It's been a while since I had a profound work experience that has left me humbled and enlightened at the same time. I have been nursing for a long time but there is always room for personal and professional growth. The best kind comes when it is least expected. I would like to share a wonderful story about a colleague, my patient, and her family.
My patient arrived to the ICU as a CODE BLUE shortly after 6 am. The family was on their way to the hospital. The physician asked me to call him when they arrived to discuss code status and plan of care.
The family decided to make the patient a DNR/DNI shortly after their arrival. Palliative care was consulted. We were continuing to provide care within the realm shy of intubation. By 9 am the patient pulled off her bi-pap mask and within two minutes arrested but was revived per RT with MD and nursing staff to assist at the bedside. IV pressers were infusing and oxygen via bi-pap was keeping the patient alive. The family was updated and care continued in hopes the patient would recover enough to return home. Sedation was infusing at a low dose to keep the patient calm on the bi-pap. Within a few hours, her eyes were open and she was communicating with her family via gestures and facial expressions. She was a very strong and independent woman despite her condition. As the afternoon continued, her vital signs were very labile. She was in and out of sleep/agitation. By 1700 she had decided she had had enough. The mask was again removed and the family was at the bedside. I was busy with my other patient when I heard the alarms in the room. When I arrived, the mask was off and RT was attempting to place a nasal cannula. The eldest daughter looked so stressed and sad. She wanted her mom to be comfortable and relax which meant leaving the bi-pap off. The patient then grabbed the nasal cannula and threw it in the floor. I looked at the family and said, “If the mask is left off, your mother will code again”. TJ Chicas, RN quickly said in a calm and loving voice, looking at me, “No she is going to be allowed to pass on her own terms. Let's make her comfortable and allow her to have what she wants.” After that statement, I realized she was right. The anxiety level in the room dropped. The patient began to relax. I gave her a swab to wet her mouth and she said, "oh that is good". The youngest daughter burst into tears and tried to run out of the room. TJ gently put her arm around her and said, "Why don't you stay and be with your mom, we don't get this time back and now is the time to say things that matter. Let her know you will be OK and she can leave this world with peace". The two daughters held her hands. Smiled and talked with love and compassion as their mother listened and took her final breaths. She never gasped a breath, was never in distress and experienced the most peaceful death I have ever seen.
The chaplain was called in to complete death paperwork. The family came to the nurses' station after visiting their mom for the last time and stated they felt love and compassion during their mom's passing and will remember their experience for the rest of their life. They hugged TJ and me on their way out. I was reminded that a decision needed to be made in my patient's room that I had failed to recognize. The time was here, and TJ guided me through a door that allowed the patient to pass with dignity, took the burden of the responsibility off of the family as the patient clearly wanted the oxygen off, and what followed was nothing short of beautiful. I am grateful for her expertise and hope I can perform as well in future situations. Her actions need to be recognized as this is truly the best example of why we are nurses.