Tuesday, February 11, 2014

Status: No-Code

I am sure that some of my readers look over at the Blog List on the right side of the page and ask, "What the heck does he see in 24hourcampfire?"  I see gems like this.

Posted at 24hourcampfire by Dan Chamberlain.  Reposted with permission from the author

I don't build anything. I don't craft or create anything. I don't sell anything, or drive anything or make your money work for you. Just like everyone else who works, there are times when I hate my job; times when it's bearable and times when I wonder how in hell I ever ended up here. Then there are times when my heart breaks. I'm an oncology nurse.

Over the last couple months, I've had occasion to take care of an elderly cancer patient who has come into the hospital half a dozen times. He was a fun old guy with something growing in his lungs that modern medicine can't cut out or stop from growing and while he was always in good humor and fun to talk to, things were progressing a little faster than he was aware would happen.

His wife, always struck me as a bit cold and distant. In the time I took care of her husband, she probably didn't say a dozen words to me, other than to ask questions about what I was doing, what treatment he was getting, what I was hanging on his IV pole; tests being run etc. Never a smile, never really a thank you or other expression you normally see with elderly people brought up in a different time when service was acknowledged.

I realized now, that she was just too damn scared of the future without her Jimmy.

Yesterday, he started his final decline. There won't be any discharge this time. He's in the hospital and this is where he will remain. His wife met me in the hall in the afternoon that was so busy I didn't have time to think. She came up to me and asked if I had a minute. Hell, I didn't have 20 seconds to spare, much less a minute, but those old instincts kicked in and I took a deep breath and made it a point not to look at my watch.

She told me that she knew the end was fast approaching and she didn't want her husband to suffer and asked what I could do to help. I told her that he needed to change his code status so that if he slipped away, we could let him go. As it was now, if she faded, we had to do everything we could to revive him. She asked if I'd talk to him about it. So I did. You can imagine this is a delicate conversation, but in this case, I'm thinking Jimmy was ready to face facts.

We went over the options and he elected to accept no code status. If he slipped away, we would let him go. When he said it, I told him I'd get the order in his chart and we'd transfer him to a private room and I patted him on the shoulder and started to walk out of the room. His wife said: "Thank you...thank you...bless you." You can imagine how difficult that was to endure without letting that old dam of stoicism break.

My shifts are 12 hours long. Last night was 14. It was a biotch of a day! So, after I got all my charting done and all I could think about was getting out the door, I went back down the hall to say good night to my patients as is my practice. I saved his room for last.

He looked comfortable; gone was the expression of struggle and fear. He'd accepted that life had an expiration date and knew his was up. His color was better and he was breathing easier. I told him I was off for a day and I'd see him on Wednesday. He said maybe not. I said he'd have to put up with me for a little while longer. He asked: "You think so?" I told him I was pretty sure of it.

His wife had changed completely. That cold, aloof, distant woman was now like the best matronly grandmother one could imagine. Her dam of self control and steel had finally broken. Acceptance has a way of doing that. They were both finally comfortable with what the future held and all that reserve I'd seen before was just a way of doing battle with that damn disease and coping.

So, yesterday was one of the worst days I've ever had as a nurse, but not because of these two people. It was because of the other self-serving, selfish patients who wanted to be served like royalty for little things like stomach bugs and headaches, while just down the hall a nice old gentleman was contemplating his impending death and saying goodbye to all that he'd come to love and cherish.

He didn't make the day suck. Patients like him make it a lot easier to contemplate going back to work after a day of rest.

I'm hoping he's still there on Wednesday, but part of me hopes he isn't. Part of me hopes he slips away, with that nice old woman holding his hand.

No comments:

Post a Comment