This was one of the most unforgettable experience I have so far and one of the most frightening to the fact that I’m dealing with a patient who is dying.
It was the last day of our second clinical rotation at Bethany Hospital [mid-day shift]. I arrived at the usual time of 2:30 pm at Bethany. As my other group mates arrives, we chatted a bit and I found out that there is this one patient in our area who just came from the Intensive Care Unit. I ask what is her condition. My classmate told me that she have a stage 3 colon cancer and ask if she needs close monitoring… my classmate told me that the order was every-hour vital sign monitoring. I was praying again to God not to be assigned in this toxic patient… but fate has a way of playing a game… I was assigned in this patient. But to consider what my [new] Clinical Instructor gave me [patient assignments] previously in the same rotation , which mostly no one in my group wants to handle, I was not surprised.
When the staff nurse gave us the go signal to read the charts, I immediately read the doctor’s order and the nurses’ progress notes to found out that she has been admitted in Bethany since April of the same year with just a complain of difficulty of breathing and cough for several days. She has an indwelling Foley catheter, in O2 therapy, has anasarca and she has a colostomy etc… I continued reading
Before going inside the room… i wear my mask… I was reprimanded about this by my Clinical Instructor about wearing a mask… I told her that the reason I am wearing a mask is for the principle of Reverse Isolation, I was only protecting the client from any infection that I may transfer since Cancer Patients are immunusuppressed because of the corticosteroid therapies that they are receiving. After that she argued no more. [We’ll the real reason why I’m wearing mask was Im a Paranoid Person… a clean freak person]
After knocking at the door, I opened it and before I greeted the patient and the family members a different odor enters my nostril. it was unpleasant and it was a good idea really to wear a mask. As I greeted the patient and the family I took a quick look at my patient, actually my patient and louella’s since there were not much patient in the unit that day so we were teamed up… I observed how pitiful her condition was.. I tried to talk to her but I can not understand he speech. Her husband assisted us in taking her vital signs, in changing positions and others since we can’t hide the fact that our little hands cannot do much things considering the condition of our patient. she can barely move, even her extremities.
After taking her vital sign and regulating the IVF hooked on her and even her O2 inhalation, draining her urine bag and recording the fluid output… we reported to the staff nurse that she has a fever… it was above 38.5 if my memory serves me right. So the immediate action is to give her PRN med- Aeknil IV so to lower her temperature immediately so it will not reach 40C above to prevent permanent brain tissue damage because of brain cells begins to die if the core body temperature gets too high [according to what I have read in my books]. However she had already received an Aeknil earlier [2:00 pm] and it was only 4 pm so we cannot administer the next dose of Aeknil yet.
So I implemented my independent nursing intervention for hyperthermia… I if its okay to adjust the air conditioner since it was really hot in the room. I encourage the husband of the patient to let her sip water… we even change her gown since it was soaking in sweat and we did TSB. Tepid Sponge Bath. Louella and I did everything we could to lower her temperature.
As we are busy doing TSB with our patient, another knock was heard, the door opened and it was our clinical instructor checking on us. maybe she was wondering where we were since most of our group mates are lounging at the nurses station doing nothing…maybe writing already their sample charting. She entered and said “Kumusta kayo diyan?” [How are you?] I answered “Okay lang ma’am TSB lang kasi mataas ang temperature ni ma’am at kabibigay lang ng Aeknil sa kanya ma’am kaninang 2:00 pm.” [We are doing fine, we are just providing TSB to lower the temperature of our patient since she was just given Aeknil about 2:00 pm] She said “Okay sige” [Okay, carry on]..
So Louella and I continued providing TSB and constantly checking her temp… a second know was heard and a girl entered… it was the patient’s daughter. I can’t help but eves drop a little. I found out that the daughter is hesitant to come actually in the hospital since she had exams and assignments to think off. she and her father continues to talk and it was like her father requests if she could stay at least since her mother is very sick and might no longer live and stuff… like they want to be complete when her mother dies… and stuff again. and As we continue to provide TSB to our patient another knock was heard it was again the other daughter of our patient.
After I guess 2 hours or maybe 1 and a half hour of providing nursing intervention… her temperature goes down a bit and increases again. we decided to check if it was okay now to give Aeknil but before that we clean up the materials we used…then we left the room. The husband said thank you on us. He always smile at us and thanked us every time we check on our patient. we rested a bit at the nurses station as we report to our CI and to the Staff. The staff told us that she will be giving Aeknil later. So as we are sitting at the benches near the Nurses’ Station, I was already making my nurses notes so that my CI can check and later I will just write additional nursing interventions I did to my patient.
As Louella and I are browsing the internet via our phones since our Clinical Instructor asked questions regarding some medications and at the same time we are reviewing for our quiz, a number of people are approaching the nurses station… Louella had a hunched that they may be the relatives of our patient since her husband said that some of their relatives will be arriving… One of them approached the nurses station to ask and the nurse pointed room 3301… they all entered… and greeted the patient.
Louella and I looked at our watch and it was already time to get her vital signs. At first we are hesistant to enter since we heard some moans/cries inside… we dont want to disturb them… sow e waited for 15 minutes I guess and entered… after assessing her vital sign she still have hyperthermia so we reported to the staff that she still has fever… so the staff looked at the time, It was already pass 6:00p pm, prepared her medication and administered it.
At the same time that we are done Dr. [I forgot the surgeon’s name! Oh My!] and told the nurse that he will be changing the patient’s colostomy bag. The staff asked us if we had seen one before and would like to assist we said we haven’t seen one yet and we would really like to assist. so there we knock at the door, the doctor entered and greeted the patient and the family and I get the tray where the needed equipment and materials are and Louella was with the staff nurse beside the doctor. So a the doctor opened the colostomy sight a foul smelling odor came out and it even penetrates in my mask which has already two layers and I really stared and observed the sight… it was edematous, the color of the surrounding tissue is dark red… and there was no bag placed but instead a diaper is placed and it has fecal matter on it. so the doctor just wiped the site, cleaned it, put some sterile dressing/ gauze and placed a new diaper and secured it with plasters. it was a quick one. Ooh I forgot to tell you, the doctor isn’t wearing any mask at all… maybe he was alraedy used to it.
After we provide colostomy care, the doctor talked to the family inside the patient’s room and the next thing we know is the doctor opened up regarding signing a DNR consent/order. [Do Not Resuscitate] we are sitting at the bench and heard the doctor say to the husband “Anong magagawa natin? Diyan din naman pupunta” the husband called some family members and went to the corner of the ward and I guess they are discussing about the DNR order/ consent. they they began crying. The sound of their moans and their feeling of anguish echoed and covered the place. Waves of emotions are flow in the place. and I felt extremely depressed and sympathetic. I can’t do anything since that time I don’t no knowledge yet regarding dealing with persons who are experiencing grief and loss. They comforted one another and the doctor went to them and talk to them. I even heard a young boy say “Wala na akong mama?” [I no longer have a mother?] I really felt sad for the young boy…
few minutes later, the family was escorted by the doctor to the nurses’ station and signed the DNR order/consent. Then they all go inside the room… And we are going to check again the patient that time.. we decided not to enter and just wait again for a bit.
We entered our patient room again. asked what the patient needs… re-positioned the patient, offer some fluids, wipe off her perspiration, drained her urine bag, check her O2 inhalation, her IVF, and assessed her vital signs… she still have fever. we leave the room and the husband thanked us again and smiles..
we asked the new staff nurse what can we do the staff nurse told us that in the case of our patient, she is having a terminal fever since she is nearing the last hours of her life. So in the next hours we just provided maximum comfort to our patient… we continued monitoring her every hour, assessing vital signs and etc.
after our clinical duty that day… we had just learned [louella and I] our patient died around 1:00 am, 2 hours after we leave the area… the time that her O2 tank is already empty…
I forgot to mention she was only around 45 years old and she already have a stage three colon cancer