Ethics, emotions, money and mortality.

The universality of nursing experience became apparent to me today. I worked with five of the D ward nurses and an American and a Khmer doctor for three hours trying to keep a patient alive. Despite the language and cultural differences that can often make things so difficult we worked well together, and differences between an Australian hospital and one in Cambodia aside, the arrest was well run. We were organised, we documented, we didn’t get in each other’s way, we were calm and focused.

Unfortunately the patient deteriorated, we couldn’t keep a blood pressure, we defibrillated her heart 6 times but couldn’t keep it in a sinus rhythm, her kidneys weren’t making urine, she was fluid overloaded and eventually she stopped breathing and her heart rate fell. After we decided not to continue I tried to tell the nurses how well they had done. I was having trouble dealing with feeling sad for the family, sad that we couldn’t save her and adrenaline and shock at having expected to save her and having her die. When I said you worked really well together today and you did a good job they said ‘ot sabai jet’ we are not happy because we could not save her. I felt so impressed with the way that had handled the situation, so proud of them integrating new knowledge and skills so well, and still, I know the feeling, of putting in the work to save someone, starting out expecting that we will and then having them pass away. That switch of focus from focusing and concentrating on how to save a person’s life to taking everything off and letting them go and trying to support a grieving family has always been hard for me, I think it is for everyone in that situation. I felt immense respect for our team, and understanding of the fact that you can try your best and still fail to save a life, and yet trying to reassure them I was close to tears myself.

The other difficulty here is that when deciding how much to give the patient and how long to try and save them is that the family (of our medical patients) have to pay for those drugs, and I never know what their financial situation is. It can be an emotionally charged decision to decide to stop trying to save someone, but there is a point where it becomes futile, their heart can no longer beat, no matter what drugs you give or how many times you defibrillate, if they have spent long enough without oxygen going to the brain the chances of surviving with viable brain tissue are reduced. To continue trying last ditch attempts in these situations can make you feel sure that you have done your best, but in cases that are futile can cost the poor and grieving family money that they could have been saved. I have no answers to this dilemma, I wish we could treat everyone, that we could give free care, which we had guaranteed funds and resources but that isn’t the case here.  I am going to try and get the hospital agree that patients and their families don’t have to pay for the cost of care given during life threatening situations. While this might help for the acute situation the reality is that many many people are going without treatment for their medical issues because they cannot afford it.