Here’s a story submission by Michelle G, RN. My thoughts are in italics at the end.

I called first thing this morning to see if they needed me to work extra. Sure enough, a scheduled nurse was not coming in. I show up on my unit which is the medical floor to see that I have been assigned 4 patients. Wonderful! Great not to have 5 right off the bat.

Today I take care of a gentleman who I had taken care of just 4 months ago. He was diagnosed back then with liver failure and was not a candidate for liver transplant. This admission brings him in with End Stage Liver Failure which means he could have a few weeks to under 6 months to live. He is in denial and refuses some of the treatments/medicines/blood draws. Patient’s wife is excited to see that I will be his nurse again with this admission. Patient has been noncompliant and has not been following medical advice. He is on a 1500ml fluid restriction but doesn’t seem to want to adhere to those restricitons nor acknowledge them. I gently remind him about his fluid restrictions during the day which seemed to agitate him. I explained to the patient why the fluid restrictions…there was a reason for this.

Well, now he wants a wheelchair to go outside. I know exactly what he wants to do….smoke. We are a smoke free hospital but I am not security. I explained I am not going to babysit him nor police him. I explained to he and his wife that we can not cure him nor are we going to give him anything that will make him better. If the patient wants the extra juice or cup of ice than who am I to restrict a dying man?! Who are we to deny a dying man’s last pleasures…ice, a smoke, a visit outside on a sunny day?

Much of nursing is not only carrying out doctor’s orders and educating the patient why those orders are there…but looking at the BIGGER PICTURE.

At the end of my shift; patient and family were greatful to have had a nurse that took the time to explain the disease process and plan of care but also most importantly to treat him as a human being with respect and care.

What do you think?

I think Michelle is absolutely right. If the patient is able to get all the information he needs, then it’s up to the patient to make the decision. If there is no cure what what ails – heck, sometimes even when there is – a life lived with restriction after restriction with no pleasure at all is probably not worth it to many people.