Comfort Cares

The day started like normal, I had two patients.  One of whom was to have an ethics committee to decide if he were going to be placed on comfort cares.  Prior to the meeting, I had done normal cares for both my patients and was getting ready for the meeting.  I had received a coin from Lt Col Witten, one of our Army folks who was grateful for the care we gave to some of his soldiers and the Afghan National Army (ANA) personnel we receive.  My spirits were pretty high.

This particular patient, Akbar, was a high ranking member of the ANA.  There was an assassination attempt on his life two weeks ago and we took him, operated and thought he would recover.  He got two very drug resistant bacterias and his condition was worsening.  Yesterday, he was trached and when he returned to me his blood pressure started to drop.  We had an ethics meeting at that time and it was decided his mortality rate was >80%.  He was to be made a DNR and be given 24 hours to show improvement leading to today. 

He did not improve last night so the meeting was held with his family members and it was decided to put him on comfort cares.  As a nurse, comfort care is very important to me.  I want my patients to die a dignified and comfortable death.  Whether they feel pain or not, I want them to just fall asleep quietly.  I placed a scopolomine patch behind his ear to help with his secretions and started a morphine drip to help with his pain, or work of breathing.  In the Afghan culture it is very important that as many artificial things be removed from the body prior to death also a woman is not to be present when a male dies and vice versa.  Andrade and I took everything except the fresh trach, one IV line and the ex-fix on his arm.  After all was done, I got Dr. Chung to remove the ventilator.

I left the room and watched his sats start to drop and then I got busy with something else.  Andrade came into the breakroom and said "Lt Sanders, your patient needs more pain meds, he's thrashing about."  I went into the room and saw this man suffocating.  I turned up the morphine and then discovered he had pulled out the line so he had been without medication for a while.  We gave him a couple of shots of different drugs but it wasn't helping.  I stayed in the room until he was more calm and then went out to Dr. Chung and said "Dr. Chung, please help me.  This man is suffering and what we're doing isn't helping."  Then I started to cry.  I have never cried like that but it hurt me so much to see this man gasping for air. 

I know some days I come in and I'm crabby, some days I don't do as good a job as I'd like but I have always been adamant about giving someone a good death and today I failed Akbar.  I learned a few things from this and hopefully I will never experience this again.  I hope I can forgive myself and I hope Akbar and his family can forgive me.  I know it happens, but I'm the nurse and I was responsible.