Ethical Dilemmas and Death

Magicdragon Journal Entry #3

Ethical Dilemmas

Today in my nurse residency program, we discussed different ethical and moral dilemmas that we have encountered throughout our nursing careers. The first dilemma I can remember was during my summer internship on a vascular and general surgery progressive care unit. Z was a 92 year old, diagnosed with end stage pancreatic cancer. When I came on to my shift that day Z had designated the code status, do not resuscitate, do not intubate. We all knew that Z had limited time left on this earth and we did everything we could to make Z and family comfortable. As the day progressed and the day turned into a week, Z went from full code to DNR/DNI to comfort cares. When a patient or their family designates comfort cares, all of their monitors and IVs are removed and we basically await the inevitable passing of the patient. Then one day, as I was making my rounds on this patient, I came into Z's room and their son was crying and on top of Z doing chest compressions, trying restart his recently deceased Fathers heart. The family does not speak English so we had to get an interpreter to translate what the family was screaming. They requested that we do everything we could to save their Father. So we initiated ACLS protocol after the patient had been without a pulse for over 30 minutes. We ended up calling time of death shortly after initiating CPR and defibrillation.

Rumination:
What an aweful feeling I had as I entered Z's room. I was so dumbfounded that I didn't know what I was looking at, let alone what I should do next. This situation was a great example when communication lapsed in the care of this patient and family. But I think that the communication wasn't completely to blame because words aren't useful to deaf ears.

During my orientation period at my new job on the neuro/neurosurgery intensive care unit, I had my second big ethical dilemma. The patient was a 64 year old who had been brought back to life after cardiac arrest, but still had no cognitive function. P was in Italy at a race when P's heart gave out after doing to many prescription drugs. P was cared for in Italy for a couple weeks before flown over seas on a private jet to our hospital. This patient took everything into account just in case something like this happened. P had three medical power of attorneys, which is a very smart idea because not one person can dictate what kind of care you should get, and there will never be a tie. But the chances of this patient restoring brain function was very low and there were only two options left… put a tracheostomy and PEG tube in and keep P mechanically ventilated the rest of life, or pull everything out and see how long P will stay alive. The majority ruled for everything to be pulled and P was transferred off of our unit. But later it was brought to me that one son kept pushing to have the nursing staff give P more and more morphine to “get if over already.” The care team had to sit down with the family to discuss the moral boundaries that our hospital follows.

Rumination:
These situation opened my mind wide to the power that death can have over a family. It’s moments like these where we need to take a moment out of each day and verbally, nonverbally, or mentally appreciate our friends and family in our lives. Although I’ve never really had a hard time being the nurse in these situations where death dominates that patients will to live. I have a cold, flat, awkward displacement in the room that’s saturated with emotions. I believe that is a good trait to have to some degree, because if you let all of the emotions drown you, I think the burnout rate in the ICU would be a lot higher than it is. It’s sad to think that I don’t really remember all of my good patient experiences, but I remember the death and moral insufficiencies of families that are being torn apart. I wish it were the other way around. I'm 25, I have been a student nurse for two and a half years and a nurse for half a year and I have seen nearly twenty-five people die. I wonder how much death one person can handle before they succumb to the dark facets of their mind.