What is Euthanasia

Mrs X has anywhere from hours, days, or even weeks to live. We all know she is going to die. She's on a continuous infusion of morphine, anti-emetics and anti-anxiety drugs, plus having intermittent boluses of morphine. Some nurses are very generous with their extra boluses of morphine, and others not so, although it always depends on how much pain she seems to be in.

Mrs X has a large tumour in her bowel. The surgeon had tried to cut it out, but upon opening her up had quickly closed her back up as there was nothing he could do. The wound had since broken down, parts of her bowel had fused together and she had bowel motion coming out of her abdomen.

At eighty six years old Mrs X was a strong woman, and had lingered in this state for 120 days. Anyone else would have died. She wanted to die, she asked us to end it. We nurses took turns looking after her as it was too much for one person to cope with.

Mrs X hasn't woken in the last 24hrs, although her eyes did briefly open once as she cried out in pain, but I don't think that really counts.

Nurse Y gave Mrs X the maximum allowed bolus of morphine, which didn't seem to help with her pain. She was still crying out as another spasm of pain twisted her body, as the air was forced through her vocal chords.

Thirty minutes later nurse Y gave another maximum bolus of morphine, within the allowed limit of course. Her pain did seem to settle.

Later that afternoon Mrs X died. It may have been hours, days, or even weeks earlier than she was due.

It was legal, specifically it was not defined as euthanasia as it was prescribed by a whole team of doctors. It was right.

In reality it was euthanasia.

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Who's to Blame part II

The silence didn't last long, it was broken with an almost incoherent Mr Wright exploding down the phone line "Who the hell do you think you are? You're just a bloody nurse. Don't tell me how to raise my kids. I've never been spoken to like that before." Even though I hadn't been exactly diplomatic in my dealing with Mr Wright I was still surprised by his outburst. I guess that's what happens when you have a guilty conscience.

I kept my mouth shut about this last thought. The line went dead. The damage was done. But I wasn't worried. The big lie which Mr Wright and Jeremy were part of was a common one. The parent lies to the school, often thinking their child is responsible enough to go to a big city in the center of Europe with their school friends. Next the child lies to their parents, because of course they don't drink, don't party, don't have sex and love visiting museums.

The only person Mr Wright should be disappointed at is himself, and he should not be angry at anyone, least of all his son who never sees his father. The son should be angry that even in hospital his dad can't take the time to see him. I should be angry at having to deal with a child whose father won't take any responsibility for his son. Sadly it looks like Mr Wright will never see this, because he's too busy trying to find someone to blame.

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Who's to Blame part I

"You'll be speaking to my lawyer" said Mr Wright. His voice was so loud I held the receiver away from my ear. "I'm only a nurse, I don't want to speak to a lawyer. I'm the person trying to help your son, Mr Wright." I struggled not to rush my words, struggled to stay calm. "My son could have died, and you let this happen, you know what these kids get up to, and don't do anything to prevent it. It's a disgrace, no, it's criminal."

At the age of fifteen, Jeremy was already a veteran of boarding schools. The last eight years of his life had been spent in a boarding school because his father was an oil man, and went wherever the huge multinational corporation sent him. He was a good kid, but he, along with his father, was guilty of the most common crime here at this school. It just wasn't quite time to tell him this yet.

I tried to change topic a little, move away from confrontation. "Perhaps you should come and see your son, he'll be in hospital a few days. It would help..." I never got to finish the sentence. "Help who? My son or you. I'm a busy man, I can't get away from work. Just do your job. I hold you personally responsible for making sure my son gets well." I found it strange the way he threatens me with lawyers, then expects me to patch up his sick son and holds me responsible. It was time to play hardball.

"Mr Wright, it would be easier if you were here because the Police will probably like to speak to you. To clear up some details." It wasn't exactly the truth, but it wasn't far off. Jeremy had taken ecstasy and been found unconscious outside a night club. He seemed to be making a full recovery, but it could very easily have turned out fatal. The police had actually been the first people to find Jeremy lying on the sidewalk.

"No, no, no, you'll have to take care of that. They don't need me there. Why do they want to speak to me?" I could sense the worry, the doubt. "I'm not sure, but Jeremy is only fifteen, not old enough to book a hotel on his own. You did tell the school that he was staying with an Uncle" I replied. The school only let students leave the campus overnight if they had parental permission that they would be staying with family.

"We are helping how we can, but he was your responsibility. I understand you are worried about your son, but we can't look after children when you don't tell us the whole story. There wasn't any uncle, there wasn't any adult supervision." There was silence on the other end of the line.

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Parents to be...

"Get me a fag woman" snarled Sam. Jenny shrank even lower in her chair, pressing her back hard against the frame, even as she began searching her bag desperately for a cigarette. Even lying on a bed in a hospital gown Sam managed to instill fear in his woman.

"Sam, you can't smoke in here" I explained as I began to change Sam's bag of intravenous fluids."Yeah, just wanna hold it, no harm in me holding it" Sam said. Jenny had given up trying to look for a cigarette and now sat with arms crossed, resting on her distended belly. She looked to be nearing the end of her third trimester, which may have explained why she was in bare feet, even though they didn't look particularly swollen.

"Woman, where's me fag?" Sam demanded. Jenny shrugged her shoulders "Don't have any" she replied. Sam's face turned to me, looking me in the eye "What're they good for eh? Nothing, can't even get her man a fag" Sam said to me as if confiding to a friend. "Well go and get me some" Sam paused while Jenny sat there unmoving, "Now." Jenny got up off her seat, and wandered out into the rain, barefoot, without a coat, and pregnant.

Twenty minutes later Jenny returned, soaking wet, shivering, and handed her husband a pack of cigarettes which he promptly opened and began to light up. I promptly made him put it out. With much cursing and threatening he responded by making Jenny carry his bag of IV fluids while he stood outside the main door puffing away.

Sam was discharged later that day, his wife in tow, barefoot, wet, pregnant, and carrying Sam's bags.

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Never in Twenty Years

Where should the line be drawn? It's only a rehabilitation hospital, not much more than a rest home really. They're not my thoughts, but from what I've seen and heard, that is the impression I get from the staff working there. It just goes to show how much the staff, the nurses that is, can make or break a place.

The hospital looks nice. It looks modern, both on the inside and out. It looks clean and looks well stocked with all the equipment needed to help patients recover from a multitude of ailments. It even passed my bathroom inspection. One of my most important criteria when it comes to judging a suitable ward environment is if they have a big, open, wheelchair accessable shower and toilet. You may think there are other more pressing priorities, but when you've got ten patients to wash before lunch, an easy access shower is a big deal.

The staff looked experienced. They all had grey hair and over a cup of coffee would relish any chance to relive nursing stories, especially horror stories, from days long past. They remembered the days when doctors' were gods, nurses servants, and patients did as they were told. Unfortunately they nearly killed a patient due to complete ignorance.

Mr Jones' chest pain began at 8pm, but he only told the nurses at midnight about his pain as it had suddenly become worse.

"We don't do that here" said Rose. I ignored her remark and placed the oxygen mask on Mr Jones' face. "You can only use the nasal cannula, were' not permitted to give any more oxygen than that. You need to take that mask off now." Rose was standing at the end of the bed, where she had stood for the last ten minutes, not helping me in the slighest.

I had given the patient his GTN (angina medicine) with no effect. His ECG (heart tracing) showed ST depression in all leads (sign of heart not getting enough oxygen) and had called the doctor who was coming in from home and was twenty minutes away. The doctor had given me specific insturciton on what to do, and I followed them exactly. It wasn't hard to do as I was doing what I had done thousands of times before in all my previous years in many different wards, and often in the emergency room.

I had the oxygen up high and asked Rose where the intravenous equipment was. "We don't do that here, this is a rehabiliation hospital" Rose repeated. I realised that I had to do this on my own. I used the IV equipment from the emergency resuscitation trolley and quickly inserted the tubing into a vein. I then drew up some morphine, Rose very reluctantly consenting to sign the stuff out of the locked cabinet with me because "We don't do that here" she said again.

The oxygen helped get the pain from the an 8/10 to a five and his ECG showed some improvement, but it wasn't quite right yet. I administered the first of the morphine, 2mg to start. Within five minutes the pain was down to a 1/10 and the ECG looked almost normal. By this time Dr Gates arrived.

Dr Gates was also a new doctor, only in his second week on the job, so he was caught off guard by Rose. "I'm not at all happy about this. I'm going to have to speak to the head of department. You can't do that here. I know you're the doctor, but we've never done this. It's a rehabilitation hospital."

By the time Dr Gates had extricated himself from Rose Mr Jones was pain free. He had a look at my collection of ECG's and congratulated me on a job well done. Rose was there, arms crossed, face red in fury as Dr Gates said this. "In twenty years we've never done this" was all she could say. Twenty years and you've never saved a life?




I guess after twenty years in one place, with

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