A Husband's Difficult Decision
Submitted by Jennifer Kinneret Ron, BSN, RN, CPAN
Mrs. A. was 54-year-old female with an extensive medical history including peripheral vascular disease (PVD) and chronic obstructive pulmonary disease (COPD). She was assigned to me in the post anesthesia care unit (PACU) to recover from a below the knee amputation, secondary to acute limb ischemia and sepsis. Mrs. A. was visited in PACU by her husband who was wheelchair bound due to Multiple Sclerosis.
Mrs. A. was very sick battling sepsis. Her prognosis was poor. Her husband was at the bedside reporting he felt she was exhausted, giving up hope, and didn’t have the strength or desire to “continue to fight”. As Mr. A. continued to watch his wife, and speak with me, he started to cry. He began to express feelings of guilt related to not being able to properly care for his wife because of his own medical condition. He then asked me if I thought she “would make it.” I explained to Mr. A. that his wife was in critical condition, but I could not know for sure how she would progress.
With continued conversation, I asked him if he and his wife ever discussed their wishes if one was ever to become critically ill. Mr. A. stated he was Mrs. A.’s power of attorney and made her medical decisions, however they never discussed any plans. He said he felt “torn” and “didn’t know what to do.” I then asked him if Mrs. A. ever made living will or a do not resuscitate (DNR). Mr. A. stated he was not sure, but had a large envelope of Mrs. A.’s legal papers with him that he had been meaning to read through.
I spent a few more minutes speaking with Mr. A., answering questions he had regarding a DNR. I then gently suggested to Mr. A. that now may be a good time to open the envelope he had been meaning to review. Mr. A. told me he was going to go have lunch and return to PACU since his wife was still waiting to transfer to the ICU.
An hour and a half passed until Mr. A. returned from lunch. He wheeled into PACU, said hello to me, and quietly sat next to me for several minutes. I then asked how he was doing. Mr. A. looked at me with tears in his eyes, grabbed my hand, and said, “thank you.” At that moment I wasn’t sure specifically what he was thanking me for, but I simply replied “you’re welcome” and continued to hold his hand quietly. He took a moment to collect his words, and then proceeded to explain how thankful he was that I opened up the difficult conversation of end of life care and DNR’s.
Mr. A. stated he had left the PACU, grabbed some food, and went out to eat lunch by the water. He finally opened the large envelope containing Mrs. A.’s legal papers. As he sorted through the power of attorney paperwork he came to find Mrs. A. did compose a living will and DNR. She clearly detailed her wishes prior to becoming severely ill. Mr. A. stated he was so relieved and grateful to find the documents, taking the pressure off of him to make the difficult decision.
Mrs. A. was severely ill with multiple co-morbidities. Her chance of full recovery was very low as she continued to decline. The decision to sign a DNR for a loved one is extremely difficult, involving multiple personal and ethical thoughts and feelings for the caretaker. Mr. A. felt lost, guilty, and torn about a decision he thought he was going to make. Mr. A. had no idea the decision was already made by his wife. Being a nurse in PACU, there are times we only spend 45 minutes with our patients, never really getting to know what they and their family are going through. I was thankful to be able to help Mr. A. work his way through his feelings and a difficult situation.