how to save a life

the NMC says:

If a nurse or midwife is asked to deliver care they consider unsafe or harmful to a person in their care, they should carefully consider their actions and raise their concerns to the appropriate person. Nurses and midwives must act in the best interest of the person in their care at all times.

what do you do when a patient is making a choice that is ultimately going to kill them?  when you know it’s going to kill them, and they know it’s going to kill them, and they still choose it anyway?  what do you do when you can’t understand their choice?

i suppose i should start at the beginning.  we have a patient named paul.  he’s undergoing chemo for lymphoma.  a few weeks back, paul rang to cancel his blood test because he felt so unwell he couldn’t get out of bed.  i demanded that his wife get a GP to the house to see him, she rang back to say she couldn’t.  i rang the GP personally and arranged a home visit.  i rang paul and his wife to tell them what was happening, and insisted that they ring me back when the GP had been.  when they hadn’t rung back, i chased them.  the GP was there, i asked his wife to ring me when the GP had gone.

she rang me back, and said the GP thought it was a virus.  i asked in passing what his temperature was, i don’t even know why i asked because we hadn’t been talking about it, but she told me it was 39 degrees, and the GP would be back the next day to check on him.  a temperature of 39 degrees post chemo means that your body has an infection you cannot fight and you’ll be lucky if it doesn’t kill you if left untreated.  i demanded that she bring him to the hospital instantly.  she said she’d get him to call me straight back.  he rang me back and said he didn’t want to come to the hospital because we’d keep him in.  i would never ever tell a patient that if they don’t do what i’m telling them they’ll die, but i told paul that if he didn’t come to the hospital straight away, the infection would kill him.  i had to be that blunt, he wasn’t grasping the severity of the situation.  so lo and behold he came along to the hospital, and the next time i saw him he thanked me for shouting at him.  his wife ran down the corridor after me the next time i was working and she was visiting and thanked me for saving his life.  a proud moment, and i’m not sure i’d have gone above and beyond to the same extent for any other patient.  i don’t know why i did for paul to be honest, maybe it was just instinct.

which leads me to now.  paul is refusing blood products.  his mother is a jehova’s witness, he no longer practices.  but he’s refusing blood products on the basis that although it’s not something he believes, his mother has threatened to disown him if he accepts them.  it’s a rarity to get through chemo without needing support with blood products at some point, chemo not only kills bad cells, but also good cells in the bone marrow, and therefore until the bone marrow starts producing healthy cells, we support the patient with transfusions.

paul is some kind of miracle, in that he’s reached his fourth cycle of chemo without receiving blood, and unbelievably has bounced back.  this time however, his blood counts are dropping and dropping, his haemoglobin was 2.5 when i left work yesterday.   we try to maintain our patients above 8 post chemo, and a healthy male haemoglobin is about 13.  his platelets are 0. they should be 150 minimum.  platelets are for clotting, when they’re low you’re at major risk of bleeding.  so paul is dying.  paul has essentially chosen to die.  he knows the risks, and he’s choosing to die for something he doesn’t even believe in himself.

i think the problem i have with his choice, is that he has a family of his own.  i could maybe understand if his mother was his only family, how surviving but being left with no family wouldn’t seem worthwhile.  but paul has three sons, and very young grandchildren, and a wife.  i suppose i understand how something you’ve believed as a child can deeply affect and influence you for the rest of your life.  i don’t understand how you can make a decision based on something you no longer believe that selfishly affects the rest of your family.

i don’t have children.  but i already know i’d give my right arm for any children i do ever have.  i could never imagine harming a hair on their unborn heads, let alone encouraging them into making a decision that puts their life at risk, or could result in their death.  

it’s been a very difficult time, none of us in work can get our head around the strength of his conviction.  it’s been an emotionally draining couple of weeks.  essentially we’re watching and waiting.  he’s at the stage post chemo where his counts should be picking up, but they’re so low, we think there’s nothing left to fight with and he’s more than likely going to die.  we’re all in total disbelief to be honest, his observations are stable, he was chatting to me yesterday.  he’s living on borrowed time, he should by rights already be dead.  

back to it tomorrow, who knows what will have happened today while i’ve been off.  it’s all very intense and pointless.  a man is losing his life when we could save it within three hours – two bags of platelets and two bags of blood is all it would take.  as a nurse it’s my first instinct to do whatever it takes to save someone’s life.  it’s really difficult to sit by and do nothing except hope to god that some miracle occurs for this man and his family.  it’s all i’ve been able to think about when i haven’t been in work.

<span style=

“font-size: medium;”>i have things about dan too, like his interview in rotterdam, for a job which could be anywhere in the world.  but that’s another miserable entry for another day.

xx