If I could turn back time, I would go back to a morning in 1991 when one of my patients died and I still have regrets regarding it.
Patients can be on dialysis for many years, and they usually come for treatment three days a week. In the VA dialysis unit, we practiced what is called modified primary care nursing. This is when each patient is assigned a nurse to be responsible for them on a continuing basis. A patient’s primary nurse communicates his/her patient’s needs, concerns and problems to the nephrologist.
This nurse also makes sure medications are reordered, tests are completed, lab work is reviewed and changes in care are discussed. Patients usually get very attached to “their nurse” over time and the nurses also get attached to them.
The reason it is called modified primary care nursing is because all the nurses take care of all the patients in the unit each day. They take turns initiating and terminating each other’s patient treatments as well as monitoring them while they are on the machines. This is a good thing because at one point, nine out of eleven patients on the machines were my primary patients.
One morning, I got a call at home while I was getting ready to go to work. The head nurse on one of the chronic wards called me to say that one of my primary patients, Mr. Roger Jacobs, was now close to death and said, “I want to see June and I am not going to die until she gets here.” This man was a widower and had no children. I was his family. I told her I would be there to see him after all the dialysis treatments were started.
Once I got to work, I told the other dialysis nurses what was happening. They all told me to go; they would get all the day’s patients on the machines. I hesitated. I decided to stay and help initiate the dialysis treatments, then went. As I was walking onto the ward, I was told that Mr. Jacobs had died a few minutes before I got there.
I failed this patient. I stalled. I did not want to be there when he died and tried to prepare myself emotionally for his death so I put my needs before his. Mr. Jacobs died alone. What I wouldn’t give to have that morning to do all over again.
The patient’s name was changed.