I received a call from a patient’s daughter requesting that a nurse come out to see her father who was not doing well. The patient did not answer the phone when his daughter called him that morning and she stopped by to check on him. The patient had gotten tangled up with his O2 the night before and his O2 saturations were running between 71 and 74 percent. The nursing part of me advised her that if the patient was having difficulty breathing that medical attention was needed urgently. The daughter explained that the patient did not want to go back to the hospital. He had just had an extensive stay at WMC and had seen Dr. C the day before. Dr. C talked with both the daughter and patient during the visit and because the patient had declined since the last appointment, as well as recently had an extensive hospital stay, it was suggested that maybe they should consider a Hospice referral. Never in a million years would the daughter have thought that her dad would deteriorate so quickly from the MD appointment the day before.

I reviewed the patient record and indeed the patient was a “do not resuscitate”. The daughter and I discussed care issues and possible outcomes if the patient decided to go to WMC for aggressive treatment or stay home. On the last WMC stay, the daughter had reported that the patient did agree to go to WMC because that was what the daughter wanted but not what he really wanted. This time she did not want her dad to go to the hospital just because she wanted it. She wanted to respect his wishes. The patient and daughter made the decision for him to stay at home. Phone calls were made to both physicians involved in the case to obtain orders for Hospice and a vent-mask to assist patient’s breathing.

Jennie Norton, RN rearranged her day to go make a visit to the patient’s home that morning and was there within an hour. Jennie had seen the patient earlier that week for the first time. Jennie however had not met the daughter prior the visit that day. Jennie’s kind, compassionate manner was just what she needed. Jennie helped the daughter “clean up the patient and make sure he was comfortable”. Jennie explained what was happening with the patient’s condition and what she could expect as his condition deteriorated and provided end of life care. Jennie waited with her until the daughter’s husband arrived so she would not be alone. Emotional support was lent to the patient and family. Jennie encouraged the daughter during the visit and told her how much she admired her for the decision to honor her dads wishes that no further aggressive care be done requiring him to go back to the hospital. She was allowing the patient to die with dignity in his own home, in his own way. The amazing thing is how alert the patient was despite having O2 saturation levels very low and continued deterioration of status. Jennie came to the office after the visit and gave me an update of the visit made. Jennie was very humble when I told her what a great job she did with this family and rearranging her day to help out. Jennie said “that is what I do”, “I am here to help”.

Later during the afternoon, Jennie went back to the patient’s home to “check on the patient and his daughter” and to see if there was anything she could do to help. O2 saturations were in the 50’s by this point. The patient passed away while Jennie was there. No funeral arrangements had been made since this event happened so quickly. Jennie helped the daughter prepare the body for the funeral home, offered to make phone calls as needed and notified physicians of the patient status. The daughter did not want her dad to go to the funeral home in his underwear but rather be dressed and dignified for when the funeral staff came. Jocelyn knew that is what her dad would have wanted so O2 tubing, etc. was removed and the patient looked peaceful and at rest. Jennie had not been scheduled to go back that day, but went back because she felt the need to support this family. That indeed is what nursing is about!

Sometimes, we, as health care providers get so involved in the treatment and curative aspects of care that we overlook what the patient wants and their needs when end of life situations occur. The daughter called back the following week to personally thank our agency for the care and concern shown to both her dad and herself. She was so grateful for “Jennie” and allowing her dad to pass away peacefully at home. Jennie is truly an angel of mercy, and is very deserving to be recognized for the sensitivity she demonstrated, to make this sad situation end with dignity and respect for the patient and his daughter.