PP was a patient on our floor for 1 day short of 3 months. Our staff tends to get attached to many of our patients but when they are here for that long we develop a special bond. In this case, the bond was strained regularly. PP made many crass comments and was steadfastly opposed to making any life choice that would improve his health. To complicate matters, his wife had substance abuse issues pushing her in and out of treatment, several times visiting the floor while under the influence. After many setbacks and frustrations, PPs health had deteriorated to the point where he couldn't be left off BIPAP for more than a few moments to take pills or eat a quick meal. He told Blake "I've had enough. I can't live like this anymore".
Blake had worked frequently with PP and had a better rapport with him than most of our staff. He had talked extensively the day before with PP about code status and goals of care along with the palliative care team. After clarifying PPs wishes, Blake notified the MDs working with him and initiated a comfort care regimen, removing the BIPAP and giving meds to reduce air hunger, ease anxiety and eliminate pain.
There were many complications, including difficulty with IVs infiltrating and getting meds delivered from pharmacy. Another nurse working that day worked closely with Blake and the Core to ensure that meds were brought to the room and Blake's other patients were cared for so he didn't have to leave PP alone when his family couldn't be with him.