Fall 1991
De Paul University
World of Work
Steve with Aids: A Case Study
Steve was a 34-year-old male. He was brought to the intensive care unit around 8:00 PM. I was at the beginning of a 12-hour night shift (7:00 PM to 7:30 AM). He had been admitted to the regular floor, but when his respiratory problem became acute, he was transferred to ICU. The nurse from the floor who brought him was dressed in full isolation attire – like what you might need for bubonic plaque, just a bit exaggerated. She said that Steve might have Aids but she wasn’t sure – and no, she had not asked him if he did or did not.
I could see immediately that Steve was going to need artificial ventilation before the night was over. He was receiving the maximum amount of oxygen that you could receive without being on a respirator. He was breathing 60 times per minute (12-20 is normal), his heart rate was 160 (normal is 60-100), his color was bluish, and his eyes were bulging with terror. I thought to myself that he looked like an Aids patient and by the sound of his chest I thought he probably had pneumocystis (the pneumonia that Aids patients get). I realized that there was not much time for me to teach Steve what he needed to know about being on a respirator; he should know enough so that he could make an informed decision.
The first thing I said to Steve after telling him my name was, “Steve, do you have Aids”?
He responded, “Pat, I have reason to believe that I do, but I have been denying it for a couple of years”.
I said, “Are you gay Steve?” (If I had this to do over, I’m not sure I would have asked this.)
He said, “Yes, I have always been gay, I’ve never had a sexual relationship with a woman”.
I said, “Steve, the reason I’m being so blunt and to the point with you is that you are very critically ill; we don’t have time to beat around the bush. I have no prejudice about your having Aids or being gay, my concern is your serious health status right now”.
“Am I that sick, Pat”? He said trying with great difficulty to breathe and talk at the same time.
“Yes. You are breathing so fast that you will soon need to be intubated and put on a respirator; it will blow air into your lungs for you. Otherwise, at the rate you are breathing now, you will simply tire out and not be able to breathe at all.” I said this while holding his hand and using what I hoped was a really concerned voice and manner. I was careful to maintain longer than normal periods of eye contact in the hopes of communicating sincerity and concern. I was trying to use my eyes to communicate a horrible truth yet do so with caring. I hoped that my eyes could say more than simple words.
“Do you mean that I will die without it”? he said.
“Yes, that’s exactly what I mean.” I said.
I gave Steve some time to think about all this mind-blowing stuff. I left the room to check on my other patient and get myself together.
I brought back an instrument that would monitor Steve’s oxygen saturation with a little probe placed on his finger. The saturation should be at least 90, Steve’s was 60. I was actually amazed that he was still sharp enough mentally to communicate with me with a saturation that low. I told Steve about the numbers (his heart rate, saturation and respiratory rate); I explained what they meant and left the conversation open so he could feel free to ask questions.
Finally, he said, “Pat, what is it like to be on a respirator”?
“Oh, God, Steve, you really ask hard stuff. I’ll explain what usually happens. They give you a drug in your IV (intravenous line), like valium, to help you relax and tolerate the tube being put down your throat into your trachea. The tube is large, and it can be a terrifying experience that makes you choke and buck the tube being in there. It makes you feel like you can’t breathe even though it helps you to breathe. You will feel a strong urge to pull it out. A balloon is inflated at the end of the tube to hold it in place, then the tube is taped to your mouth to secure it even further. Many patients need to be kept sedated the whole time the tube is in, but there are some that can just lay there and let the machine ventilate them – this happens less frequently.”
“After they get the tube in they hook up the machine to give you air”? Said Steve panting.
“Yes, that’s right. Another thing is that when you are under the influence of drugs like valium, you can no longer consent to your own treatment because your thinking is altered.” I stopped allowing questions before I went on. I could see his mind going around and around. So I changed the focus for a while and asked,
“Steve, you said you have reason to believe that you have Aids. Were you ever tested”?
“Yes, it was about 2 years ago, and they said that I was a carrier. They said that I didn’t have Aids yet. I went on with my life and tried to forget all about it because I couldn’t deal with it”. He said looking down at the bed.
I left the room again because I was finding it hard to deal with it emotionally myself – I needed to break away. I told him I’d be right back.
As I left the room, I was greeted by 3 young women (around Steve’s age). They asked if I was his nurse, I said yes and could sense that they were very concerned. I took them down the hall to a vacant room so we could talk. After assessing their relationship with Steve I knew that they were quite sincere. They said that they had gone to grammar school with him. They always knew he was gay; they loved him and were close friends.
They were not surprised that he thought that he had Aids. I explained that he was seriously ill right now but hesitated to go further without talking to Steve about what information was OK to share with them.
I went in and asked Steve, “There are 3 ladies here to see you who seem very concerned about you. They are asking me questions and I want to know how much or what you want me to say to them”.
“Pat, they are as close to me as family, they brought me here. You can tell them the truth just as I sense you are doing with me”.
“OK Steve, I needed to know that. How are you feeling”?
“Well, he said, I am starting to feel really tired like you said.”
“Steve, we are going to be doing a blood gas in about 10 minutes to see how your breathing is. It will give us more detailed information than this oximetry.
“Pat, I don’t know what to do, I don’t know if I want to go on that respirator and be drugged up. Will it make me better”?
“We don’t have the HIV test back yet so at this point we can only go on what you have told us and how your condition appears. If you have Aids, it will not cure the Aids, it will certainly temporarily make you better by giving you the oxygen you need right now. It will prolong your life by forcing air into your lungs since you are too sick to do it for yourself”, I explained. “I want to try the respirator, I’m tired now and I want to try it overnight because I am so tired and it will let me get some rest, especially with the drugs, then in the morning, I will feel better. In the morning I will take off the respirator and see how I feel. It will be better to make such an important decision when I am rested”. (Steve said between taking little puffs.)
“Oh my God, Steve, we have so much to talk about and so little time to do the subject justice,” I said, wondering where to begin in telling him that you can’t just “try” the respirator. Cases about taking people off respirators are very involved and our society has not dealt with the realities that this technology is posing every day.
Just then I saw an older black man outside the isolation door peeking in. I went to the door and asked the man who he was and he said he was Steve’s father. I asked him to wait a few minutes.
“Steve, your father is here. What do you want me to tell him?” I asked.
“Oh God, Pat, I haven’t spoken with my dad in 3 years. He doesn’t understand my lifestyle and he just couldn’t understand – so we haven’t seen each other in 3 years.” Steve said with true sadness in his eyes along with tears.
“Do you want me to explain what’s going on”? I asked.
“Yes, I guess so, but how about saying that I just have Aids Related Complex not actual Aids”? He asked already sensing what my response might be, and with a smile shook his head “no”, meaning to tell him the truth.
“Steve, the problem here is one of time, if you go on the respirator, you won’t be able to talk because it pushes against your vocal cords on the way to your trachea. So, we have to gear our actions to fit the time you have to communicate verbally. You can write while on the respirator, but we have to untie your hands first. Before he had a chance to ask me about that I realized that I left that out and said. “Oh God that’s another thing about being on the respirator, most hospital policies dictate that the patients’ hands must be tied to prevent them from pulling the tube out – its uncomfortable and anyone would want it out”.
“Ok Pat, I realize this is a lot of work and stuff for you too. Let’s deal with my dad as you said time is important. I can ask him to make the decision for me. Oh God, I forgot my dad is terrified of hospitals, he lost a couple of relatives in them and hasn’t been able to go back into a hospital in 20 some years. It must be really hard for him to be here”, Steve said with understanding in his eyes.
“Would you like me to talk to him first to help him to deal with it? Maybe with help and support he will be able to cope. Do you want me to be honest with him?” I said wondering how I was going to care for my other patient, who was now on autopilot because of my being with Steve so much.
“Yes, Pat, be honest, you’re right, time is important and I really love my dad. I’m so glad that he’s here. You know all sons want desperately to be accepted by their fathers.” (He said, moving me to tears.)
I went out of the room, told the father that I had to check on my other patient, but that I would be back and speak with him at length in a few moments.
I went to the charge nurse and explained what was going on. I told her that the patient didn’t know yet whether he wanted to go on a respirator and thought he could maybe just go on it for the night – she realized I had a lot of explaining to do. The other nurses could hear me and were all supportive – to my surprise. One of them said she would watch Eleanor for me (my other patient who was already on a respirator with no chance for survival). So I went to speak to Steve’s father with my heart a little relieved.
I brought Steve’s father to a room down the hall that was vacant. We sat down and he immediately told me that he did not think that he could go in the room. He explained his horror of hospitals. Then he asked, “What’s wrong with Steve, nurse?”
“I understand from Steve that you and he haven’t spoken in 3 years. Is that right? I asked.
He nodded, “Yes”.
I proceeded. “Steve said that you don’t approve of his lifestyle, so you know that he is gay?,” I asked.
“He never really told me. We didn’t talk much about it but, I suspected that it was some crazy things like that. I don’t approve of them funny guys – you know that stuff is sick and its just not right.” (He said getting obviously angry just at the thought of gays.)
I could see I was not going to change his values at this time and that wasn’t my goal anyway. My goal was to get Steve the support he needed to make the decision that faced him. My goal was to help Steve to have a peaceful death whether on a respirator or not. So I proceeded with great caution.
“Mr. Smith, (not his real name) Steve is pretty sure that he has Aids; the reason he is in intensive care now is because he has a pneumonia that seems to be of the type that Aids patients get. Right now, his breathing is very bad. He will probably need to be put on a respirator because he won’t be able to maintain his life breathing like he is now,” (I said holding my breath to see how he coped with it.)
“Miss nurse, its so sick to think that my own son has that disease. I don’t think I can go in the room,” he said.
“Mr. Smith, Steve got tears in his eyes when I told him you were here. He told me how he has missed you since you two stopped speaking. He said that he loved you very much and that he knew how hard it must be for you to be here since he knows how hospitals affect you. Steve really needs you right now. I will try to help you to go in the room. I will be with you and answer any questions that you have. Sometimes understanding things can help you to cope with them, even things this bad,” I said, hoping to reach him.
“Can I get that Aids thing if I go in there? I’m scared of that, too. And what do I say to him. No, I can’t do it, I just can’t go in there. He will have to handle this himself, he got himself into it. It’s not my fault he got this sickness,” he said, getting up and pacing. I sensed that I better grab him somehow now, or he would be out of here.
“Mr. Smith, this is hard for me to say but I feel that I must. Steve is dying. Even with the respirator, Steve is going to die in the very near future. I know he loves you very much. You two don’t have time to let anything get in your way. I think he would feel better dying if he thought that you two had mended things. Perhaps you could just go in once, just seeing you here would make him feel better,” I said, thinking that maybe I sounded like I was begging and feared it would turn him off.
“Miss Nurse, will you really go in with me? Will you tell me what to say? Will you let me cover myself up so I won’t get Aids,?” he asked, with an overwhelming nervousness in his voice.
“Mr. Smith, I will give you all you want to cover yourself. Come with me, and we’ll get you dressed,” I said, as I led him to the isolation cart.
We got him dressed with a gown, hat, mask and gloves. (I had nothing to cover and protect his heart, though). We went in the room together. Steve was sleeping so I had a few moments to explain the things in the room and what they were all about. I wanted him to feel safe at least with the physical environment.
I touched Steve’s hand and said, “Steve, your father is here.”
“He’s here in the room? He’s right here you mean,?” he said, so tired that he could barely see.
I took Mr. Smith’s hand and guided it toward Steve’s saying it’s OK to touch him. He did take Steve’s hand. Thank God.
“Dad, I’m so glad you came. I know this is really hard for you. It means a lot to me,” he said, clutching onto his dad’s hand.
“Its OK, son. I’m wondering how you are doing?”
I sensed that it was OK for me to go, to give them time together. Steve had done a great job of breaking the ice.
I said, “I am going to give you two a little time to talk while I go see about getting Steve’s blood gas done. I’ll be right back.”
I left the room and came across the 3 ladies who were Steve’s friends. Now they wanted to talk. I explained that Steve thinks that he has Aids, and it looks like he has the type of pneumonia that goes with it. They were not surprised. They totally accepted his being gay – it really didn’t matter to them – they said they loved him. I explained the seriousness of the situation and told them about Steve’s not knowing if he wanted the respirator or not. I explained that I still had to discuss it with him further, but that his dad was his priority now.
They were shocked that his dad came, they were aware of that situation. They were very glad that I was able to get him in the room. They said that they would do whatever was necessary to help Steve; they would stay at the hospital and really be there for him. They said that whatever Steve chose was OK with them. I was happy that Steve would have a support system.
I had already told the respiratory therapist that Steve needed a blood gas done, but she was very busy down in the emergency room. I knew I had to remind her and I did. Actually, I hoped that she would be delayed a long time because I needed time to give Steve all the information he needed to make his decision. Steve’s dad had left the room and was sitting down the hall. The 3 ladies were in with him now. At least he got to talk to his loved ones before we got the bad blood gases.
As I was trying to get some charting done a heavy-set black lady approached me. She said, “Are you, Nurse Pat?
“Yes, I am, Pat Anderson. Can I help you?”
“Yes, I’m Steve’s aunt, his mother died when he was a baby and I raised him as my son. Can you tell me how he’s doing?,” she asked.
“Sure I can,” I said, as I led her down the hall to the empty room where we sat down.
“What’s your name?,” I asked.
“My name is Jones (not her real name), but call me Dorothy, dear.” She said.
“Did you see Steve’s father in his room? I asked.
“No, my God, he’s here? I’m so glad to hear that,” she said, with obvious surprise.
“Have you seen Steve lately? What has your relationship been like lately?,” I asked.
“I talk to him on the phone all the time and he visits me at least once a month. We are very close, so I know that he is gay and I accept that. What is he in intensive care for?” She asked.
“Steve told me that he has reason to believe that he has Aids, he was tested 2 years ago and told that he is a carrier. He told me that he has been denying the whole thing ever since, but he became so short of breath last night that he had to come to the hospital. It appears that Steve has the type of pneumonia, called pneumocystis, that Aids patients usually get. I explained.
“Is it real bad? Could he die? Oh my God, I have to see him. Said Dorothy, now terrified with tears streaming down her brown face.
“Before you go in I need to talk to Steve alone to discuss the blood gas that was done to check on his breathing,” I said.
The blood gas was horrible – so bad that I didn’t know how he was still alive. I went in to talk to him. I asked the ladies to leave and they did. I began by telling him that the time factor was getting down to the wire.
“Steve your Aunt Dorothy is here, I will let her in but I need to talk to you alone first. Your blood gas shows that you need the respirator or you will die very soon. Have you thought any more about what you want us to do for you? I asked.
“Pat what do you think, what would you do if you were me? Can it make me better? Can I just try it like I asked you about before? I don’t know what to do.” He pleaded.
“Steve I can’t tell you what to do, you must decide, your life belongs to you. I can tell you that you cannot just try the respirator. Once on it, it can take a court order to get you off of it. Have you heard about cases like the Karen Quinlan case where people end up in the courts to get people off respirators or to stop tube feedings? These are complex issues. Our society hasn’t really dealt with these issues yet but I know you can’t just go on it overnight. Remember, once intubated, if you are on drugs you will relinquish the control over your decisions. Remember that your hands will be tied, you will not be able to eat or speak, and if you do have Aids, which you think that you do, you will possibly never get off the respirator. I say possibly because no one can know for sure how a patient will do.” I said.
“Pat, what would you do? I could die on that machine. Since I have Aids I’m going to die anyway. He said.
“I feel obligated to tell you what being on the respirator is like. There are some patients who can get better, get off the respirator and breathe on their own again. I want you to know all the possibilities. It is possible that you could go on it, not need drugs, and get better in an unknown time span. I can tell you what I know about other hospitals and how they deal with Aids patients. St. Joseph Hospital in Chicago is the Aids center for our area. They do not intubate their Aids patients; they do not send them to intensive care. Those are their policies. They think that since they cannot yet offer a cure they should not painfully prolong their lives. On the other hand, Cook County Hospital does intubate and ventilate their Aids patients. Steve, there are no “right” answers. You must go on with what your guts tell you. I just don’t want you to think that you can easily get off once you go on. I want you to know what a big decision this is.” I explained.
“Pat, you seem like a real strong, caring nurse. I somehow know that you are sticking your neck out for me because you care. I feel that – thanks.” (He grabs to hold onto my left hand in addition to the right one).
“Steve I think I am just doing my job being honest with you. I believe in your right to choose with all my heart. If you really must know what I would do, I will tell you that I would not choose to be on a respirator IF I had a terminal illness. We don’t know for sure whether your illness is terminal or whether it is at a terminal stage. After all these years of caring for people on respirators, I know I would not want it for myself or for anyone I loved who was terminally ill. You cannot do what I would do though, you must make your decision to fit your values. I should not be telling you what I would do. What I would do doesn’t pertain to you. My conscience will probably make me pay for telling you what I would do. I will be supportive of whatever decision you make. I’m afraid that you need to make it soon though because things are bad with your breathing, and I need to discuss all this with the doctor right away.” I said.
“I want to talk to my aunt and my dad before I make my decision – OK?” He pleaded.
“Sure, Steve I will go and get them.” I left to get them.
While they were in with Steve I told the other nurses who were in the nurse’s station about his asking me what I would do and I told them that I did share my own personal feelings with him. A male nurse, whose opinion I do NOT respect, from working with him before, said I was horrible for telling him what I felt. He said I was a disgrace to nursing and went on and on yelling at me. I held my tongue for a while, listened, and decided that he was not putting on this show of morals with my patient’s concern at heart; he had not recently spent 2 1/2 hours with this man. I looked him straight in the eye and told him to shut up -it was none of his business. I was not in a popularity contest, I had no idea beforehand that I would judge that a patient needed this type of honesty. I was terrified that I could be wrong, I was so emotionally affected by the situation I could make an error in judgment, but my guts told me that things were going right.
I called the doctor who was assigned to Steve (he didn’t have one when he came to the hospital – so he was assigned a doctor). I told her that Steve was debating whether or not to go on the respirator. I told her about the blood gases and the rest of his assessment too. She was very short with me on the phone, and I could tell she was not pleased to be involved in this situation.
She said, “Well, he’ll die soon and if he’s not a “Do not resuscitate” by the time he stops breathing we’ll have to code him,” she said.
In other words, I better hurry up. If a patient codes (his heart stops beating or he stops breathing) without a DNR (do not resuscitate) order we are legally obligated to do everything to try to save his life, including intubation and placement on a respirator. Then Steve would not have a choice.
I went in to talk to Steve with his father and his aunt in the room. We talked for what seemed like 6 hours, but it was probably only 15 minutes. Steve vacillated between going on the respirator because his dad initially said he should try all that he could to live, to doing whatever his aunt and dad decided, to realizing that he must make the decision. Steve finally told me that he didn’t want to go on a respirator. He said that he had lost control of his bowels and urine – that was killing him. He was going to stay in control of his breathing. He couldn’t lift his fingers to write because he was that weak. I saw that if he took his oxygen mask off for 30 seconds to take a pill his heart rate went down to 40 and his eyes started to roll back in his head. He talked about all these things and decided not to be intubated.
He said he had a lot he wanted to say to his father, his aunt, and especially to his lady friends. He said that he decided to take the time he had left to say things that were important to the people who meant life itself to him. His father and aunt soon came to agree with Steve’s decision.
I called the doctor to let her know about Steve’s decision so she could give me a DNR order to make his choice legal. She was very angry with me and said, “What did you tell him? Why did he decide such a thing? I want to speak to him and his family right now”.
I went in to tell Steve and his family that the doctor wanted to speak to them about Steve’s decision. I brought the portable phone in the room.
Steve was not very interested in speaking to the doctor, nor were his family. They said that she only saw him for about 5 minutes during his stay at the hospital.
The doctor called the isolation room directly and spoke to Steve himself. I, of course, could only hear his responses to her. He told her that he did not want to be on a respirator. He said he would only try it overnight so he could get some rest. He told her that I told him he couldn’t do that because sometimes people have to get court orders to take someone off a respirator. He said he didn’t want to change any type of involvement like that over what should be his decision. He said that Pat, his nurse, had spent a lot of time with him explaining what it’s like to be on a respirator and that he has decided against it.
The doctor must have asked to speak to the aunt because Steve handed the phone to her. The aunt said, “Pat has explained a great deal to us and we agree that Steve should be the one to decide in matters involving his body. The doctor said something and the aunt responded, “Yes I would agree to an order not to do emergency stuff to him.” She said to the doctor, then handed the phone to me.
“What’s your name?” the doctor asked.
“Pat Anderson,” I replied.
“Just who the hell do you think you are telling him that you need a court order to get someone off a respirator? You should never tell a patient anything like that,” she barked.
“I explained to Steve that going on a respirator is a big decision. I think patients have the right to know what they may be facing. How could I, given that I had the opportunity to explain things to him, not do so?,” I replied.
“You are not an attorney, so you cannot advise patients about the legalities of medical care. I will be reporting you to the hospital administration in the morning,” she said.
“I am qualified to tell patients the truth about being on respirators because I have spent 20 years working in hospitals. I do know that you don’t just put someone on a respirator for the night and they don’t just take them off because they change their mind – it’s not that simple. I don’t need to be an attorney to know that. I was telling Steve about possibilities. I explained to Steve that the issues posed here are very controversial. I shared my experience in these matters with him,” I asserted.
Steve’s aunt grabbed the phone before the doctor could respond, “You listen here doctor, this nurse, Pat, is HERE with us. She is not giving us any bullshit. She is HERE with us and we FEEL her concern for Steve. We will listen to her – not you. So you give her that order to let his heart stop and leave us alone,” she said with passion in her voice.
She handed me the phone and the doctor said, “Write the DNR order. I will be reporting you in the morning,” she said with fury in her voice and hung up on me.
I called the doctor back to have another nurse witness the DNR order as this doctor did not exactly inspire trust in me.
I went back to the room and the family apologized for the doctor talking mean to me. Steve said, “Pat I knew you were a strong nurse and I knew you were not doing things by the book. Thank you,” said Steve.
The aunt and father went to get coffee. I helped Steve change his wet diaper, helped him to take a pill, changed his position in bed, and asked him what his understanding was about the DNR status.
“I’m not totally clear but I’m sure it is OK,” said Steve.
“It means that if your heart stops or you stop breathing we will not pound on your chest, we will not intubate and put you on a respirator, we will not use electricity to shock your heart, nor will we use emergency heart stimulants to force your heart to pump. We, however, will take care of you, we just don’t do heroics. We take care of your needs to the point of not forcing you to stay alive after your body has given in to disease,” I explained.
“Pat that sounds beautiful to me,” he said, as he held both my hands to his heart.
“Well, I’m getting out of here now. I will let you do that talking you said you wanted to do. Your lady friends have been waiting to get in here to be with you.” I said as I left the room smiling at him. He smiled back weakly. I can’t describe the eye contact between us – it pierced me to the core with its meaning.
I told the ladies to go ahead in. I explained that he had told me that he had things he wanted to tell them – things he always meant to say – he would say now.
I saw his aunt and father down the hall and told them Steve wanted to talk to them in a little while when the ladies left.
I peeked into the room about 20 minutes later and was touched to see Steve talking 100 miles an hour and trying to breathe 60 times a minute all at the same time. Tears still come to my eyes when I picture the scene. The ladies were all physically close to him, one touching his foot while standing at the foot of the bed, one holding his left hand sitting next to the bed on the left, and the other one wiping his head with a cool cloth. They were laughing one minute and I saw tears well in their eyes the next minute. I sensed a profound joy and sorrow in the room.
Later the ladies asked me what would happen to Steve. They wanted to know what to expect as far as his death. They planned to be with him. I explained that as he got less oxygen to his vital organs his heart rate would probably slow down eventually to zero, then he would probably just not be breathing anymore. I could not say for sure that that’s exactly what would happen but I told them that that’s what happened when he took the mask off to take a pill, so I imagined that’s how he would die. They went to take a break – it’s very hard to stay with the dying patient; it is so emotionally draining that you MUST take breaks. I told them I would call them if I thought the time was near so they could be there with him.
His father and aunt had their time with Steve. I saw his father hug him so I think things were “cool” between them. Aunt Dorothy gave him T. L. C. (tender loving care) as I imagine she had done all of his life.
I went in to take Steve’s vital signs and give him some medications in his intravenous line. He said, “Pat I feel real good about things now. My father and I have fixed things, I told my aunt how much I loved her and those ladies and I rehashed old times from way back in grade school. I told them I loved them too.”
“Steve it’s against the rules to make the nurse cry – I think it’s written somewhere,” I said, feeling overwhelmed and trying to use humor to deal with it.
Steve smiled, I’m sure with understanding. “I can’t tell you how much your honesty has meant to me. I hope you don’t get in trouble. I know I have been denying my Aids, but somehow you have helped me to stop denying. I accept it now.” Steve could no longer hold his eyes open, I knew those were his last words.
Steve’s heart rate dropped at about 6:25 am. I called the ladies and the aunt to be with him. It happened as I thought it would, his heart rate simply slowed down gradually to zero and she had a last gasping breath. He died with peace, dignity, and his loved ones were near. Steve never knew that his father left because he couldn’t take it anymore.
I overheard one nurse tell another nurse, “Pat might be starting a new trend in nursing – being honest with your patients. Another nurse told me that she would not have thought to tell him that he had a choice; she would have seen intubating him as an emergency because of his bad blood gases. Some other nurses who heard her said that they would have just intubated him too. They told me I was brave to do such a thing. I realized that we were all taught that patients have the right to refuse treatment, we are not taught how to buck the system to help them to do so.
As I was leaving the hospital that morning about 8:00 am I ran into his aunt who hugged me for what seemed like 1 hour (I was so tired). She said thank you.
I left that morning feeling like someone had just vacuumed out my brain and my heart. I knew that this is what I feel and think that I do best in nursing – giving patients honest information, in the language they understand, showing them that I care and thus giving them real power over their health care.
Grade: A
Bibliography
Minogue, Jack. (1991, Fall). School For New Learning Class, DePaul University “Ethical Decision Making”
Weber, Leonard J. (1976). “Who Shall Live? The Dilemma of Severely Handicapped Children and Its Meaning For Other Moral Questions” New York, Paulist Press.