Realities.

Today I am in Wisconsin, hanging out with a really good friend from college. Life is good.

3 days ago I was getting ready to work my 6th day in a row when the phone rang. It was my bank telling me of suspicious activity on my debit card. Someone managed to empty out my checking account over the previous 4 days. Life wasn't so good then.

That night I went to work already beyond stressed, only to discover a post-op patient with a trach that wasn't on oxygen, was struggling to breath and desperately needed suction. I did, and pulled out what looked suspiciously like his tube feeding from his lungs. His life isn't going so good either. I spent the night suctioning his lungs every half hour. checking his blood pressure as it came too close to tanking too many times. Calling doctors for fevers, blood sugars, crappy lungs and urine output of less than 200 over 12 hours.

Did I mention the dude didn't speak English? That makes things fun.

I do not understand the medical community sometimes. This man did not become so sick that day. His lungs were pretty bad before they took him to surgery and removed one leg and completely redid his veins in the other. He had so many co-morbidities that I sit here and wonder what the doctor was thinking we would accomplish?

Some nights go better than others. Some nights you swab wounds and culture sputum and check UA's without orders, cause the order will be written first thing in the morning anyway. Some nights you can make the night without calling a doctor, some nights you have to decide which one to call first.

By the time I left, his lungs sounded marginally better, his secretions were thinning out thanks to the mist and the breathing treatments and his blood pressure and urine output were improving thanks to a fluid bolus. I think I improved the situation... his situation. In that shift, I made a positive difference.

But really? In the long run, at what point is it okay to say that someone has no quality of life left, maybe we should stop the invasive procedures and just manage symptoms? at what point is it okay for me as a nurse to start wondering why I have to be doing all the things I do? I firmly believe that there is a good way to die. I just don't think we let people do it often enough.