When I worked in ICU, we had many patients whom we secretly or not so secretly hoped would die soon. These were the patients who were in end-stage organ failure, with no chance for recovery, who were being kept alive through chemical and mechanical means, nutrients being fed into them and waste products removed through dialysis and rectal tubes. Frequently these were people who had been neglected by a family member for years, and now that it was time for them to die the family member was attempting to expiate their guilt by insisting that everything must be done to keep Mamma alive at all cost. Month after month these people would lie in an ICU bed, unresponsive, being turned and cleaned in a vain attempt to keep their skin from breaking down.

One old gentleman I took care of for three months. He was so swollen from fluid retention due to his failing heart and kidneys that his skin literally wept fluid. We had to change his entire bedding every 2 hours, it was so saturated with fluids. He was on vasopressors to keep his blood pressure high enough to keep him just this side of alive. There was not one nurse in the unit who didn't pray daily for his suffering to end. On night shifts we would frequently crack open his window (an ICU superstition) to enable his soul to finally depart.

One night when I took over his care, I took his temperature as per routine, and discovered that it was 95.7 rectally. This is far lower than it should have been, definitely into hypothermia range. My fellow nurse and I discussed this, and that he was probably preparing to die. We felt that it was possible that the only thing tying him to his useless, worn out body was the vasoconstriction from the hypothermia. I decided that it was within my nursing scope to treat his hypothermia, and placed him under a warming blanket. If he was about to die, I felt at least he should die warm and comfortable. I spent much of my shift at his bedside, trying to keep him dry and turned. We opened his window again, and told him it was all right to stop fighting if that is what he wanted to do.

He was alive when I turned him over to the day shift nurse. I reported his hypothermia and what I had done to treat it. When I returned that night, his bed was empty.

Am I sure that what I did contributed to his death? No. Do I believe so? Yes. Do I still feel it was the right thing? Yes. Would I do it again? Yes. Does it still bother me? Yes. Do I hope that if it were me, someone else would do what I did? Yes.

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