was lifeless and he was pretty much unresponsive. We were giving him morphine to keep him comfortable and watching respirations. When the bed alarm went off, my heard dropped. All I could think on the way to the room was this patient literally collapsed (fell off the bed) and died. I think it's the EMT in me that expects scenes to be gruesome. It was one of the worst feelings. When I arrive another RN had beat me to the room and all looked well in the room with the exception of the shocked family. It scared the life out of them. I let them know what had happened and left the alarm off. I spent another half of an hour in this room talking to the family. They were very nice and had a lot of questions. The one question they asked me that stuck with me was, "can he still hear us?" I got goosebumps as I replied, "definitely, hearing is the last sense to go". They thanked me for my time and I stepped out to give them some time alone. It was quite emotional night and I managed to keep it together. I felt most of the night though like someone had kicked me in the chest. It got even worse the next day...
If you think dealing with a mourning family is hard...It was even harder to deal with one of the sons who came in the next day. The first thing he said to me was along the lines of, if his (referring to the patient) oxygen isn"t going down and he is holding on it's going to be forever and I might as well just go back to work, it was a waste of my time coming down here...This is ridiculous. I couldn't believe this man was acting like this, in the room where the patient could have heard his every word. Could you imagine if a family member acted like you taking a couple days to pass away was such a big inconvenience to a job? I was so in shock. I spoke firm to this man and encouraged him to return to work and we could call him or he could call us if anything changes. I ignored his other shitty remarks while in the room. When I stepped out I had that feeling in my chest again and all I could think was , did that man really just act like that. I wanted to give him piece of my mind. Had I been a family member maybe I would have, but I didn't want to cross any lines, especially in the patients room.
The next night I had this patient I knew he was going to pass at anytime. Patient's get this gray look to them and start to have a hard time clearing secretions out of their throat and an even harder time breathing. He passed close to 2am that night after I had left. His family was so appreciative of the great care and I was thoughtful of the experience, drained from the emotions and still in disgust of the patient's son.
My next two hospice patients would come last Sunday. It was a completely different scenario the patient's family were completely in denial of the fact the family member would pass away soon and that was a really hard place to be in. I think that I possibly handled it a little better than I would have if I hadn't already had my first hospice patient as an RN...but I can't be sure of that.
