Thursday, September 17, 2009

Passing the Final Test

I do not remember Mr. Hardy’s case very well. I think it was a GI problem where surgical options had been tried and exhausted. I am sure the prognosis was firm. Mr. Hardy was also firm; he wanted to be allowed to die naturally.

He looked good for his age. He was mentally appropriate. He might have gone a few more weeks before his code status really needed to be finalized.

I decided not to wait. I was not looking forward to talking to the family, especially since I seemed to be a little out in front of the herd from the beginning, but we can never be so sure how things will go.

I talked to the family. As I expected, no one had really broken the news to them. They handled it well though and supported Mr. Hardy’s decisions. They did not want to interfere or talk him out of anything.

I pressed the doctors to get the documentation in order. They decided to order a psyc exam for good measure. Fair enough.

The psychiatrist came and started her examination. I bristled with the first questions, “Why do you want to die? What’s wrong with you, you don’t want to live anymore?” I relaxed as it became apparent she was not out to push something on him. It was only right for her to prod Mr. Hardy a little. We pinch patients for neuro exams. She needed to know where Mr. Hardy was coming from.

Mr. Hardy remembered the list of words she gave him and could recite it frontwards and backwards even after a little distracting conversation. Mr. Hardy was a little fuzzy on the date and where he was, but the psychiatrist did not make too much of it. Then I watched as the substantial part of the exam began. Mr. Hardy seemed to know exactly what to say. I wonder if he did know somehow what had to be said of if he was really just in the space he needed to be in.

“Do you want to die?” “No.”

“Are you in pain?” “No.”

“Do you feel like hurting yourself or others?”

“Do you feel depressed or sad? “No and no.”

“Why then do you want to be DNR/DNI?”

“I just want to live on my own terms. If I cannot live on my own terms, I do not want to be maintained artificially.”

For some reason, the above answers, and particularly the last one, are THE ONLY answers that do not lead to loss of autonomy and control over decision making. Who knew the words “on my own terms” had so much potency. I suggest concerned readers commit the phrase to memory, but don’t try using it for other situations - you will just end up tied to the bed.

The paperwork was completed. The family was on board. I went home for the night. When I came back the next day, Mr. Hardy had just expired. The night nurse was just a little flustered. He had given a few fluid boluses, but there was nothing else to do.

I was happy with the job I had done. I was assigned a nursing student that day and the two of us set to work cleaning up the bedspace. We got rid of everything we could and made it as inviting as possible. I saw the student feeling inspired by it all. Mr. Hardy’s grandson came and spent a good 15 minutes sitting beside Mr Hardy’s body, just looking at him. His gaze was full of admiration. His grandfather had known his time of death was coming and had ended his life in dignity.


risaden said...

Good job!

Jay said...

May each of us die - and live - with as much dignity and grace.