For the sake of protection, we’ll call him Bill. Bill was dying. Bill’s family knew it. The once vibrant, ox-like provider was laying in a hospital bed. And not doing well. The man who had endured everything from a impaling himself on a ladder as a volunteer fireman to being sprayed with boiling bleach in an industrial accident to living with a progressive neurological condition, an almost pseudo-Parkinsonian ailment, that sapped his strength and ability to do things for himself couldn’t even turn over. It seemed like he could not endure much longer. What had started as an altered mental status brought on by a raging UTI was turning him increasingly septic. That was how I got him the first night.
The day nurse reported that she had fought with his o2 saturations all day, finally resorting to a non-rebreather mask, cranked up to 12lpm that was barely keeping his sats above 90%. Not to mention he was tachypneic and febrile. A little tachycardic, but his blood pressures were holding well. But he had been basically unresponsive since about 1400. She had watched him slide and felt like she hadn’t been able to do anything about it.
I pulled up his labs. It didn’t look good. BUN and creatinine were rising, LFTs were going up, urine output was OK, but his ABG sucked. Acidotic, but he was trying to compensate. What he really needed was a tube and a ventilator. But as a DNR that was not in his future. I saved Bill until last on my first rounds of the evening, just knowing I would be spending a little extra time. Not so much with him, but with family.
His wife sat there at the bedside looking tired. I introduced myself and explained what I was going to be doing for Bill that night. She introduced herself as Betti, Bill’s wife of nearly 55 years, who had up until the last 6 months been his sole caregiver at home. Now Bill was not a small gent. Well over 6 foot, he would have hung off the bed if there wasn’t a foot board and well over 250lbs. Betti was a small lady, but she had wrangled him everyday until his condition deteriorated to the point where he could no longer transfer himself. The wear shown on her face, she had been through the wringer. We talked as I went about taking vitals and getting stuff sorted to where I was comfortable. I stopped thought and asked, “I know he is a DNR, but I wanted to make sure that was correct. It is right?” The last thing I wanted was to have people changing their minds in the middle of a situation.
She responded, “Oh yes, last thing Bill would have wanted was life with a tube down his throat. And we all have talked about it. The children are all agree, these are his wishes.”
We continued to talk, about the prognosis the docs had given her, the treatments we could do and the fact I was going to try to make him as comfortable as I could. You could see the weight lift off of her shoulders, no longer having to do it all herself. She told me how they had been sweethearts, no one had believed in them, yet here they were, together still. She spent the night resting on a cot at his bedside. I kept her supplied with snacks and hot chocolate and a friendly ear. The running refrain though was, “Yeah, I’ve seen worse, but I’ve also seen far better go quicker than anyone thought. The last thing I want to do is give false hope. He’s one sick guy, but we’ll keep at it, OK?”
Through the night Bill didn’t get worse, but he didn’t get better. He was still running temperatures in the 39C range and nothing would touch it, Tylenol? For about an hour. Ice packs? Nada. I think we would have burned out an Arctic Sun machine with him. All the time his respirations were running 35-40 a minute. He was blowing off CO2, but the wear was telling. Every now and then when I talked to Bill he would open his eyes briefly, almost as if to say he was still there, or that maybe he recognized my voice, or thought I was someone else. I always let him know what was going on, even if he was out of it, he needed to know I felt. And so it went that night.
I gave report and went home. When I got back, things had not changed much. But I felt something in me. Call it the power of the spirit, or the guidance of a higher power, but I knew I needed to get Bill ready. Betti, who had stayed all day decided to go home. In fact I encouraged it. I told her, “You need to take care of yourself too y’know.” She nodded wanly, tired. The weight had been put back on her over the course of the day. A family friend offered to stay the night, to which I added, “Should anything change, we’ll call, ok?”
I felt helpless though. There was nothing I could do to stop the inevitable. I knew it, the inexorable slide had commenced. No amount of antibiotics I could give would change it, no treatments, therapies or medical miracles could stop the process. Bill and his family had made their choice. In my head I commended them for their strength. Too often, the resolve changes. While a loved one sits at the door, they decide to throw the weight of modern medicine against Time. Time always wins though. But not Bill and his family. They knew he wasn’t going to be here much longer. While I couldn’t facilitate the “fixing” of him, I could give him every ounce of comfort I could.
Somewhere along the way I got bit by the bug to give Bill a bath and a shave. I knew family would be there the next day and I wanted Bill to look good for them. I can’t explain the why of it, just that I knew it was something I had to do. Getting him ready for a trip.
So we did just that. Got him cleaned up right good. I even took the time to shave him, something I hadn’t done since school. He was fluffed and buffed, ready for the day.
As I left at the end of my shift, the friend pulled me aside and said to me, “Thanks for doing that, especially before his son got there last night. I understand why Betti was glad you were here tonight.”
That made it all worth it.
Now, I kind of alluded to above, but I’m not particularly religious. I believe in God and that mankind has an innate need to fulfill the expression of the spirit and that takes many forms. But that night, I felt something. Maybe it was the connection to the family. Maybe it was the compassionate nurse in me. Maybe it was born of exhaustion and doing what I did gave me a way to “neglect” my other patients for awhile. I went home feeling better than I had in weeks. I felt in some small way I had touched Bill and Betti’s lives and they knew it it and responded in kind. Maybe it was something spiritual working through me. I don’t know, but whatever the case was, I’m glad I got to experience it.
Bill departed on his trip later that morning, surrounded by his family, in peace. and comfort.