...see below for this RNs reasons on why you need to get with the RN trend.

Tuesday, July 21, 2009

48 Years.

"48 years," he said. "We've been married for 48 years." His wife, in the bed, managed a weak smile from under the stiff plastic mask pumping 100% oxygen into her lungs. With the hat on his head declaring service to the U.S. military, and a Bible in his hand, he sat at his wife's bedside - close enough to see her and yet far enough to feel the wall of illness separating them - for almost my entire twelve hour shift.

The day was busy. We floated in and out of the room to and from CT scans and MRIs, each time we left, he made sure to tell her he loved her, and leave a kiss on her forehead. As her results came back, showing a small hemorrhage in her brain, and as the hours past, and I checked her declining neurological status, he sat, calmly talking to family, hardly batting an eyelid at the bad news.

He doesn't understand, I thought. He doesn't realize that his precious wife, who he painstakingly cares for at home, might not see tomorrow.

I approached the resident, telling her of the patient's declining mental status, and high risk for respiratory failure and need for mechanical ventilation. "You need to talk to the husband, give him a heads up," I say, all the while knowing that the words from her would undoubtedly come out wrong; twisted by medical jargon, a foreign upbringing, and lack of experience. But I was busy, I needed to catch up on things from my other patient, she was a second-year, she could handle it.

But, as I suspected, when I returned to him, I could see the confusion in his eyes. "What is this doctor talking about? Intubation? A ventilator? Isn't that mask breathing for her?" Things hadn't gone well. I sat down, and for a good while, explained to him and his son, what the blood in her brain was doing, how, if the bleed grew, it would cramp her brain, drowning it, keeping oxygen out, making it harder and harder for her to stay awake. The ventilator might become necessary to keep her alive, if that happened, and her brain stopped working as well because of the stroke.

Some people stop there. Why continue? You've gone above and beyond to give them fair warning -- why tell them that even thought the venitaltor might save her now, it might prolong suffering that she won't recover from? Her brain might get better, and then we'd all be thankful for the tube, the breathing machine, right? But what if it got worse, and she didn't wake up, and we, as we do so often, find ourselves with little else to do but pull the plug? Would she want to live on life support, in a nursing home for her remaining years, with little to no brain function? Or would it be better to just leave things as they are now, to let her pass quietly in her sleep?

But I had to, and I did. He loved her so much, and the last thing I wanted, was for him to visit tomorrow morening and find her garishly altered, with a tube in her mouth and a machine breathing her -- without having at least a warning. I didn't want him to miss his last conversation with her -- I wanted him to know, and see, just how sick she was.

He and his son talked it over. They said, if she needed the tube and the machine, that they'd want to be called first -- no matter the hour. Hopefully she wouldn't need it, they said. I agreed. It was a wise decision, a good conversation. They understood. He understood. When I left the room, I was glad I had taken the time.

Later, walking past, I caught a glimpse of him. Hat off, crouched in the chair by her side. His eyes looked tiredly at her, I could see his fear. For the first time, he realized her life wasn't as secure as he thought. While I never doubted my decision to inform him of how critical things really were for her, my thoughts haven't left him these past few days. I can only imagine what he feared -- losing her, meant losing his wife, his companion, his friend -- 48 years worth.

My thoughts are to my own life, my own relationships. What decision will I make when it's my time? Will I push hard, asking for everything, knowing that I'm only prolonging the inevitable? But, if I make it to 48 years, will you be able to blame me? 48 years is a long time to love someone.

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