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End of Shift: Milkshakes and Morphine

Monday April 6, 2009
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I liked him almost immediately. Mr. K was a 65-year-old man who was admitted to our ICU after his defibrillator had fired several times. Although he was in cardiogenic shock, on a ventilator, and had an intra-aortic balloon pump, the team was surprised by how well he was doing.

“Hello, I’m Cindy. I’ll be your nurse today,” I said. “You can’t speak until the breathing tube is removed, but you’re doing very well. Hang in there. I know it’s hard.”

This was my usual script to vented patients. I have always felt a bit like an imposter saying it. Having never awakened critically ill with a breathing tube in my trachea, I felt ill-equipped to give advice on the subject.

I finished with a wink and attempted a smile to reinforce what I hoped was calming reassurance.

To my surprise, he winked back.

Within the next couple of days, Mr. K improved and was weaned from the balloon pump and ventilator. He soon transferred to the medical telemetry unit.

But Mr. K was not away from our unit for very long. Two days later, a call from the supervisor stunned me, “Mr. K is coming back to the ICU. He needs to be reintubated and put back on a balloon pump.”

Mr. K had left our unit looking lively and joking and returned to us gray and dyspneic. The cardiologist and the ICU attending were on hand to perform the necessary interventions. They spoke to him about his options. Mr. K was considering them all but focused on one. He wanted to forego further life-support measures. Since it meant he would die, he wanted to talk with his family first.

When Mr. K’s children arrived, it took them little time to accept his decision. They assured him he would not be a burden but that they would support him in whatever choice he made. My heart ached for them, but I marveled at their strength.

The youngest daughter brought welcome relief to the tension of the moment. “Well, I guess that means you can eat now, Dad. So what do you want?” she said.

When I walked into Mr. K’s room near the end of my shift, he was sitting up in bed with a black and white Steak ‘n Shake paper hat on his head enjoying a milkshake. His broad grin told me he knew he looked silly.

“I need a picture of this,” I said. “No one would believe me.” Camera phones recorded the lighthearted moment.

Any hopes of Mr. K returning home for his final days were immediately put aside because of his respiratory status. We wanted to do more than offer milkshakes, so when he asked for a beer, he got it. Later when he asked for morphine, he got that too.

Mr. K was dead within 24 hours. When I returned to work I found the Steak ‘n Shake hat taped to my locker. A note of thanks from his children was written on it. Alone in the locker room I mourned quietly.

Several weeks passed, but I often thought about Mr. K and his children. One night while checking my e-mail I saw a familiar name in the return address. When I opened the e-mail, I saw Mr. K’s face smiling back at me as he wore his Steak ‘n Shake hat.

I sent a note back thanking the family for sending the photo. I expressed how I thought their father was a thoughtful, brave soul to have made such a difficult end-of-life decision and that he was a marvelous example of grace and courage. I commended them on their unblinking support of his decision and acknowledged how they must miss him. I hoped that as a family they would stay bonded.

Sitting at my computer, I recalled a moment I had with his oldest daughter. We were standing at the nurses station and she was telling me about her family’s struggle with their mother’s death just a few months earlier. When she saw that I had tears in my eyes, she stopped and said, “You look like you need a hug.” Then, she gave me one. The family member was comforting the nurse.

Twenty-five years of being a nurse, and still there are times when I feel completely unprepared to deal with the stirring drama that can unfold at the bedside. Do I feel inadequate? A little, but mostly I feel human.


Cindy Erickson, RN, works in the ICU at Glenbrook Hospital in Glenview, Ill. To comment, e-mail editorNTL@ gannetthg.com.