The Order

You must understand, I rarely defy authority. I understand it's place and my place in the universe. I also understand the delicate role I as a nurse play in the unit compared to the physicians I work with. There are always those that we would not use ourselves and might I add are on the list of those that shan't touch me, but I still respect what they order for their patients. Until......

He's been in the unit for some time, I have never taken care of him but as charge I have kept up with his progress, actually, the lack of progress. We knew in our guts this man would not make it out of the unit, but we still tried to make it so. A week or so ago I began talking to the wife, I saw her daily in there and at some point either as a human or worse as a corporate slave I began to check on her each time I was there. Yet I knew where this was going and I'm not sure she did.

So the man is dying, all systems are shutting down, his body is visibly showing signs of breakdown. The sons had come in the day before at our request because we thought he would die that day. I had been shocked to find him still with us on my return. A doc that is covering for another decides we should get a test that will require us to leave the unit, be off the vent and bag, and jostle him around. When the nurse caring for him tells me about this order I was dumbfounded. I had looked at his labs earlier in the day, and this would blow his kidney function. He had been too unstable for dialysis for days and we were eeking by as it was. I can't defy the order, but in good conscious I couldn't do the order.

I quickly asked God for wisdom, as I didn't know what else to do. We decided to call the kidney doctor to "inform" him of this order. He called the "offending
doc then called us and said it was fine with him for the pt to go for the test as long as the family understood this would knock out the kidneys and he would have to have dialysis at this point. I talked to the family twice, explaining that while I would never defy an order, my concern was that their dad would die in process and I had to live with myself over the benefit of the test verses the consequenses. We were questioning whether or not we could do this but I needed direction from them. In answering questions they came to understand there would be little benefit from the test: we might find out why he was suddenly worse but we couldn't treat him and he would lose the kidney function he had. In the end, they decided not to do the test. The man died during the night.

In explaining to the family why this order was written I tried to protect the physician. They couldn't understand why he would order a test that might kill their father in process and for sure wipe out the kidneys with no real benefit. I explained that for many people they had to understand why. I never made this doctor look bad in my effort (I think) but tried to explain what I really couldn't.

But I was left with the feeling of here's the doctor coming in for 5 minutes ordering something that I will have to do and then I'm left with a grieving family when he dies during the test. I was angry! I support you and at the same time I have to wiggle around to try to be a patient advocate. It is about the patient, not why? Then I have to remember, I can't show the anger, I must comfort the family even when I have little to offer them.

As I left that night, they were each saying goodbye to the husband of 50+ years, the father that was special (they told me this, but I knew from meeting the family the kind of man he was), the grandfather that taught him how to be a man, and a man who endured much from my staff.

I stood up for my patient, I have nothing to hang my head about. I did more than my job, I helped my nurse through this situation, and God gave me wisdom to do all without compromising my self.