It requires courage to assume the responsibility of assisting dying patients and their families.
A nurse's role includes functioning as a mediator and advocate; we facilitate communication between clinicians and our patients. As such, we must ensure that important documents such as advance care plans are readily available in the patient's medical record and that all healthcare professionals involved in the patient's care are aware of and understand the patient's wishes.
Laura, my 93-year-old mother-in-law, never wanted to be placed in a long-term-care facility, primarily because her mother died in one. Laura documented her wishes in a signed and witnessed advance directive for healthcare.
In May of 2021, Laura developed pneumonia due to COVID-19.
She fought for her life for 5 long days. When we visited, she did not recognize us, know where she was, or why she was there.
My wife Dianne, who had limited healthcare knowledge, was Laura's medical power of attorney and the only individual who could make healthcare decisions for her. Luckily, I could speak and interact with the physician and nurses caring for Laura. I translated their messages to my wife so she could fully understand the situation and communicate with Laura's physician.
Laura's advanced directive stated that she wanted to be kept comfortable when she could no longer make her own decisions and it became apparent that her life could not be saved. Four days after her hospital admission, we felt she had reached that point.
Dianne advised the physician that Laura did not want to be kept alive by artificial means, but he did not listen to what Dianne was trying to tell him. Over a long, impassioned phone call, my wife pleaded with him to follow Laura's advance directive, but he refused.
The following day, Laura's pneumonia had progressed to sepsis. After a meeting with the hospital ethics committee, the physician agreed to follow Laura's advance directive.
The following morning, Laura was put on room air. She passed away that afternoon.
Nurses are called upon in the final stages of a patient's illness to care for the patient and provide comfort and understanding for family members.
In the final stages of Laura's illness, I assisted Dianne by explaining to her the role of comfort measures such as morphine to help with easing respiratory distress.
It is also our responsibility to ensure that the last moments of a patient's life have meaning and dignity. This is a daunting responsibility, but it must be done.
I helped Dianne in her fight for Laura. Dianne had the courage of her convictions and the strength and wisdom to follow her heart.
Laura had fought her last fight, and with Dianne's help, she got her last wish.