Academic journal article The Hastings Center Report

In the Care of a Nurse

Academic journal article The Hastings Center Report

In the Care of a Nurse

Article excerpt

Mrs. Jordan is a fifty-two-year-old woman with Stevens-Johnson Syndrome, a rare disease that causes large, blister-like lesions to form on the skin and in mucous membranes. In fatal cases blisters form in the lungs and kidneys, causing pneumonia and kidney failure. Doctors have been unable to find a cause or do much to stop the downward course of her illness. Large, painful, weeping blisters cover her body, soaking her skin and bedding with bloody drainage.

Mrs. Jordan's unstable respiratory and cardiac status further complicate matters. Three days ago she stopped breathing. She was coded, resuscitated, and placed on a ventilator. At the time of arrest her blood pressure regulatory mechanisms also stopped working. Doctors ordered intravenous dopamine to maintain a blood pressure high enough to circulate the blood. Each day increasing levels of the drug have been needed to sustain an adequate blood pressure.

Several hours before her cardiac arrest, Mrs. Jordan told Janet, the nurse who had been caring for her during most of her stay in intensive care, that she was ready to go. "Even if I stay the same you should let me go," she said. Janet clearly heard Mrs. Jordan discuss these same thoughts with her family on at least one occasion, and she and another nurse communicated this information to the physician. Moreover, Mrs. Jordan's advance directive states that she wants no life-sustaining measures in the event of terminal illness.

Today, three days after the code, Mrs. Jordan's two daughters and husband are exhausted, worried, and distraught. They told Janet they really wanted to let their mother go since "She's not going to get any better. …

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