Stories of Moral Distress

From a nurse working in an ICU -

I was working in a critical care unit caring for a 96-year-old African American woman who had metastatic carcinoma of the breast. She was cachexia, skin and bones at this point. The cancer had really eaten through her body. She was clearly dying. I talked to her family earlier in the day and they were ready to make her a DNR, Do Not Resuscitate. But the doctor had not gotten around to writing the order for the DNR yet.

My patient coded in the ICU and the interns and residents came rushing in, and because she didn't have a DNR order yet, they started to resuscitate her, and I said, "Wait a minute, the family is in agreement. The only thing that's not done is the order. This woman should not be resuscitated." One of the doctors grabbed my arm and threw me up against the wall to get me out of the way so that they could resuscitate this woman. She died, and of course it was awful. They broke every rib in that poor woman's body and she was left like this, and then they walked out. I went to my manager and to the Director of Nursing and I got no support for what I'd done, to try and intervene in this hopeless situation, and it was a matter of paperwork. Everyone in that unit knew... There was one family member there saying, "No, no, no! We made her a DNR."

That was my final night in a hospital. I never went back to a hospital after that.

From a nurse in a pediatric critical care unit -

We had a very difficult case that involved a young person who had a situation that resulted in not having enough oxygen to her brain. It left her in a persistent vegetative state. After many attempts to try to change that outcome, it was clear that this was irreversible. At that time, her family had requested that we not continue the life-sustaining treatments that we were providing, a breathing machine and she had tube feedings. Basically, we were sustaining her biological functions.

The physician who was in charge of her care denied their request to discontinue those therapies. As a result of that, she basically lived in our unit for almost two years. She was, in many instances, moved around from unit to unit, from bed space to bed space, to accommodate other patients who had the potential to actually benefit from what we were doing. It felt like such a violation of her, as a human being. First of all, we were providing care that was sustaining her biological functions, but wasn't restoring her to any awareness of her existence. Her parents didn't believe that this was the best way for her to be cared for. They stopped visiting. It caused them incredible distress and grief, to the point where she basically died in our company, without her parents.