Tuesday, November 6, 2007

How low can you go

So I'm going around doing my oxygen rounds (for the RT students, this is the fun time you get to check on all the patients who were or are on oxygen, mainly for charging purposes and sat checks), and I come upon this patient who has been in the hospital for awhile and notice that she looks awefully purple grayish in color, especially her lips. Now mind you this is in the middle of the night so the lights are off of course its 4 am. I proceed with my check by saying "Mrs. Namewithheldduetohippa I need to check your oxygen saturation levels" for which she complies and gives me the regulation oxygen check finger into my pulse ox device. After looking at the flow meter to see what flow she is on I look at the pulse ox and WHOA it's 52%!!!! So quickly I turn on the light, damn she really is purple grayish and not red in her lips at all. This lady has been on a 10-15 liter high flow nasal cannula and she had decided to take it off. I then ask her if she had been the one to take it off, she replied "Yes I did, I'm going to be a hospice patient and I cannot go home with this much oxygen on." So I go into my RT talk as to how with that low of oxygen in you blood you can cause damage to your heart and brain, along with a large increase of CO2 you your blood you might not wake up. Then I get the stunner "That's the point, I don't want to wake up. My lungs are really bad and I'm not good to anyone anymore, I don't want to be a burden on anyone, I'm just ready to let go and die." she says. Ok I'm a little shocked now and trying to figure out what to say next. How do you go about trying to lighten up this situation and help a dying person think they are worth being alive to people. Yes she is in bad shape but with her lungs, but her mind is in perfect shape and no she cannot run around with her grand kids in the yard, but she can talk with them, tell them stories. So I tell her, "You are not burden to us here, thats what we are here for it to help you out, and besides I enjoy talking to you and so does other people I work with so I'm sure your family enjoys just having you around to talk with." Not sure how much that helped but the nurse chimed in and added some more encouragement. So after this discussion with her I rechecked her sats and they were back up to 86% after about 15 minutes. This person is a great patient to have, had never complained or given anyone a hard time and yes she is enjoyable to chat with during treatments but yes she is past the point to getting well she was a 50 pack year smoker who was told 10 years ago that her lungs were bad and decided not to take the warning and get some help and now it's to late and she knows it.

How do you talk to patients like this, they are at the end of the line and they know it. I don't know it's just a bit surprising when something like this comes around, you never expect people to tell you that they are ready and want to die and they are being serious. This is a subject that comes up in our profession due to respiratory being involved with very ill patients but it's a population we have to deal with. Along this same line we deal with turning off the ventilators with patients have not chance to recover and are brain dead, these thoughts are very well explored over at Keep Breathing in a post he had about doing a terminal wean. I once worked with a RT who would refuse to do a terminal wean, he couldn't handle it personally and religiously... I don't think he is a RT anymore.

Once again it takes a certain type of person to do a medical job and it's not for everyone, but sick and dying people need this type of person, compassionate. That's what I would hope for if I was in their shoes.

Drive on RT's.


Anonymous said...

I'm bad at talking to people like that. I like to think I'm good at explaining the technical aspects of things, but talking to people about big life issues...what do you say? All of that stuff is such a personal decision that I feel like saying anything to them as an RT crosses some sort of line.

Hairy situations all around, I tells ya. And thanks for the link, BTW.

Djanvk said...

I agree, but you hate to say "let me get your nurse" because then I feel I'm blowing them off.