It was the 1980s, and I was a critical-care nurse in the cardiac-care unit (CCU) of a big Philadelphia hospital. I came in one day to work the 4 p.m.-to-midnight shift, and one of my patients was a 50-something man with profound cardiac failure. I went into his room, where he was surrounded by his large Irish family of daughters — a mix of nuns and nurses — and introduced myself. The patient, despite his discomfort, managed a smile and a bit of a joke.
His daughters left the room when I did my physical assessment. The findings were sobering. All of the man’s cardiac “indicators” — heart sounds, internal heart pressures, frequent irregular heartbeats on his EKG, shortness of breath — were bad. His heart had so little contraction there was barely any blood flow. If a patient presented like that today, he’d be a candidate for a heart transplant. But this was before the days of transplant ubiquity. Everything that could be done for him was being done, but it was clear to me that his heart was likely going to stop beating on my shift. His chart indicated that he was a “full code” — meaning that if his heart stopped, I was obligated to initiate resuscitative protocol: CPR, defibrillation, intubation (placement of a breathing tube), and more.
As the daughters were filing back into the room, I asked one of the them — a nurse to speak with me at the nurse’s station. I reviewed with her all of her father’s cardiac data, and noted that there was no “DNR” (do not resuscitate) order on his chart. I just wanted to make sure that everyone knew this was the case, and understood its implications should her father code. She said she understood and would talk with her father and the family to make a determination of what, if anything, they wanted to do.
About 45 minutes later, two of the sisters told me that they and their dad had all agreed not to resuscitate if his heart stopped. I then notified both the on-call M.D. and the patient’s attending physician, and got the paperwork in order. Signatures quickly followed.
At this point, visiting hours were over, and the nurse in charge of the CCU was insisting that the man’s family leave. I resisted, telling her that he was likely to die soon, that he was now a DNR, and that his family wanted to be with him. She called the nursing supervisor, upset that I was refusing her direction. When the supervisor said that she also wanted the family to leave, I stood my ground with her, too. I then called the attending physician for backup. He called the supervisor, and the hue and cry about the family finally halted.
I pulled the wires from the central station monitoring the patient’s heart and shut the curtains in his room, to give him and his family more privacy. Sure enough, about two hours later, the patient died, with his daughters around him, all together, singing Irish songs as he drew his last breath.
I have been present for the lives and deaths of many patients. But this man — and his beautiful family of smart, thoughtful, spiritual women — made me grateful that I had such worthy work to do. It also made me so conscious of the difference that one person can make in the most important moments in the lives of others. I will never forget him, or them.
Donna Gentile O’Donnell, Ph.D., is senior vice president of innovation partnerships and programs at Thomas Jefferson University & Jefferson Health.