A Lession in Kindnessby Kelly Maher Morrissey, RN, MSN
The ED appeared relatively calm on Sunday morning as I arrived to work my 8-hour shift. I received report on two patients; both sounded clinically stable. One patient, Dominic,* was particularly memorable.
Dominic was an 87-year-old man who had been transported from a nursing home to the emergency department (ED) at about 4 AM for symptoms including a 104F fever and chest congestion. He was evaluated, diagnosed with pneumonia, and admitted. During report, the departing night nurse indicated that Dominic was oriented to person only and had been agitated since arrival. Because of his growing agitation and impending admission, Dominic's son was contacted to come to the ED to be with his father. Despite his son's presence, Dominic remained agitated and oriented only to person. The off-going nurse indicated Dominic had a do-not- resuscitate (DNR) order that accompanied him from the nursing home, and it was valid. She also said Dominic's son had just left to run home but would be back within two hours.
On my way in to greet and assess Dominic, I quickly pulled his chart to confirm the presence of the signed DNR order and review his most recent vital signs. As I proceeded to his room, I felt tremendous empathy for Dominic - he was elderly, not feeling well, and was displaced from his familiar nursing home environment. It didn't sound as if the ED night shift was successful at relieving his agitation or making him comfortable. I hoped to change that.
Walking into his room, I told myself I was going to be the best nurse Dominic would encounter that day. I would be patient with him each time I reoriented him to place. I would see that he was kept physically comfortable prior to transfer to the floor, and I would make sure he felt respected. I remembered a phrase my father used to say - "Kill 'em with kindness." At that moment, I determined to do so for Dominic.
Dominic appeared semidisheveled and feverish. I took his vital signs, performed a brief assessment noting crackles and wheezes in his lungs, and asked him how he felt. "Terrible," was his response. I helped straighten him on the stretcher, fluffed his pillow, and asked if he'd like something to drink. "Yes," he said, "juice."
Assuring his side rails were up, I noticed he appeared more comfortable than when I arrived. Standing beside his stretcher, I offered Dominic the orange juice through a straw. He greedily and gratefully gulped down the 4-ounce container of juice. With the juice gone, he let out a contented sigh. A split second later, Dominic gazed at me, then gazed into space, extending his right arm and index finger into the air. Dominic immediately became unconscious.
Staring in disbelief, I quickly dropped the stretcher from a high Fowler's to a supine position and called the ED physician to the room. The physician confirmed Dominic was apneic and pulseless. With the valid DNR order in place, we stood with Dominic for the next few minutes and spoke quietly to him. We told him everything was all right and it was OK to let go. Dominic's death was calm and respectful.
Dominic's son arrived approximately 30 minutes after Dominic's death. Of course, the son was shocked and grief-stricken, not thinking his father was gravely ill when he left a few hours before. I tried to comfort and reassure him. I reassured him that my time with his father was peaceful and calm, and his father was comfortable before his death. I explained that the ED physician and I were with his father from the moment we sensed something was wrong, and we stayed with Dominic and spoke words of kindness to him as he departed this life. Dominic's son was genuinely grateful for our efforts and kindness towards his father.
I've never forgotten Dominic or my innocent but fateful thought, "Kill 'em with kindness." While I no longer use this phrase, I hope my every action reflects nothing but kindness towards my patients.
* Name has been changed.
Dominic was an 87-year-old man who had been transported from a nursing home to the emergency department (ED) at about 4 AM for symptoms including a 104F fever and chest congestion. He was evaluated, diagnosed with pneumonia, and admitted. During report, the departing night nurse indicated that Dominic was oriented to person only and had been agitated since arrival. Because of his growing agitation and impending admission, Dominic's son was contacted to come to the ED to be with his father. Despite his son's presence, Dominic remained agitated and oriented only to person. The off-going nurse indicated Dominic had a do-not- resuscitate (DNR) order that accompanied him from the nursing home, and it was valid. She also said Dominic's son had just left to run home but would be back within two hours.
On my way in to greet and assess Dominic, I quickly pulled his chart to confirm the presence of the signed DNR order and review his most recent vital signs. As I proceeded to his room, I felt tremendous empathy for Dominic - he was elderly, not feeling well, and was displaced from his familiar nursing home environment. It didn't sound as if the ED night shift was successful at relieving his agitation or making him comfortable. I hoped to change that.
Walking into his room, I told myself I was going to be the best nurse Dominic would encounter that day. I would be patient with him each time I reoriented him to place. I would see that he was kept physically comfortable prior to transfer to the floor, and I would make sure he felt respected. I remembered a phrase my father used to say - "Kill 'em with kindness." At that moment, I determined to do so for Dominic.
Dominic appeared semidisheveled and feverish. I took his vital signs, performed a brief assessment noting crackles and wheezes in his lungs, and asked him how he felt. "Terrible," was his response. I helped straighten him on the stretcher, fluffed his pillow, and asked if he'd like something to drink. "Yes," he said, "juice."
Assuring his side rails were up, I noticed he appeared more comfortable than when I arrived. Standing beside his stretcher, I offered Dominic the orange juice through a straw. He greedily and gratefully gulped down the 4-ounce container of juice. With the juice gone, he let out a contented sigh. A split second later, Dominic gazed at me, then gazed into space, extending his right arm and index finger into the air. Dominic immediately became unconscious.
Staring in disbelief, I quickly dropped the stretcher from a high Fowler's to a supine position and called the ED physician to the room. The physician confirmed Dominic was apneic and pulseless. With the valid DNR order in place, we stood with Dominic for the next few minutes and spoke quietly to him. We told him everything was all right and it was OK to let go. Dominic's death was calm and respectful.
Dominic's son arrived approximately 30 minutes after Dominic's death. Of course, the son was shocked and grief-stricken, not thinking his father was gravely ill when he left a few hours before. I tried to comfort and reassure him. I reassured him that my time with his father was peaceful and calm, and his father was comfortable before his death. I explained that the ED physician and I were with his father from the moment we sensed something was wrong, and we stayed with Dominic and spoke words of kindness to him as he departed this life. Dominic's son was genuinely grateful for our efforts and kindness towards his father.
I've never forgotten Dominic or my innocent but fateful thought, "Kill 'em with kindness." While I no longer use this phrase, I hope my every action reflects nothing but kindness towards my patients.
* Name has been changed.