Mrs. M found herself at home, unable to breathe. Her husband called 911 and she was rushed by ambulance to the emergency room. As her shortness of breath worsened, all she could say was “help me.” The medical team immediately jumped into action ordering blood work and a chest X-ray, placing an IV line and administering antibiotics. Eventually, anesthesia was called to insert a breathing tube and Mrs. M was placed on a ventilator because she could not breathe adequately on her own. Unfortunately — and unbeknownst to anyone present — this was not the type of help she sought.
Reflections from Residency
Comments
Kudos to Dr. Gupta for shedding light on the importance of discussing end-of-life wishes with loved ones and health care providers in her recent “Reflections from Residency,” (The Boston Globe, February 18, 2013, p. 14). While I agree with Dr. Gupta that our fragmented health care system makes it challenging for any single physician to take the lead in facilitating end-of-life discussions, it would have been refreshing for Dr. Gupta to acknowledge the insight that the hospice nurse could have contributed to the conversation. Clearly, in the relative comfort and familiarity of the patient’s own home, the nurse was able to know Mrs. M. and help her feel known and cared for in an important and meaningful way. While it’s true that physicians are ultimately responsible for the scope and direction of patient care, nurses are responsible for providing, monitoring, and evaluating the effectiveness of the many complex, moment-to-moment interventions that comprise the overall care plan. In this capacity, nurses are uniquely positioned to expertly and compassionately advocate for and support patients and families. It’s what we do. As physicians endeavor to empower patients to effectively communicate their values and beliefs about end-of-life care with loved ones, it seems remiss to overlook such a valuable resource: nurses. Ironically, the Boston Globe solicits nominees for their “Salute to Nurses” on p. 24 of the same section in which Dr. Gupta’s reflections are shared.
Sarah McCaffrey, BSN, RN, CEN