Awhile back, I came out of report and walked into my patient’s room to talk to the day shift nurse. In group report we were told this patient was really sick and receiving massive blood transfusions to reverse his coagulopathy and maintain organ perfusion. Walking to the bedside I was told that the family had just decided on comfort care and the resident physician was at the bedside writing the orders.
After talking with the previous nurse, I went to the bedside and introduced myself to his family. Gathered around his bedside were his adult children, his grandchildren, his significant other, and his siblings. This family’s world had rapidly unraveled over the last 16 hours. They suddenly found themselves in an ICU at a hospital 80 miles from home waiting for other family members to arrive to say good-bye before we remove the patient’s breathing tube. They kept repeating the crazy reality that yesterday he was fine and they were having dinner and today they are taking him off life-support.
I listened as they described what happened, the nightmare day they had had, and what finally brought them to this decision. They asked questions about what withdraw of care looked like and whether or not he would be in pain. I answered their questions the best I could with the caveat that everyone is different and I will adapt our protocol to his needs ensuring he’s not having pain or shortness of breath. They then asked me how long it would take and how much time they had.
This is one of those situations that can be difficult and awkward as a nurse. Working with a family as you transition their loved one to comfort care is emotional and without an established relationship it can be a process that is fraught with clichés.
“I don’t know.” I answered. His blood pressure was 90/50 and his heart rate was 90 on very high doses of vasopressors. “His blood pressure is low but stable on the medication. We have a little time to wait for everyone to get here.”
I told them about starting the continuous infusion of pain medication and that it would take a little time for it to arrive from the pharmacy and get it started. I encouraged them to spend some time together as a family talking to him and to each other. I told them I’d be back.
About 20 minutes later I walked in the room to start the morphine drip. They were laughing so hard they were crying and telling so many stories they were interrupting each other. They all looked at me as I walked in and apologized.
“No reason to apologize.” I told them. ” It’s rare and an honor to watch a family celebrate a loved one’s life at the time of their death.”
They laughed and cried and held his hands as the morphine was started and the vasopressors were weaned off. They honored and celebrated him together as a family; it was really remarkable.
After he passed I stepped out of the room to give them time together. When they were ready to leave they said good-bye to me and thanked me. I thanked them in return.
It was interesting to me that this family was who I was thinking about today as I called and wished my dad a Happy Father’s Day.