When Is Enough, Enough? Compassionate Care

In the past 18 years I have witnessed more people dying than I could ever recall.  The sound of the last wet breaths, the modeling of their skin, the cloudiness of their eyes.  When people are terminal, dying, they have "that look".  It is the look that I know as a nurse, but sometimes my patients' families don't understand.  Many time the family of the dying is holding out hope, and they are paralyzed, unable to make a decision on when enough treatment is enough and when compassionate care should begin.

A few years ago after my father's chemotherapy failed, actually it was is body that failed the chemotherapy, his oncologist came into his hospital room.  My mother and I were sitting in the plastic chairs to the side of his bed.  My father, weak, but alert, laid in bed as his doctor told him chemo was no longer an option, his weak heart couldn't handle it.  The doctor's eyes hardly met mine.  She danced around the subject of what the next step was.  But I knew the next step, it was hospice, and it would be soon.

When the doctor left the room my parents were left with the impression that my dad should return to the rehab facility.  When I left my dad that evening at the hospital I kissed him goodbye and I knew that he would have a long night of trying to sort out what he was told.

The next morning I spoke with my mother.  She had said she was going to look at rehabs.  But I already knew that the man who couldn't stand, go to the toilet, the man with lung, bone, kidney and brain cancer was not going to thrive in rehab.  He was miserable there before and now he had nothing to work for, his oncologist told him the cancer had won.

About a week later my dad was still in the hospital.  He was just waiting.  Waiting for the end.  

Originally my mom thought he could do hospice at home, but the set up of the home really wasn't going to be easy.  Fortunately the reality began to set in, and she visited a few hospices, eventually finding one, that when she walked in she knew he would like it, and he didn't have much time.  By the time she found a peaceful place for him his AICD had been turned off per his wishes.  His lung had collapsed.  He was slipping away.  

My father arrived in hospice on a Wednesday evening and died that Friday.  

Sometimes doctors don't like having "that" conversation with the patient or their families, and I find it selfish.  When there is little to no hope and someone is struggling it is unfair to hold information from them.  When they are drowning in their own fluids and their terminal disease had taken the life from their body patients deserve the respect of knowing how ill they are, so that they may plan the way they would like to be cared for.