My patient is medflighted and arrives on my unit intubated on 2 pressors. BP 62/45, nodding head appropriately and following commands. 2 more pressors added. Physician states this patient won’t make it two more hours. 30 years old, 6 kids, attempted suicide. I look at physician and say" this patient is not dying on my shift. We are going to do all of the things.“ After 8 hours, 10 liters of fluid, albumin, electrolyte replacement, bicarbonate infusion. A very tired me gives report that the patient’s systolic BP is finally above 90. The patient is able to follow commands the whole night. During the day pressors are weaned off and patient is extubated. Life saved. 3 nights later, 89 year old patient down time of 90 minutes between several episodes of v fib arrest. Intubated, On 2 pressors, completely unresponsive with no sedation. Physician states, we are doing all the things! Me looks at family, what are this patients goals at the end of life. Family talks, we withdrawal care administering morphine and lorazepam for comfort of patient and family. Patient passes peacefully surrounded by family. A very tired me gives report in the morning. Life not saved. My husband thinks I'm crazy because sometimes I get mad when the physician wants to do all the things and sometimes I get mad when they don't want to do all the things. I find that advocating for the patient in either capacity is exhausting.
