When I was still in the neurosurgery unit, I had a Bangladeshi patient who had a history of being hit as a pedestrian by a speeding car. He was apparently on his way to his second job as a car wash boy. I later found out from his friends that his stay in the country was illegal and he has no legal papers about his entry.
Ahmed (not his real name) suffered a severe head injury and some multiple fractures all over his body. He had a skull fracture, brain hematomas and his Glasgow scale dropped to 3 out of 15. He was intubated and was attached to a respirator. He was paralyzed from the neck down. No relatives were available since he was an expatriate with an illegal entry to the country. Only his co-workers visited him once in a while, but none were always available. He was basically left alone most of the time, under the care of the nurses.
By some miraculous interventions, Ahmed recovered from an acute stage. He was weaned from a respirator and he was shifted to a tracheostomy collar for breathing. A big portion of his skull was removed though, so his brain was left open with only the scalp covering it. He had a nasogastric tube for his nutrition, which was later changed to a percutaneous endoscopic gastrostomy (a tube directly connected to the stomach). His multiple fractures healed but he had some contractures. He was still a vegetable though – unable to move, unable to eat, unable to talk. His breathing was supported by a tracheostomy through a hole in his neck.
The doctors decided to put him on a “No Code” status. This meant that if the patient goes into a cardio-pulmonary arrest, he would not be resuscitated anymore and that reviving measures would be very conservative.
The patient did not recover further. He was supposed to go to jail if he recovers, but his health condition did not permit him to go out of the hospital. He maintained a stable vegetative status although there were times he almost coded due to instances of tube blocks, increased secretions, and aspiration problems. But because of the excellent nursing care Ahmed was receiving, he continued to live. He was always fed on time. His medications were always provided. He was given bath daily, sometimes even twice a day. He was always turned from side to side. His basic nursing needs were always met.
Taking care of Ahmed, I sometimes thought of the kind of life he was having in the unit. Although my co-nurses would always talk about how pampered he was in the ward, being provided with excellent services for free, I still feel how miserable to be in his situation. His face was badly scarred, and he had no skull on the top of his head. He will not be able to walk anymore. And I imagined how his family back home was suffering. How they always thought about how he was doing, what his status could be.
I sometimes felt that as nurses, although we were able to keep him alive, we could also be prolonging his agony. I knew that he would never get a quality life anymore. Because he was unable to talk, we could not assess the amount of pain he was receiving every time we had to give him his daily injections, every time his NGT needs to be reinserted, every time we need to move him in and out of his bed. What about the pain he had every time he needs to be reintubated? Or could he still feel the pain? Is his thought processes still working?
The most terrible pain he could be suffering must be the pain of loneliness, of being alone in that place, of missing his family back home. I would always see some tears roll down from his eyes. Could he be begging for us medical professionals to stop prolonging his suffering and just to let him go in peace? That was always the million-dollar question.
The issue on euthanasia is still a controversial topic up to this day. Most hospitals practice it especially if the family members are available. The decision is given to them after the doctors have informed them about the patient’s irreversible condition, and that only the supportive devices are maintaining his life. The family’s decision would sometimes base on how they perceive the situation was – whether continuous medical measures would just prolong the amount of pain and agony of their loved one, and whether they could still support the amount of expenses the situation is causing them.
I realized that although as nurses, we don’t have a direct influence on a decision for euthanasia, we are greatly involved in providing the care the patient needs for him to be able to live longer. This means that whether we like it or not, we are the ones who keep them here in this world. And yeah, whether that is a good idea is still a debate.
Ahmed still continued to live until I resigned from that hospital. Whether he died later or not, I still believe that the extended life given to him was not as useless as other people would think it was. By just lying on his hospital bed, he touched so many lives, including mine, making us realize how lucky we are to still be able to communicate with our loved ones, to be able to eat whatever we want, to be able to sing and dance under the sun, and to be able to dream our ambitions. We had a greater appreciation for the blessings that we receive each day.