Thursday, July 17, 2008

Just a Quick Addition...

I wanted to tag a quick story on to the last post that is somewhat related to the idea of "family members with limited understanding," but I thought it would be more appropriate to seperate it from the other. This situation occured during my last rotation in the ICU up in a hospital at school. I was taking care of a patient who had undergone his second AAA repair. I can't recall exactly what had happened (and now it's going to drive me nuts trying to remember), but during the second surgery, the patients abdominal aorta was clamped for too long, causing his bowel to become ischemic (which led to an ostomy) and his lower extremeties to lose significant circulation, resulting in a severe lack of perfusion and progressive necroses of his feet and calves. I came to know him while he was sedated and on a vent in the ICU and my role as a student nurse came in to play at a crucial time in the patients care.

The doctors and nurses were trying to decide whether or not to amputate the leg or begin this treatment or treat this problem before this one or blah blah blah.... but the biggest problem for them that I think they overlooked didn't even concern the patient. It really had to do with his DPOA, the son. Because the father was unable to make his own decisions due to the heavily sedated state he was in, the decision making burden now rested on the shoulder's of the son.

I had the opportunity to meet him one morning while I was in doing my assessment. He was kind of a punkish, bushy unkempt bearded kid, probably around my age, who wasn't very well educated, but had an incredible heart. He came in kind of quickly, awkward, and flustered. Because I was in the room he assumed I was the nurse and immediately started up with the "how's my dad?" questions. Making every effort to keep the son optomistic, I tried to explain that his father was doing slightly better, but the condition of his legs caused a great deal of concern for the doctors and staff. I really tried to keep the terminology simple and stick to what I knew, but despite my efforts to remain in a medical conversation, the son just kept directing me off that path.

What I can remember most vividly was the son coming back to this one assumption "... yeah but when he's down to (say 50%) the doctor said that's when he'll wake up and be able to make his own decisions... he's at 65% O2 he's almost there!" (this was all followed by a nervous smile and a complete lack of regard for any statement disproving his assumption) I kept trying to explain to him that his father coming to it was really conditional on how he would be able to tolerate weaning and there was no magic number that would bring him back. During the rest of that day I felt like no matter what I said or how I said it, that kid was not going to believe anything but what was in his own head.

What I had come to find during my conversation with the son was why he was so eager for his father to wake up, besides the fact his dad would be better (This was also something no other nurse had taken the time to find out. Not one nurse had sat down with him and just let him talk). The two lived together out in the woods and his father was the type of man who drank the night before to help ease the pain of surgery and spent the day up until that chopping wood (this is no lie). The son tried to explain that the father did not want to get the 2nd AAA, even after he very well understood he would, in fact, die if he were to leave it be. The son I guess had convinced him to get it fixed, so he went in and a few days later was next to me in the bed in the ICU. The son couldn't even begin to imagine the reaction the father was going to have waking up to a bag attatched to his intestines, let alone the reaction he would have if one of his legs was gone. The son couldn't make the decision for the father and was feeling a tremendous amount of guilt for making the dad get the surgery in the first place. It was just a terribly sad situation that I knew could not be swayed by myself or anyone else but the father.

One of the greatest things the son owned became one of his greatest weaknesses, and that was his immense respect and love for his father. He truly cared but he was unable to get past his emotions and fears in order to think clearly for his father in his worsening medical condition. You can't blame him, though, he's young and completely unexperienced with such critical decision making. But his lack of understanding of what was happening with his dad was causing him to drag his feet and hold out for his dad to wake up, which I knew wasn't happening any time soon. My rotation ended before any decision was every made by the son.

In situations like these you almost want to shake that family member and say, "look, you've gotta do this, you've got to make a decision..." But who am I to put my two cents in and tell someone to stop feeling and start thinking? We're only human.


Tracey said...

As I read your posts I cannot help but think that you are wise beyond your years. I only wish I had known, or picked up on, some of these things earlier in my career.

jenny said...

I found this post so moving. I could feel all the worries and compassion you felt helping this father and son and I truly believe you are going to have a long career ahead of you. http://www.degreesinhealthcare.og Thank you