A tale of two patients

In 1859, Charles Dickens wrote the book “A Tale of Two Cities”, through which he compared life in London and Paris and compared the lifetime of the aristocracy with the lifetime of the peasantry in these two cities. Throughout my greater than 30 years as a nurse and nurse practitioner, I even have observed and took part in the moral dilemmas that nurses and other health care professionals encounter every day. I spent most of my skilled nursing profession in intensive care units. As a nurse, my role is different than after I was a nurse; nonetheless, the issues I face are the identical as all nurses in relation to providing patients with optimal care that improves quality of life without necessarily prolonging it. This brings me to “A Tale of Two Patients.”

Just a few weeks ago I used to be caring for 2 patients; two patients with an analogous history, each had end-stage COPD, and each were admitted to the ICU because of COPD exacerbation. Both patients received similar treatment, and each patients continued to deteriorate just because their disease didn’t allow for recovery. As a nurse, I used to be at all times taught to deal with quality, not quantity of life, and that quality of life is defined by the patient, not health care providers or family.

The first patient had a complicated directive and apparently communicated well together with her family. Everyone agreed that the patient mustn’t be intubated, but placed in hospice and made comfortable. There was great peace among the many patient, her relations and all of the nursing and medical staff. They were glad that the patient had lived a full life and will now move to a greater place where she lived together with her husband, who had died two years earlier. Everyone agreed that following the patient’s advanced instructions and telling her to not resuscitate was the appropriate decision.

The second patient didn’t have advanced directives and never discussed her wishes together with her family. Despite quite a few attempts to debate the prognosis with the patient and her family, the family insisted that all the things be done and the patient capitulated to their demands. The patient was intubated and placed on a ventilator. Everyone knew the patient would never make it out of the vent and would ultimately die within the ICU. After a number of days, the patient developed multiple organ failure and the family finally agreed that the patient must be allowed to die in peace. The patient was given an infusion of morphine to comfort her and she or he died, together with her family still arguing about her. There was great sadness within the eyes and hearts of all who cared for her. The nurses were committed to high-quality care, and although the patient ultimately died comfortably, all of them knew the situation might have been avoided if the patient had discussed her wishes together with her family and first care physician and adopted advanced directives.

As nurses, we see the moral importance of doing what our patient wants; we’re their advocates and their voice even of their most desperate hour. Healthcare professionals have a responsibility to consult with patients before they’re in a life-threatening situation. The first conversation mustn’t happen when the patient is in a critical condition and has no probability of recovery. Quality of life should be defined by the patient and nobody else. Nowadays, the story of two patients mustn’t be the story told in healthcare.