The patient was about ninety eight years old, and her only remaining family was a middle aged son. It was obvious by his demeanour that he didn’t want his mother to die, and I ached for him, knowing the inevitable was just around the corner. The lady, against medical advice, had requested full medical intervention in the case of resuscitation. I remember that she was very small and very white. Her skin, her hair, her teeth: all of them very white.
Eventually she stopped eating, and a decision needed to be made about her continued nutrition. The doctor talked to the son, implored him to make the woman a DNR and let her go onto hospice. The son could not do it though, and it was left to me, her nurse, to utilise a nasogastric tube.
Not only did I hate dropping NG tubes on healthy, young patients, I felt it was immoral to put one into this older lady. NG tubes are one of the most uncomfortable, invasive procedures we can perform on a patient. Even an IV stick only lasts a moment, but an NG tube procedure can last half an hour or more. I was ordered by the doctor to do it. I strongly disagreed and made my opinions known, but in the end, I had no choice but to perform the procedure.
I brought other nurses in for help and moral support. None of us could believe what we were doing, and we all screwed ourselves up for the struggle that was to come. My little white lady didn’t understand what we were doing to her. She thrashed her head from side to side, and I could barely get the tube into her nostril. When I advanced it, she would whip her head, and the tube would thrash out.
I could advance the tube into the oropharynx, but she would obviously gag. We all yelled at her to swallow, but she only gagged, throwing up a white fluid onto her gown. Sweat poured down my face as I tried time after time to get this tube down her throat. I think I may have cried as I tried to push it through. The patient was crying, asking me to stop, but I had my orders.
After what seemed like a lifetime, I stood up, threw the tube aside, and said I wasn’t going to do it anymore. I marched out to the desk, placed a call to the doctor, and told him that if he wanted the tube placed he could come in and do it himself. To my relief, he spoke to the son, and the son finally allowed his mother the comfort of hospice. She soon left our floor, and I like to think she died a peaceful death.
This story sticks with me because it was a time when I went against my morals. I knew that I should not have tried to place that tube. I knew that it would have caused more suffering to the patient than good. I was a relatively new nurse. It is very, very hard to tell a doctor no. It is hard to tell family no, especially when they are holding on so tight.
When facing a situation that goes against your moral values, it comes down to what is best for the patient. What I did was not in the patient’s best interests, and I wish that I would have advocated for her a little more strongly than I did. I can only plead the internal reaction to the order of the doctor.
Fight for your patient. What would they want you to do? How would you want your own parent or child to be treated? What kind of suffering would you inflict?
As humans, we feel the pangs of our morals. As professionals, we work past them.Document this CPD