Monday, 18 January 2010

The Bell Tolls

Her bones are clearly visible through her yellow tinted skin. She has a cannula in each arm both have tissued, her veins having shut down hours before. Her last set of observations tell me her systolic blood pressure was sixty-seven, barely compatible with life. She has been on the liverpool care pathway for two days. She is Dying.

Despite all this my patient was incredibly lucid. She was aware of what was going on around her and could answer all of our questions appropriately. This is why, when I was asked to take a set of observations on her I refused. She is on the pathway for the dying with twenty-four hours left on it all of her previous vital observations and physical observations suggest it will be much sooner than that. I refuse to tug a blood pressure cuff onto her arm, inflate it to a painful level and drag it off again when the results will be of no use to anyone. I still cant believe the nurse asked me to do that to my patient.


Sage said...

I think you guys do such a good job, I hope I come across someone like you who care, when my time comes xx

Asclepius said...

This kind of situation doesnt come terribly naturally to me, I know its best to do nothing, but I'm wired for A&E, we dont get palliative patients there, I am used to fighting for a patients life with every scrap of knowledge, every trick, every ounce of my training. I accept in situations such as this that I shouldnt do those things it still doesnt seem to feel right somehow. My fiancé is a truely gifted nurse who has the psychological and mental fortitude to deal with palliative care on a very regular basis. I think this shows the wide variety in nursing and its good that it attracts such a wide variety of people.

Vincent said...

I agree with your viewpoint, but when I told my wife about your post, she saw a different angle. She has no clinical duties in her hospital. Within Infection Control she performs myriad secretarial functions including recording the daily progress of patients with MRSA, C. difficile and so on in a database. She remarked on the professionalism of nurses who may see that patients have not long to live but carry on regardless, on the grounds that they must not give up on them; for hope is therapeutic. She thought that discontinuing routine tests on a lucid patient could convey the impression that the routine efforts of daily care were no longer worth it.

She felt that the signalling of impending death, whether initiated by the patient, nurse or doctor, would be a call for relatives (and priest, in the case of Catholics) to attend the bedside, rather than the cessation of clinical observations (unless they were highly invasive).

However, the above is merely a set of generalisations from another observer.

To me, what counts is no so much the nature of the rules, or when they may be broken with impunity; but the individual care and sensitivity of the nursing care, so clearly demonstrated in your story.

Asclepius said...

Thats a really good point Vincent. Having read that I cant understand how that point of view didnt occur to me.

Thank You