07/29/10

I spent an hour this morning doing something that is so anathema to my sense of right and wrong that I makes my stomach hurt. I'm a hospice nurse and my job is to keep my patients comfortable and peaceful.

This morning I made a follow-up visit to see a little man who is dying of heart failure. He is hardly breathing with breath sounds almost absent. His heart rate is irratic and faint. His little arm is too tiny to record a blood pressure, and he reponds only to pain. Sooooo, I proceeded to hurt him. When I first went into his room, I had to chase roaches out of his bed.

I was given the task of changing the dressings on his legs. The circulation in them is nearly absent and the skin is thin and weeps blood. He's on blood thinners. If you can figure that out, please let me know. My job was to change the dressings on his legs. I gave him morphine twice because it was so painful for him. And when I was done, I realized that I had made a horrible nursing judgment. The dressings looked clean, and I should have left them alone - in spite of the instructions to change them.

When I removed the old dressings- complicated layers of dressings meant to heal burn patients - sheets of skin came off with them. And my patient grimaced with pain and recoiled - in spite of the morphine that I gave him before we got started. I was horrified and guilt-ridden at what I had done.

I got the family together, and explained that I was going to put a skin barrier cream on his poor legs and wrap them gently in gauze. I instructed them NOT to touch the dressing unless the the drainage became visible through them. I explained that the purpose of the cream was to make sure that it was what came off with the dressing and not my poor patient's skin.

Gruesome? Yes. Part of life and learning? Yes. Cruel? Yes.

What was I thinking?