Family and End of Life in the ED

Nurses every day make a difference in the lives of patients and families. At BWH, nurses are fortunate to be members of teams committed to bringing the best of technology and care to these patients and their families. Including patients and their loved ones in the clinical care team is an important aspect of patient-centered care, and no where is this more evident than in the national trend to include families at the bedside during codes and emergency situations.

Michael A. Lage, RN, NIC, in Emergency Medicine, describes how an expert nurse in the midst of an extremely busy night included a family member in the multidisciplinary ED team that worked to save a life. In this story, Lage details a rapid fusion of thought, feeling and action: how relational skills potentiate treatments, how this ED team stood beside this husband to acknowledge the patient’s personal situation and how Lage, as an expert nurse, focused himself and his team on the most salient issues during a crisis. Lage shared this experience out of a sense of pride in his colleagues, and BWH Nurse shares it with you in that same spirit.

To my dear colleagues,
    
 I would like to share with you the most powerful feelings I have ever felt delivering healthcare in my 30-year career. In September, I received a telephone call from another Emergency Department that an Oncology patient had taken a turn for the worse and required admission in our intensive care unit. She was an end-stage cancer patient in her 50s, married with four children. Her husband accompanied her to our department and was aware that she was on a breathing machine with a newly diagnosed sepsis.  He went out to the waiting area to call her parents and inform them that he chose to keep her alive by all means even though his in-laws asked the preceding facility to avoid using machinery to keep her alive. About 30 minutes into her admission at BWH, she lost her vital signs, and we initiated CPR.
    
Before I went to the waiting area to inform the patient’s husband of the change in her hemodynamics, I sensed the disagreement with her parents over her code status may have been due to his realization that his life with her was ending. In a matter of seconds, I realized we could provide him with an experience that he will never forget.  I have initiated this practice a few times before, and, in all cases, I have to assess the situation and prepare the staff in seconds. In this case, resuscitation team member were very early in their careers and never experienced this practice. After quickly preparing the team, I asked the husband about his feelings, and he responded with a loud, “Thank you.”
    
While I was informing the team of my thoughts the patient was in asystole receiving CPR and medications. When I brought the patient’s husband into the room, he immediately hugged her and held on, even with chest compressions. I was taken back by his immediate run to her bedside. He spoke to her in a calm manner, and, to my astonishment, she got her pulse back, which allowed us to hold compressions and enable him to say some of the most powerful words I have ever heard. It seemed to me that she fought off her death as he spoke to her long enough to feel at peace with dying. I truly believe that as we pumped on her heart and delivered oxygen to her brain she maintained her senses. Who can dispute that she could see him over her or feel his cheek against her’s? I also think that she could smell his cologne, and I know in my heart she could hear him whisper in her ear that he has always loved her and that he and the children will be OK. I believe all this because after he said this, her heart stopped again and this time he asked us to stop. He was at peace with telling her what he had to tell her, and I believe she was at peace with hearing him. I looked around the room and felt so proud of my colleagues for their expertise, dedication, compassion and professionalism. There were too many emotions to describe what each of us felt, and I know that our patient’s husband could see first-hand how hard we work to save lives while displaying compassion for people we don’t know. 
    
I am grateful to work at a place like BWH where we can follow our instincts and challenge ourselves in ways that evoke unparalleled feelings. I want to thank my management team for encouraging this newly accepted practice. I also want to thank my resuscitation team for the expert empathetic care they delivered that night.

Michael A Lage, NIC, ED