Updated: Feb 7, 2020
(Caution: some sensitive topics)
I am standing next to the wife of a severely demented and now delirious man that is clearly losing his grip on life. His last few years had been changed by a recommended spinal surgery that he never truly recovered from. His mind lost in the fog of anesthesia, pain medication, or the possibility that during surgery he had not received enough oxygen to his precious brain. No one will truly know why he never regained his mentation, although much of his loss of cognition was suspected from the surgery. At this time, he lies in bed, unable to recognize his wife, strapped, and drugged into submission.
They have been married for 60 years, and his wife can not begin to fathom her life without this man, even if for the last several years, he has been more of a shell of the man she once knew. She is struggling to make a decision whether she should stop intervening with his imminent death. She is desperately seeking advice, seeking for someone to tell her what to do. She does not want to be the one to make these impossible decisions. She looks to the physician to guide her. The physician states that maybe if her husband was able to take some of his medications for his cognition, maybe that would help him “recover.” But, recover to what?
In order for him to take his medication in pill form safely, we must insert a nasogastric tube. This is described by the doctor as, “simply put a tube into the nostril, down through the esophagus, and into the stomach.” This bypasses his weak swallow, and reduces the risk of pneumonia caused by choking on food or drink contents. Up until this point, because of his weakness, we have restricted him from eating or drinking anything, including water. He is receiving IV fluids, but nothing combats a dry mouth and shrinking tongue. Yes, that’s right, when a person’s mouth becomes extremely dry, the tongue shrinks to about half the normal size. He is also being restrained and heavily sedated because while he is awake, he is so full of fear that he begins kicking, punching, and attempting to bite anyone that touches him, including his wife. When patients come to the hospital with an illness and they have even mild dementia, they are at very high risk for becoming delirious. In my opinion, delirium is the body's way of coping with stress. This can be either a blessing or a curse.
In this man’s case, it is a curse. Here lies a man in the last part of his 8th decade on Earth, severely delirious, tied to the bed, bruises up and down his arms from pulling on the restraints, tongue so dry it has shrunk to half the size, lips cracking, starving, and the doctor recommends to the wife that we insert this feeding tube. In order to do this, I give him more sedation medication, hold his head down, and watch the doctor place the tube into his nostril over and over again, meanwhile the tip of the tube is turning bloody. The man is screaming, “Help me! Help me!” The doctor is doing it this time because the day prior, the nurse attempted but quickly aborted when they realized the tube was continuing to go into his lungs. The nurse attempted two times. This doctor attempts for what feels like and eternity, man screaming and pleading, unable to understand why this is happening. Someone outside the medical system may see this as torture, however, these are the faulty protocols that exist in our current sytem. Four days later, the man goes into respiratory failure, and the wife decides on comfort care, which means, we stop intervening with his death, and let him pass. This man, demented to the point of not even knowing who his wife is, was in the hospital for two weeks. The last two weeks of his life, he was tied to a bed, denied food or drink, and without the comforts of his home. You would like to think this is an isolated case. Sadly, this is not. Sadly, this is a common occurrence for the eldery person that becomes acutely ill and is brought to the hospital seeking a solution to death.
This is one of the hundreds of reasons I decided to leave the ICU and bedside nursing. My last day in the ICU was bitter sweet. In one moment, I look at my watch and realize I have five more hours until I retire myself from bedside nursing. Five more hours of taking care of my alcoholic patient that had been to the ER twenty plus times in six months. A patient that admits to not wanting to quit drinking alcohol, but keeps coming to the ER for one complaint or another. Desperate spouse, who also drinks. Both living in a car. We hurriedly discharge her so she does not begin to withdrawal from alcohol. Hurriedly discharge her back to the bottle. Five more hours of taking care of a man who has a sick heart and sick kidneys because of life choices to continue his addiction to processed and fried foods. A man that we will “patch up” and send back out with no proper nutritional guidance, a handful of prescriptions, with the expectation that he will return to the hospital, more than likely within a few months.
In so many ways, my heart hurts to know what I have been a part of. My heart is heavy knowing that I didn't ask the doctor to stop attempting to place that feeding tube. Or that I didn’t, or wasn’t able to help that alcoholic, or obese man in a way that would truly help. My heart aches. I look back on all the patients that I had “tortured.” We were trying to save their lives, and in the beginning of my career, as a new nurse, I had followed orders, and did in some ways feel like I was helping. The more exposure and experience I had with humans nearing the end of their lives, or battling chronic illness, the more I began to feel “burnt out.” I was a part of the problem. As I became more confident, I began speaking up and being more frank with patients and their families, but as “just the nurse” they didn't always hear me. I looked to the physician to hold these very difficult conversations, because the patients and families looked to them for the truth.
But not all my shifts were like this. Some days were filled with heartfelt connections. Some days were filled with people recovering. Some of my favorite days were the ones where I got to remove the tubes. Take the ventilator out and hear the patient’s voice for the first time. Take the nasogastric tube out and relieve the painful throat. Take the bladder catheter out. Get the patient out of bed for the first time in two weeks. Brush the matted knots out of her hair. Talk about family, travel, god, life, and love. Hold his hand and comfort him during a procedure. Or hold his hand and comfort him during his journey through death.
Becoming a nurse was the best decision I have ever made. It has changed me in profound ways. Nursing has made me aware that I am a healer, and I have an amazing ability to connect with patients and establish trust within minutes. I feel their struggles, joys, and accomplishments. I also feel their pain and suffering. Because of this, ICU was extraordinarily challenging. My experiences in the last decade as a nurse are painted colorfully with countless beautiful stories. I have shared a little piece of my soul with thousands of people. Although I will continue to do so in the procedural area, it’s time for me to spread my wings once again. It’s time for me to follow my intuition towards helping people heal themselves by focusing on what they can do to remain OUT of the hospital, to remain resilient, and robust.
Modern medicine is a gift, it has saved countless lives, and extended our lifespans. But somehow, we forgot about what has brought us to this point. We have forgotten that we ARE nature, we thrive when we use what Mother Earth provides us to help heal ourselves. We started calling this medicine “alternative,” when rather the modern medicine should be what is considered alternative. We need to relearn how resilient the human body can be. We need to reconnect with the plants that surround us. We need to reconnect with the food we choose to nourish our bodies. Reconnect with our own ability to heal ourselves without having to give our control over to another. By uniting the ancient wisdom of healing, and the modern advances in medicine, we can truly have a powerhouse system.