Student nurse, Tracy, learnt a valuable lesson that it can be all too easy to make judgements about quality of life issues when it is not your own life you are considering.
During my first placement, a stroke ward, I cared for a lady who was blind, partially deaf, had suffered a stroke and had a grade two pressure sore on her ankle.
She was developing spasticity or “high tone” in her legs. Left untreated this would develop further, causing her severe pain and making it difficult to reposition her, hoist her to a chair and indeed would affect her ability to remain in a chair safely.
We regularly attempted to stretch her legs but she repeatedly put herself into a foetal position, which was how she felt most comfortable. The act of stretching her legs straight was painful for her.
Her doctor had considered prescribing Baclofen, a muscle relaxant, however a side effect of this drug is sedation. Our lady was fairly sleepy anyway and any increase in time spent asleep would lead to decreased time eating, drinking and interacting with her family, which could lead to a deterioration in her condition.
Evidence-based practice pointed to one action and person-focussed practice pointed to another. A conflict of ideas that most nurses are familiar with.
“To a new student like me, her life looked bleak with much suffering and no hope of recovery”
So we did what most nurses do - some of both: we stretched her legs as far as we could and then put pillows between her knees in the hope that her legs might remain more straightened than if we had done nothing.
She was doubly incontinent but often constipated and regularly given suppositories. She could eat pureed food if assisted and her drinks were thickened to prevent liquid from being taken down through her trachea rather than her oesophagus.
To a new student like me, her life looked bleak with much suffering and no hope of recovery.
I found myself wondering about the ethics of extending the life of someone who apparently could not experience the joys that life has to offer and whose condition was unlikely to improve.
During the days that followed I read articles about end of life and futile care and discussed this with nurses and my mentor. Many nurses felt that it would be a good idea for everyone to prepare an advanced directive (or living will) stating how we feel about our own end of life care for when we are not able to articulate such preferences. The big problem with this is that how we feel now cannot predict how we might feel when circumstances have changed.
“We feel now cannot predict how we might feel when circumstances have changed”
The following week, I returned to find the lady still on the ward with no immediate plans for discharge and I again felt despair for her situation. Overnight, we changed her pad several times, attempting to stretch her legs on each occasion.
She was in pain and appeared unable to make herself comfortable.
But in the morning just before finishing my shift, I helped her sip some thickened hot chocolate through a feeder cup.
“It’s wonderful!” she exclaimed and a huge smile lit up her face. The obvious joy she was experiencing from the taste of the chocolate brought a tear to my eye and I left my shift asking myself who am I to judge whether a life is worth living and an awareness that small pleasures can be enormous ones, depending on who you are and the situation in which you find yourself.
Tracy Blunt is studying nursing at Brighton University