Tuesday, June 05, 2007

I Don't Know The Answers.....


I wanna feel you--- oh, I wanna touch you,

Please let me near you, let me near you,

Can you hear what I'm saying?....


("Hide in Your Shell", Supertramp)


I'm sad today because another patient of ours died.

It happened like this:

Our home health aide had gone to see her in the morning to help the elderly lady get a bath. The home health aide also dutifully recorded the patient's blood pressure, which we have always checked quite closely as she has a history of a stroke and high blood pressure. The patient's blood pressure was normal today, which is unusual for that particular patient. Usually it is too high.

For some reason, no matter how many times we've found this patient's blood pressure elevated, her daughter has always refused to allow the doctor to change or adjust her blood pressure medicine. She has always claimed that her mother's blood pressure gets elevated simply because she's "nervous" about when it gets checked by medical personnel, and that when we nurses aren't there, that her mother's blood pressure "goes back down to normal."

We have never really understood this reasoning, but we have tried to provide as best of education as we can for that patient's daughter regarding the dangers and risks to cardiovascular health of high blood pressure---whether the blood pressure is high at just "certain times" or all the time---- but she would never budge her opinion on this issue. In fact, she got to where she flat out refused to allow any changes in the patient's medication which the doctor advised, actually refusing to allow him to add any new medicine, change, or adjust the dose of her existing medicine, whenever we nurses contacted him about the patient's frequent episodes of high blood pressure. The patient's daughter is a nurse and has always made it a point to inform us that she "knows" about blood pressure and thus can make the proper decisions for her mother. She also ordered us to NEVER contact the doctor unless we first called her to get approval.

And the patient always followed her daughter's advice.

These type of situations are very difficult for nurses. We want to do the best for the patient, but the patient was in her right mind and had every right to do as she pleased with regard to her blood pressure and medications. And if she wanted to follow her daughter's way of doing things, then that is not for us nurses to judge or rebel against. All we could do was educate both of them as best we could and hope for the best.

Although we nurses perform many medical duties and functions, one of our most important duties is, to put it simply, provide the patient and their familes with education about their illnesses. Then, if we have done our job right, and armed with this knowledge, the patient and their family can make their decisions regarding choices in their health care. It is not up to us nurses to judge whether or not we think they make the best decisions. And yes, many times we see people making what we consider poor decisions---- but as long as they are in their "right minds", then we must respect their choices.

Today, our home health aide noticed nothing wrong with the patient when she performed her visit, helping her get a shower. After her shower, the patient then asked the home health aide to assist her with putting a big cast-iron pot of beans on the stove to boil. She had soaked the beans all night and wanted to put them on to cook. She wanted to make a good pot of pinto beans for her son---- who loves pinto beans when they're simmered all day in a pot with a big piece of ham. She also planned on making him some good ole fashioned Texan skillet cornbread to go with the beans.

The son found his mother later, sprawled on her living room "easy chair", dead. She had experienced a massive stroke.

The pot of beans had boiled down dry, and smoke was everywhere in the house. In fact, it is a good thing that her son had found the situation when he did or else a fire may have developed.

When I found this information out through small town gossip, I immediately called the patient's daughter to express my own and my company's sympathies. As you can imagine, the patient's daughter was shocked and distressed.

She said to me: "Nurse, I just know it's my fault....it's my fault, isn't it?"

I told her of course not, that it wasn't her fault. I mean, what was I going to say? That it might have been her interference in the blood pressure medicine issue that contributed to her mother's death? No way. There was NO WAY in hell that I was going to suggest to her that anything she had done had contributed to her mother's death.

Because for all we know, the patient's death may not have had ANYTHING to do with regard to the blood pressure issue at all. After all, the patient was in her 90's. Who are we (or anybody else) to decide what the reason was for the patient to have died today? Perhaps it had nothing to do with her blood pressure at all. Perhaps it was simply "her time" to pass on, no matter what the situation was with her blood pressure or medication.

I thought it was the blood pressure issue bothering the daughter---but it wasn't. The daughter wasn't thinking of that. There was something else bothering her....

"You know," the patient's daughter told me, crying hard. "I have always tried to take care of Momma as best as I know how. I'm a nurse and so I always tried to use my knowledge to advise her on things. But lately, Momma had been asking me to come up and visit her, asking me to just bring a few clothes and spend a couple of days with her. She said we could go fishing at the lake. But I was always too busy and never had time to do it. And little did I know that she was going to die! And now I'm asking myself WHY, oh WHY, didn't I just go spend a day or two with her? To think that she died alone!---and if I'd gone to see her then I would have been there and might have been able to do something...."

Her voice trailed off as she weeped into the phone.

Feeling helpless, I told her: "Honey, you didn't know this was going to happen. You couldn't have known. And she was just fine. She hadn't even been showing any signs of being ill. Please don't blame yourself. You know that she would not want you to think like this. Please don't blame yourself. You didn't do anything wrong."

My heart was breaking for this woman.

"But I should have gone over there more often!" she insisted. "I should have spent more time with her! But I didn't. I was too busy and I neglected my mother. And so I prayed to the Lord this morning, asking His forgiveness. Do you......do you .....do you think He forgives me for not being there when she died?"

"The Lord isn't mad at you," I told her gently. "You were a good daughter. And did it ever dawn on you that you may not have been supposed to be there when she died?"

And so I told her. I told her how, in my experience, many patients seem to die when none of their family members are present, whether in the home or in the hospital.

"Perhaps it was meant to be this way," I suggested. "Perhaps either she or The Lord knew that it would have been too traumatic for you to see her die. Perhaps you were meant to remember her as she was when she was alive, a beautiful loving lady, cooking your favorite dishes for you with that lovely smile she always had on her face. I admit that I don't know the answer for sure---but I do know that you shouldn't feel guilty about anything."

I cried right along with her on the phone, knowing that her poor little heart was torn in two--- and that she had truly loved her mother. It hurt me for her to cry for her mother, thinking that something was "her fault". I knew that I would absolutely DIE if I lost my own mother. And I sure as hell didn't want her to live in guilt for the rest of her life over something which was out of her control.

I wanted desperately to say the right thing to help her. But sometimes I don't know the right words. I always worry terribly that I'll say the wrong words in these situations....

After awhile she stopped crying for a bit and seemed to get a little calmer. She told me resolutely that she had to go gather the other siblings and start making the funeral arrangements. I told her that we nurses wanted to go to the funeral and that if she needed anything to call me on my cell phone. Gratefully, she told me goodbye and staetd that she'd call later with the details on the funeral arrangements. Sadly, I dialed the number for the florist to arrange for some flowers to be sent.

I was sad for the rest of the day.

Because I don't know the answers. I don't know the reasons for what happens in life. To tell you the truth, I have no dang idea what God's Plan is for ANYTHING. (In fact, when I get to Heaven myself I'm going to have a lot of dang questions about that sort of thing for God.)

Why? Why why why!??? Why is there sadness? Why would my patient die today? Why would her daughter tear herself up over guilt when she was doing things as best she could?

Anyway, that's why I'm sad today.

So I came home and tried to concentrate on something happy to get out of this mood.

And right now, I confess that I am finding some happiness in the New Mockingbird Eggs. I can't help it...it's such a beautiful thing.....

In fact, I'm so excited that I feel like one of those people who whip out their 3-foot long photograph collections and bore the heck out of people by showing them every single one.....

But I can't help it---I am enthralled by nature, as you guys know.

It's probably fortunate that I haven't got access to my patients' animals which have babies, like the cows, donkeys, goats, etc.----because I'd be in their barns, photographing every minute of everything when an animal had a baby....every day until the hapless baby grew up to adulthood and then had its own babies...

But these mockingbird eggs I DO have access to and that suits me just fine. I love the little things! (And I hope you allow just a tiny bit of indulgence for my obsesssion....because my apartment complex doesn't allow pets, and so this is the closest that I'll get to "having a pet".)

Anyhoo, here's today's update on The New Eggs:

Although I am trying to leave the poor bird alone while she "broods" on the eggs, as I don't want to spook her and cause her to abandon the nest--- the plant where the nest is located is so close to my balcony door that I can literally grab a picture in 5 seconds. And so today when I came home from work (which always causes her to fly out of the nest due to seeing my front door open) I took the opportunity to grab a picture while she was out of the nest.

(She returned in a minute, so all is well.)

And to watch the nest without her knowing, I crawl on the floor on all fours, slumped as low as I can get behind my sofa----in order to peer up at the nest from a vantage point where she can't see me watching her, at the far end of my sofa. When I did this maneuver today (which looks ridiculous if you could see me do it) it enabled me to obtain a picture of her sitting on the nest, "brooding" and, thus, incubating the eggs. I'm like a little kid looking at a gift-laden Christmas tree when I watch her "brood"----it THRILLS me to watch!!!

If you look reeeeeeeeallly hard at this crummy and grainy picture, you can see her little head sticking up out of the fern while she's sitting on those eggs, right under the curved plant hanger:

And also, when I grabbed the picture of the eggs, I noticed something......they've been moved. How interesting, I thought to myself. She MOVES them. She TURNS them. Fascinating. (I can tell by the way the patches of spots are located on the eggs.)

So here's what I call "Day Two Since The Discovery of The Eggs":

You can compare Day One and Day Two:

(See? The eggs have been moved and turned....)




girlvet said...

I love your blog. Write more often.

Warrior Knitter said...

I don't check in for a couple of days and when I do I find MORE mockingbird eggs and really cool baby sweaters.

I'm sorry about your patient. You did a good thing with her daughter. You are wise.

I wonder why the mockingbirds didn't use the old nest in the already dead plant? Maybe they like the fresh greenery of the new one? Have you seen the mockingbird "dad" yet?

So glad about your niece.

I like both sweaters. The aran sweater looks very intricate. I love cables. No way would I try to knit one up one my own with NO PATTERN. I like the colors and style of the Red Heart sweater. I also like all the buttons.

Lucky babies!

Taueret said...

Sorry about your patient, you were very kind to her daughter. Love the egg pics.

Lisa said...

You have got to be one of the most sensitive and loving people that I have had the pleasure to stumble upon in quite some time.

I know that my world is a little brighter and better because of your blog, so I can only imagine how fortunate your patients and their families are.

Thank you for just being you. Plain and simple and without any appologies!

Keep your head low when dad decides to appear!

poody said...

The eggs are so pretty too! As an old neuro nurse I remember working in the unit and having the cardiologists fighting with the nuerologists over B/Ps. The cardiac Dr would always want the B/P to be between 120/60 to 140/80 and the neuro Dr would counter saying that the brain of these people is not perfusing with a low pressure when they were used to having it be 160/80 to 180/90. Who knows why things happen when they do sometimes? She was old and ready to go I suspect. I have run into the same problems with family members wanting to play Dr. As a rule in our company if we had a situation such as the one you described we would make sure to document the daughter's refusal to follow Dr. orders and then D/C the patient as noncompliant telling the daughter why we were d/cing her mother. We actually had a similair situation where the daughter was a nurse and was neglectful in the care she gave her mother. We had to call APS but as you say unless the pt. is not in her right mind then there is very little to be done.We all have free will.

Deacon Barry said...

It's probably quite difficult to die with your family in the room. Imagine trying to get to sleep with all your nearest and dearest in your bedroom. Which is why a lot of people slip away when their folks have slipped down to the cafe to grab a much needed cup of tea. When they get back they find the nurse telling them that Granny/Grandad/Uncle Fred passed away five minutes after they left. People shouldn't feel guilty about not being in the room when someone dies, certainly not if they've attentive.

Anonymous said...

The birds roll the eggs regularly so that the embryos are warmed evenly and develop evenly and to stop them sticking to the shell and growing all crinkled up.
I watch birds on webcams all year around, it is so special to be allowed to share their lives in this way.
I am so happy that your niece is on the mend, and I hope you can balance that joy against your sadness for your patient dying. She did die doing what she loved, making a meal for her son, useful right to the last moment.

Anonymous said...

I so get the feeling of the circle of life reading this ... people or animals or whatever, one life comes to an end and others begin or continue. And life goes on, but we can not only observe, but contribute to the "fullness" of our own lives and others'. And hopefully make life better for us all ...

Thanks for sharing life's sad and awesome moments with us!

Runs With Scissors said...

I agree with Beth on the "circle of life" thinking. Do you think it's ironic that as your patient died, you found new eggs? I don't.

I'd love to come to Podunk and meet you one day, Bo!

may said...

sad. i can totally understand to daughter. we always try to blame someone if a loved one dies. most of the times, the easiest person to blame is ourselves.

Katherine said...

So sorry to hear about your patient. I know it never gets any easier. You were so sweet to the daughter. I still remember the pain of my Mother passing two years ago.

As for the bird eggs--don't you just know that Momma bird has to kick those eggs around every now and then to get comfortable! There's little Eggbert always poking her in the hip....