I hate it when a patient is made palliative.
The Dr's write the order, and I don't know how they feel, but I know how I feel when I go into the room and I disconnect the IV, I stop checking their vital signs, I stop giving them medication. All that nourished, sustained, or tried to fix and maintain some semblence of "making them better" is gone. I can't imagine being the Dr who has to convince the family that this is what is best. I can't imagine writing the order to discontinue everything except for the things that will keep the patient comfortable until they die. I only know what it's like to carry the order out.
It's very sobering. Taking someone's IV fluids that were their only source of nourishment. I take it down and I know that my action will lead to this person's death. I know that the death would only have been delayed otherwise, but in that moment I feel, very poignantly yet subtly that I have failed.
If I was a better nurse I could have turned this patient around.
Why do I think this? I have no idea. Clearly I am not God, and in no way shape or form have the ability to cure someone. But, it's the health care worker way. Our initial goal is to diagnose, treat, discharge home, and when we discover that no matter what we do this patient will most likely die, we must change our goal to help them die in a dignified and comfortable manner and that often feels like we've failed.
And I'm not going to say that we shouldn't feel this way. Because I do feel this way. As irrational as it is, when I take down that IV fluid, I feel like I have let this person down. Like somehow, I should have had some sort of crazy amazing thought that would have been able to stop the brain from bleeding, the cancer from spreading, made the infection vanish, or fixed that damaged-beyond-repair liver. Because that was why I went to school for 4 years. Because that is less painful than reality.
Reality where people die, and I let them. Where they die, and I give them morphine to make them comfortable, scopalomine to help them breathe easier. Where they die and I softly ask family members if there is anything I can do for them.
In other news, over the weekend like 2 patients died. 1 kind of traumatically despite his families fierce denial that he was terminal. The other alone. So alone that we had no one to notify of his death, and his body was still in the morgue on Monday. Which was incredibly sad because I really liked this patient. He was a frequent flyer, and was incredibly way sicker than he realized. And he just died. Just like that. The end of his story. Then, Monday morning at the start of my shift, before I was even out of report 1 of my patients died. It was kind of expected, but he deteriorated really really quickly. My cat, back home, is sick too. She has tumours. At least 1, that was originally on a toe that was amputated, and now it's even bigger on her foot. Our choices are to completely amputate her leg at the shoulder and hope that there are no more tumors waiting to grow all over her body and hope that she will live out the rest of her life and forgive us for taking her leg (she's 13 years old) or put her down.
I should get back to packing and doing laundry and cleaning the kitchen. Instead of dwelling on all this death.
You should probably go do something fun now too. Something that will make you smile. :)
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