By Nurse Berth, MSN,RN
There are some things nurses do behind the scene that people never know. Read this story to find out what Nurse Tiffany did when her patient Bryan was at the end of life, and the plan of care was not going like it should.
The other nurse is Tiffany. Tiffany has been a StepDown unit nurse for three years, and she’s my hero.Tiffany’s patient was a 29 year old named Bryan with a primary brain tumor metastasized to….everywhere. The cancer had invaded his bowel to the extent that he had not had a bowel movement for seven days. He has a nasogastric tube (NG) because without it he throws up continually. He’s been through chemo, radiation and every diagnostic test that exists. No surgeon will touch him.
Amazingly, he refuses pain meds unless his mother is not at the bedside. The reason? He is protecting his mother by saying “No, I’m OK”. Still, three mornings this past week at around 0400hrs, he wakes up screaming. Screaming. From pain? Nightmares? Nightmarish pain? and lately the worst pain, if he admits it at all, seems to be in his lower left leg. Bryan is a full code.
His oncologist, Dr. Positive, has not permitted the nurses to get Palliative Care on board. He also has not initiated The Conversation. Instead, when he rounds, he always brightly says “Well, we can do this. (and) We can try that” and beams at his mother, brother, and Bryan. Mom’s eyes light up with hope but Jake, his brother, scowls.
Dr. Positive is a very good oncologist, and well liked, but none of the nurses will endorse him personally. His bedside manner is unrivaled. His competence is unquestioned.
So why not? Why do the nurses not endorse him? Because he is not doing his job. That part of the job where, at the end of life, the doctor needs to let the patient and family know there is not going to be a recovery. Yes, provide hope, but not false hope. Realism.
For whatever reason, he will not give up when there is nothing left to be done.
Tiffany believes he is misleading the family and giving false hope. Tiffany has a different vision- one where Bryan is given sufficient pain medications in his last days. Where Bryan is allowed to spend the end of his life in his home, where his beloved dog Max can snuggle in and sleep on the bed with him. Where Bryan can smell the familiar odors of what Mom is cooking in the kitchen. Where he can finger his own worn, blue blanket, and look out his window to the neighborhood where he grew up. Where he is allowed to die.
So the other day, Tiffany felt she had had enough. She called Dr. Positive and said “You have to get real with the family. Stop giving Mom false hope. I want you to come in now. Talk to the family. Tell them they can choose hospice and do not Resuscitate. They are here now. I also want you to order Dilaudid around the clock.” Dr. Positive replied “Ok on the Dilaudid, order what you think.”
Tiffany responded “No. You come in. You talk to the family. You order Dilaudid. And you change the Level of Care Orders.”
Guess what. He did. He did every single thing Tiffany asked. After he left, Jake went to Tiffany, bear-hugged her, and said “Thank you. Thank you. Thank you so much. No one else has done that for my brother.” Bryan was transferred home that day on hospice.
I don’t know the end of Bryan’s story yet. I do know I am humbled yet again by what nurses do. Things that the public rarely realize. Thank you, Tiffany. You are a blessing and an inspiration.
How about you? How have you seen nurses make a difference, or have you made a difference?