Not long ago I was blessed to care for an incredibly brave woman. Not that most of the patients I care for aren't brave but this one was different.
She came to the ER because she was "turning yellow". She was in her 80's had already suffered and mostly recovered from a stroke a few years earlier. She had just a few minor residual effects from that stroke. In the ER they did a scan, admitted her to the general med floor where she stayed for 3-4 days. She learned during this stay that there was a mass on her pancreas. Not only was there a mass, but she had cancer, it had already metastasized to her liver and basically she was told there was nothing they could do for her. She was not a surgical candidate and really it was too far already to start treatment.
The family all gathered around and took shifts staying 24/7 with their mother as the doctors worked to find ways to improved her quality of life. To see if there was anything that could be done. They changed her to a DNR, and were making plans to take her home to die at home.
Issues. . . her INR was off the charts!! I am not sure I have ever seen one this high. We were giving her Vitamin K to help reverse it and decrease the chance of spontaneous bleeding, but it was not working. After several doses of Vit K the INR results were left unchanged. Her liver was not functioning enough to make the clotting factors needed to bring the INR back down. The original plan was to get the INR down and send her home.
The night I cared for her, was crazy. I had the Resident on speed dial and he spent many hours talking to the family, and on the phone with me. The patients IV went bad. We were giving her fluids to help with her blood pressure because it had been so low, she was also receiving antibiotics through the IV. I pulled the bad IV with the intentions of starting a new one, however that didn't work out. When the bad IV was pulled, the bleeding started. I held pressure on that spot for literally one hour! That is not a good thing when you have 3 other patients on your assignment. I called for help from another nurse who tried to start another IV while I held pressure on the bleeder. He tried twice to get the IV and both times the vein would blow then more bleeding. The doctor was called about the IV site problems then came questions from the family. I spent many hours at the bedside of this sweet lady. Comforting her, answering questions and trying to help them make sense of this sudden diagnosis and what to expect. They were a very attentive family. They loved her very much and that was evident. They wanted to make sure we were doing everything possible. They were fine letting go if that was the only option, they just wanted to be sure. They were scared, and I could certainly understand that.
She didn't get much sleep that night. It seemed there was a reason for me to be in that room at least every hour. Then when morning came and it was time to check vitals again, her blood pressure was 70/40. At this point I again called the in house Resident. We both thought there was probably internal bleeding going on. It only made sense. When the patient saw this blood pressure on the Dinamap, she looked at me as serious as could be and said, "I'm dying aren't I?"
HOLY COW!!! What am I supposed to say to that? I sat on the corner of her bed, held her hand and as gently as I could I told her the truth. That is what she wanted. I told her that the blood work was not good. I explained about the INR being high, I explained that the blood pressure wasn't good but that we were going to see if we could get it up. I also told her that as she knew the prognosis wasn't good. This was not new news to her. However I didn't think she was going to die today. Her daughter looked at me with tears and asked if they needed to get her other children in town. Some of them lived out of town and even out of the country. I told her daughter that it would probably be a good idea, however I nor the doctors would be able to tell them when she would die or how long she really had. That was up to someone much bigger than us. The patient squeezed my hand and thanked me for being honest with her. She said she already knew all of this but still felt she needed to ask.
My heart was breaking. She was so sweet and was so brave. She laughed and joked and told stories and treasured the time she had with her children. If she herself was fearful at all she certainly didn't show it. At one point all the family had stepped out of the room for one reason or another and the two of us sat on in the room, just us, and I prayed with her. I prayed that God would give her strength, that He would ease the pain she felt and keep her at peace with what was before her. I prayed for her many children and grandchildren that they would be able to handle this journey as well. That they would hold on to all that was good about their mother. We together prayed for safety for the children that were traveling. I could tell this was difficult for her, however she faced it with such courage. Not letting on that if there was one ounce of fear.
She went to the inpatient hospice unit the very next day. She knew she would never again see the inside of her home. She knew that this was where she would spend her final days with her children and grandchildren by her side. She was resolved that this was what was left of her life here on earth.
She lived about a week longer. Honestly, it was a week longer than I expected. She passed peacefully with her family at her side. She savored all the moments she could with each of them until God decided it was time.
I will never forget her smile. . . her courage.
I go to work thinking that I am there to help my patients, to care for them and hopefully bring some form of healing to their lives, their bodies. What I learn is, that most days, the patients that I care for are really bringing some form of healing to me. I take a piece of them with me at the end of my shift. Whether it be the patient who is dying, the one who has tried my very last ounce of patience, or the one that is a simple post op that will stay 24 hours and go home. I learn something from each of them. And, my heart is forever changed. . . . on a daily basis!