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A Chance to Say Goodbye
Cynthia Whalley
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The ward doors closed as visiting hours had finished. I watched Mr Green disappear with the crowd and reflected on his visits over the past week, since his sister had been admitted.
As the long afternoon shadows appeared, I thought about Mr Green ... he was a quaint old gentleman who came every day to visit his elderly sister and they seemed to have a special bond. Mr Green told me that they had been together since childhood. This separation was difficult for them both, as his sister had never spent a day in hospital in her life.
Miss Green was 82 years old and three weeks ago her health has deteriorated to the extent that she was admitted to our medical ward for investigations. As yet, nothing specific had been isolated and some of the health team put her condition down to 'just old age'. Her admission continued and there was talk of finding a nursing home placement if Miss Green was not well enough to return home.
Meanwhile, her brother continued to visit each day and his devotion to his sister was quite touching. Everyday he would come to visit wearing his blue serge suit, his brown felt hat and highly polished shoes. He carried a brown globate school-case which contained clean nighties for his sister. Even though Mr Green's posture was stooped he would walk in the door, hat in hand, and look up and smile at each nurse as he passed. He seemed extremely grateful for the care we were giving his sister. His sincerity and appreciation felt almost tangible.
I was drawn to them, because there was something unique about the way they cared for each other. Occasionally, I would stop by the bed when he visited and the three of us would chat about their life, past and present.
Enough daydreaming, it was time for work. Immediately a mental checklist of my workload of the next two hours appeared in my head. Firstly, I wanted to check my clients and see if they needed anything. As I got to Miss Green's bed I realised something was wrong, she did not appear to be breathing. I then felt for a carotid pulse ... nothing! I rang three short sharp rings on the buzzer to alert the rest of the staff and then laid her out flat and commenced cardiopulmonary resuscitation (CPR). By this time, other staff had arrived with the emergency trolley and things began to happen. The monitor was connected and the client was in ventricular fibrillation. The team arrived from Intensive Care and sited an intravenous line. Amazingly, within minutes, Miss Green was breathing on her own again with very intervention and the monitor showed that she was in sinus rhythm. The resident medical officer asked questions about the client's age and then expressed the futility of resuscitating someone so old. He seemed to be angry with me. I believed that I had reacted the right way in the situation and then thought about the impact on Miss Green's brother if we had had to tell that she had died.
The staff eventually contacted Mr Green and he immediately returned to the hospital. His face looked strained and then the doctor gave him the news of what had happened and told him that the future looked grim. Mr Green looked concerned but he sat with his sister and held her hand and acted as if everything was fine. I wondered if he was trying to be brave for her.
Mr Green spent a lot of time with his sister, who remained conscious, and then the following day had another cardiac arrest and died. This time, Miss Green was not resuscitated because she had decided she did not want to be resuscitated and a 'not for resuscitation' order was documented in the client's notes. The last thirty-six hours of Miss Green's life were spent peacefully, with her brother at her bedside giving them a chance to say goodbye.
This experience draws attention to a nurse's responsibility to provide a duty of care until stated otherwise. In this instance, there was a moral and ethical obligation to five CPR and resuscitate the client as there was no documentary evidence of 'not for resuscitation' order and therefore the nurse acted in the right way. Fortunately for the Greens, this permitted them some time to decide whether further resuscitation would be required and also gave Mr Green time to prepare for the death of his sister.
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