Playing God?

One of the most memorable events of my stay in intensive care was the "treatment" of an old guy who had respiratory problems in the bed next to me.  He was definitely of the "old school" and was brought up in an era gone by (probably just as well).  He was most definitely a racist bigot, and he had something against Asians which may have been developed during the war.  This was unfortunate however, as this was St Leonards in 2009, and quite a few of the nurses were of a cosmopolitan background, and yes, a fair number looked Asian.

A lot of them had been to school in Sydney.  Someone may have an Asian appearance - that's difficult to hide - but often they'll open their mouth and sound like Kylie Mole, indicating they are, if not actually born here, certainly bred here.

The old gentleman in the bed next to me was quite troublesome.  They had him hooked up to a respirator which required him to keep pressure on his mouth and not to speak in order for it to work properly.  He was resisting the thing, and would often throw it off.  In Intensive Care you have a number of monitors hooked up to you giving instant readings. One of them attached to your finger will be a blood oxygenation probe indicating the percentage of oxygen in your blood.  They aim to get the reading at around 94% or higher - any less and they will put you on oxygen to get the levels up as high as possible (I am accutely aware of this as I was on oxygen in various forms for over a month).

Apparently he had been a smoker and his lungs were in a bad way - he was managing to get readings around 80% or so, indicating quite a dire need for a respirator.  But he hated it, and kept throwing it off, much to the chagrin of the nurses.  There was a constant running argument.  He'd say he's better off without it, and at one stage the nurse was pointing out to him that his oxygenation levels were much higher with the respirator on than without it.  It seemed to no avail, as the machine WAS quite uncomfortable, and he kept throwing it off.

I remember at one stage, one nurse made him a promise.  She said if he'd wear the respirator for an hour, she'd make him a cup of tea.  To someone on nil by mouth promised a cup of tea that would be a strong incentive.  I would have done anything for a cuppa at this stage, wearing a respirator for an hour would be most definitely worth it (mind you MY problems were a bit different and consuming anything via the oesophagus at this stage would not have been wise).  Despite him being nil by mouth the nurse was still prepared to make the offer - she may have gotten in trouble for it later on, but she figured it was a calculated risk, and if it got him to use the respirator the benefits outweighed the problems.

One night, a young nurse came in to do the dogwatch shift.  In Intensive Care there is a high ratio of nurses per patient.  For the first week or two, I actually had ONE nurse for only myself, and at most a nurse looks after two patients.  Our gentleman friend was also allocated one nurse (indicated by a special sticker they'd put on your shoulder) for that night.  The young nurse was definitely Australian (very likely schooled on the North Shore), but of Asian appearance.  The old guy didn't get off on the right foot making a tasteless racist remark to greet the poor girl.  Let's get this clear, he was most definitely a racist bigot.

For the first hour there was a hate-hate relationship between the two, and he threw his respirator off at least eight or nine times, meaning the nurse had to re-fit it under very trying circumstances, handling not only physical resistance, but also hatred racist remarks from the old guy.

The poor girl wasn't handling him well at all.  Some of the nurses dealt with it through a carrot (such as the one who promised him a cup of tea, which he DID get incidentally), others would use a stick, and simply yell at him to put the respirator back on, and not taking any crap from him.  This method seemed to work the best: I think this was the sort of discipline he would have been brought up with.

But this night, she was trying to use reason and appeal to his good side (which was, if not non-existant, quite miniscule).  And it wasn't working at all.  Finally after another rejection of the respirator she simply walked out.  Some of the other nurses tried to reason with her, but her clinching comment was "why should we bother to save him?  It takes a lot of time and effort to treat these very sick people and it takes a lot of resources to do so.  If he's going to be like that, why should I have to put up with it?  He can just lie there without a respirator and if he dies, so be it".  She walked out, went home and I never saw her again.

The nurses didn't quite know what to do in this situation.  By this time it was well after midnight, and management were quite absent at these hours.  Fortunately the old guy mostly slept that night, and didn't require much help.  The nurse allocated solely to me, who was sitting at the foot of my bed during all of this, did spend a bit of time looking after the old guy when required.  Her caring mode kicked in and despite it not being her job, she went over to fix up a few things that went wrong as the night went on. 

We got through the night and the Nursing Unit Manager was prowling around next morning asking questions and trying to get to the bottom of the issue.  As I said, I never saw that nurse again.  I was in ICU for probably another three or four weeks after that, and would often see the same nurses again on different shifts.

So for the actions of one old beligerent man on one fateful night I am wondering whether a fine nursing career has been ended?  You don't get to be a nurse unless you are caring and dedicated.  It most certainly is a well-paid profession, but it involves work that is quite difficult physically and emotionally, plus it's hard on the stomach.  I had to be cleaned up of faeces, urine, vomit and blood quite a number of times during my ICU stay, and my hat is off to the wonderful souls who did this for me.  Plus there were a few deaths, which to a nurse must be the ultimate occupational reinforcement that something has gone wrong.  I reckon you'd constantly be thinking if only you'd done something differently perhaps the outcome would not have been the same.  You'd always be blaming yourself for the result.

I hope she has managed to return to the profession, although I don't think it'd look good on your resume.  Fortunately nurses are in high demand so if she takes a few months off, she might be able to continue her careeer given her qualifications.  I certainly hope so.

The old guy was discharged from the ICU well before I got out, so I'm not sure of his ultimate outcome.  The prognosis was not good - smoking causes so much damage to your lungs their chances of oxygenating the bloodstream decreases sharply as age increases.