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[ Page 3 ] / [ Previous page ] When the doctors returned to Phyllis's room during afternoon rounds, they were discouraged by what they found. Her breathing -- ragged from pneumonia -- and her low blood pressure had not improved. ''She's slipping a little bit," said Dr. Bill Benedetto, an anesthesiologist, bringing tears to the eyes of Phyllis's son, who was sitting nearby. Julia told the doctors that Phyllis was in a lot of pain and receiving little pain medication. But the patient was quiet while the doctors were on hand, and attending physician Ed Bittner was focused on avoiding the need for a breathing tube for the frail woman. If Phyllis were too sedated, he worried, it might weaken her will to breathe. ''I really dread the idea of her [breathing] continuing to worsen," he said. ''That would just suck." Bittner suggested that Julia sit Phyllis up in bed, so that she might be able to clear her lungs, and the doctors moved on. ''OK, dear, we're just going to sit you up," Julia said, as she started to adjust the bed to a more upright position. Phyllis began to moan. ''Oh, it hurts so bad," she cried out, and complained that she was freezing again. Just then, M.J. walked in. ''Did you tell them that she's on no pain control at all?" MJ demanded, looking toward Phyllis, her gasping mouth wide open beneath a breathing mask. Julia said she had told the doctors, but M.J. was unimpressed. |
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''You've got to bring them in the room, because this is unacceptable. You have to go back to them and say their plan isn't working." ''Again, I raised it several times," insisted Julia, her back straightening. As M.J. looked at the medication record, she got even angrier. Though Phyllis's heart was beating slightly faster than the target set by the doctors, Julia was not giving Phyllis the full dose of Lopressor that could slow it. ''I brought this up at 11," M.J. said. ''Now it's 4:30, and she's still over 90 [beats per minute]. . . . She actually is somebody who, at that heart rate, could be vulnerable." As Phyllis continued to moan, a red-faced M.J. finally exploded, letting loose frustrations that had been mounting for weeks. ''If this was my grandmother, I'd be ballistic," she said. ''You have to appreciate that I'm a little bit aggravated. . . . I left it up to you to decide what to do. . . . It's not pain control to do nothing while she's lying there. . . . You have a brain, and you are not just supposed to follow orders." |
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Julia didn't say a word, and she did what M.J. asked, retrieving a vial of Dilaudid from the medication room. Still, she did not believe that she had done anything wrong in caring for Phyllis. Like the doctors, Julia had been worried that any sedative would further weaken Phyllis's already-shallow breathing. And wasn't it M.J. herself who preached that protecting the patient's breathing comes before everything else? ''Sometimes you have to admit that there's nothing you can do," Julia said later. ''This isn't magic. It's medicine. I saw her in a week, and she was still moaning. This woman was in chronic pain. It was her cancer." Julia did, however, agree deeply with the principle behind M.J.'s criticisms: that a nurse must champion her patient's needs, even if she has to stand up to the doctors. Early in her training, Julia and her other teacher, Jeanne, had gone over the head of a young doctor when he tried to stop the sedation for a girl who had suffered severe head injuries in a car accident. Julia believed that the first priority for the girl was rest. The supervising physician agreed, and reversed the order. ''It was a great lesson for me," Julia later wrote for a class that was part of her ICU training. ''It demonstrated the meaning of being the patient's advocate. We are here at the bedside every minute. . . . We should speak up." |
