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You Can’t Save Everyone

As a nursing student that was a tough pill to swallow. I’m not referring to patients who have succumbed to their health conditions, but rather those who suffer due to their active non-compliance with their care regimen.

During my third clinical rotation in Med-Surg, I was assigned to the Acute Cardiac Telemetry unit. The task at hand was to choose one patient among the four assigned to my nurse, develop a relationship with them, and create a care plan based on their needs and my assessment

My nurse suggested selecting a lady who had been on the floor for a while, as she had taken care of them before and knew they wouldn’t mind having a student observe and care for them. As the day began, I became interested in my patient’s medical history. They were born with a congenital heart anomaly and were admitted this hospitalization due to an acute exacerbation. Their current treatment involved managing fluid volume overload, which required strict fluid restriction. I vividly remember their Furosemide (diuretic) drip, as my clinical instructor commented that it was unusual to see a patient on such a prolonged and high-dose regimen. 

As my shift went on, I learned more about my patient’s condition and medical history. I learned that she was a wife and a mother. I listened to her heart and lungs while they were on a phone call with her husband. Almost instantly, I wished for her to become healthy and wanted to see her go home. My nursing rotation schedule that semester was tough and I had not seen my family for more than 20 minutes in the span of 72 hours. If anyone knew the ache of being away from home it was me in that moment.  

As I was constructing my care plan outside my patient’s room I noticed them step out while holding on to their diuretic drip and walk down the hall. I curiously watched them sneak to the elevators and slip out. My nurse was on lunch break and so there was no one around I could consult. 5 minutes later the patient walked back into her room with a very large soda in hand. An alarm went off in my head since I knew she was on a fluid volume restriction. I knocked on the door and peaked my head inside.

“May I come in?” I asked. 

“Sure” came the reply. I walked in and asked if I could retake her vitals to which they said yes. As I took the patient’s pulse and blood pressure, I asked what they had in their hand.

“A drink” they replied. 

“That’s a big cup don’t you think?” I asked with a pained smile. In return I got a raised eyebrow. “I haven’t had a drink all day. I’m thirsty.”  Their tone was irritated and It was evident that they didn’t appreciate my opinion as a student. Realizing that this wasn’t a battle I couldn’t win in the remaining few hours of my caregiver role, I told myself that my words would do more harm than good. Reluctantly, I nodded and said, “I hear you.”

When my nurse had come back from her lunch break I let her know what had happened and she sighed and thanked me for letting her know. She went back into the room and I could hear her talking to the patient about how much she had to drink that day. I listened and nodded my head as my nurse educated the patient as to why they needed to keep their fluid consumption minimal. I could feel my patient’s eyes glaring at me through the blinds the whole time. I didn’t have the courage to go into the room and stood outside and watched my nurse talk to my patient. 

Before the shift had ended my clinical instructor had stopped by to hear my report so far. I explained my care plan and rationales for my decisions. I pointed out my patient’s non-adherence and rattled off solutions on how to solve the issue.

“Perhaps we could get a sitter or turn on the bed alarm? We could have the charge nurse stop the patient from returning with drinks in their hand.” My instructor cut me short and reminded me that it is ultimately the patient’s decision whether they participate in caring for themselves or not. 

“Remember, It is not appropriate to force care upon a patient.” My professor lectured. 

“But she’s on the transplant list! We have to make sure she gets it”

“She most likely won’t. Not with her lack of effort so maintain her diet. She is invalidating herself as a prospective recipient and you can try your best to educate her but ultimately that is out of your hands.” 

I just stood there. Stunned by her words. What she was saying made sense but I couldn’t accept the reality of the situation. Suddenly helplessness morphed into frustration and anger. Why is my patient actively ignoring her diet? Doesn’t she care about her family? Doesn’t she want a fighting chance to live a longer life with them?

“Sometimes when life becomes difficult, we hang onto little things that bring us comfort. Even if those habits are ultimately harmful to us.”

All I got was a pat on the back as my instructor walked away. Leaving me on the chair outside my patient’s window in deep contemplation on the quality versus the quantity of life. I felt helpless as I began to understand patient choices no matter how harmful are out of my hands, and these choices will eventually lead me to accept, you can’t save everyone.