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She died in the bright lights of an ED room

Published Jan 24, 2008 in Blog, End Of Life/Hospice, For Administrators. DON's, Nursing Homes

White Coat writes about his experience watching an old woman die in an ER. She had been transferred to the ER from a nursing home:

As I walked in to evaluate her, I could tell she wasn’t going to live much longer. She didn’t respond when we called her name and she didn’t move when I gently gave her a sternal rub. She had agonal breathing and wasn’t moving any air. I just stood there for a second. Everyone was obsessed with her being a DNR. This is a woman, for Pete’s sake. She’s a grandmother, maybe a great-grandmother. Someone’s wife. A next door neighbor. The one who always seemed to win at BINGO in the nursing home. Someone who baked cookies for the church bake sale.

Then my mind began to wander. What songs did she used to sing to her kids to help them go to sleep when they were scared at night? What were her fears? Did she know how to bowl? How many people have her picture sitting in their homes somewhere and will forever look at it differently after today? Did she have any co-workers? Would they even know she was gone? How long had it been since she cooked her husband’s favorite meal, waiting to surprise him when he got home from work? It was like I was subconsciously overcompensating for her being a “DNR” by thinking about all the things that made her human. A whirlwind of these whacked out thoughts kept running through my mind.

How often do we label our residents/patients by their diagnoses or diseases, or, in this case, their Living Will status?

This is haunting:

I stood there and watched her for a little while. I watched her take her last breath. I watched her heart generate it’s last electrical impulse on the cardiac monitor. It felt strange not to be calling out orders for medications and chest compressions. For some stupid reason the whole scenario bothered me. She died in the bright lights of an ED room and the only ones at her side were a doctor and a nurse she had never even met before.

Is there a lesson to be learned here? When I worked in nursing homes, far too often we shipped off very ill people who we knew were going to die; the nurses knew it, the aides knew it. Usually the defense for uprooting the resident was incidental and based on legal fears; one nurse used to often say “No resident is going to die on my shift HERE!” Whatever. As the doctor says, why do the ER thing? Can’t we just allow our residents to die in the setting they now call home? Even those with no family deserve better.

7 Responses to She died in the bright lights of an ED room

Holly

Published 25 January, 2008 in 8:09 am

I think they opt to send them out in hopes that maybe something can be done to prevent a death. From the sounds of this, the woman had been very sick for several days. She should have had treatment long before this final trip to an ED.

A bigger question for me is how come the nursing homes cannot manage people who are this ill but who are dying at the same time? It is cruel to transfer old sick people. They should just make them as comfortable as possible, call in family or friends, or staff even, to stay with them. Let them go in peace.

Donna Swicklik, RN

Published 26 January, 2008 in 12:26 pm

As an RN in wonderful skilled nursing facility, these situations are often frustrating. We are more than capable of caring for very ill and dying residents. We send residents to the ED when they have a treatable conditions that require the resources we do not have.

We feel strongly that our residents who are DNR’s and who are dying, should die with us - in their “home”. However, often family members who have the power of attorney (POA) panic and demand the resident be sent to the ED - even though they know they are going against the wishes of the resident. Often the resident then dies with strangers “in the bright lights of an ED room”

If it us up to the staff at the facility where I work, we would prefer to keep are residents with us where we know they will be provided with loving care through the dying process.

Heather

Published 26 January, 2008 in 4:43 pm

Thanks for your comment Donna.

I have to share Patti’s experiences with this; I too have seen nursing staff panic and make the call for a transfer to an ER. I have also seen families do the same, but the MD stops them before the call is made.

Either way it is too bad. No one should die like this. It’s an unfair world, full of unfair situations and realities. My other thought is why did this nursing home wait so long? A person with a high fever and other signs of infection need not wait four days to be seen, especially one who resides in a nursing home.

Patti

Published 27 January, 2008 in 10:06 am

What I see is nurses who panic, and it’s because of families. Some family just cannot accept the impending death of Grammah, so the nursing home feels compelled to ship her out just to “make sure”— and it’s really not right.

In this case it does sound like the facility should have done more sooner. I can’t say much though because of the lack of detail.

Cheryl

Published 27 January, 2008 in 6:19 pm

Oh that’s just a heartbreaking story.

I can’t say anything more. It should not have happened.

Stephen Russell

Published 28 January, 2008 in 6:26 am

I had the pleasure of working in skilled facilities as a CNA, I also had the opportunity to hold the hands of dying residents that were DNR in the ED. In the moment of panic, I too had experinced the family members go against the wishes of a DNR and request they be transfered to the nearest ED. How frustrating this can be for the staff. Our job as care takers is to provide the level of comfort during all medical emergencies and extend this passion to the family members as well. The greatest concern I had experience from family members, is wheter or not we the staff are providing the levels of comfort to their dying family member? The question I propose is, am I doing all I can with the gift that I receive to provide those measures of care?

Stephen Russell
ED-Tech

Holly

Published 28 January, 2008 in 7:11 pm

Hello Stephen,
I am sorry to say the answer is probably NO.

We try to do the best we can. But with the amounts of work expected, and the numbers of staff being asked to perform, it all cannot get done. The people who are close to death get the worst of it where I work anyway. There is no one to hold hand or just sit with one who is in the process of dying. If the family doesn’t come in, the person is pretty much on their own. I have gone in on my shifts off, days off, and held hand without pay as it was thr right thing to do. But then my own health suffered, and chores around my house did as well. So I stopped coming in on my own time.

Hospice isn’t a help either because they cannot provide someone to stay with the people either. They do good with controlling pain and things like it. But actually just being htere- no.