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October 24, 2004 Internship Journal

Michelle and I went on vacation the second week of October. We spent most of the week at her mother's in Gainesville Florida. I was able to see my mom and Michelle was able to see her brother and sister as well as her grandparents. On our way home, I said to Michelle that I would probably return to work and learn that Mrs. Baker had died. I was right.

Somewhere around October 1, she had made her self DNR. For those of you who don't know, this stands for do not resuscitate. This DOES NOT mean that we do not treat these patients, it just means that if there heart stops or they stop breathing, we do not perform CPR. The reason that I capitalized "does not" is because this is a common fear/misunderstanding. Mrs. Baker had been resuscitated countless times during her hospital course because she had stopped breathing. So when she became a DNR, I had a feeling that it wouldn't be long before she stopped breathing again, and would therefore die.

I went by her room to say hi and see how she was doing before I left her vacation. She was upset about something, so I said something, that I cannot even remember now, that made her smile. I then told her that she was much prettier when she smiled. After leaving her room, I wonder that was the last time that I would see her. Obviously, it was.

Even though I had kind of predicted it, I was very surprised to hear of her death. Part of the reason for this was the situation in which I learned of her death. Morning report on the Monday that I returned from vacation was about ethics, and she was the subject. As they introduced the patient, I knew it was, but then they said that she was deceased. She was found with her oxygen mask off of her tracheostomy and her oxygen saturation in the 40's. After the mask was put back on her, they were unable to get her saturation's back up.

This was not the reason for this discussion however. She had recently expressed that she was considering coming off of the ventilator, and therefore passing on. Usually, when someone decides to remove support, they have a terminal illness. In her case though, she did not have one thing that was going to kill her. She had multiple issues that prevented her from getting better and coming off of the ventilator. She had been in the hospital since February and on the ventilator for most of that time, with no end in sight. Therefore, her desires to remove support were certainly understood. However, she kept changing her mind back and forth.

When someone is removed from the ventilator, drugs are usually administered to make the patient comfortable. As you can imagine, dying from a lack of oxygen would not be comfortable. This is where the ethical question concerning her comes from. By administering these drugs, her ability to change her mind would be removed. Plus, the question of physician-assisted suicide also comes up. The discussion was interesting, but I was only able to half pay attention because I kept thinking about all the conversations that I'd had with her.

After some reflection, I realized that she is now in a better place. She suffered for a long time and put up a good fight.

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