1. Ufema, Joy RN, MS

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As a critical care nurse, I'd like to know more about how to talk with alert and oriented patients who have a poor prognosis and little time left to live. Any advice?-G.R., N.J.


Of course no answer fits every situation, but many patients appreciate a nurse's sensitive intervention in this time of crisis. Recently, I spoke with Kristen, the daughter of a critically ill woman who'd developed sepsis after extensive abdominal surgery. As I sat beside her, Kristen summarized her mother's frightening medical course, which included several emergency surgeries, respiratory arrest, and mechanical ventilation. Now her mother had reached a point where palliative care seemed to be the best option.


"I don't want to have to make that decision," Kristen told me. "What should we do?"


"Because your Mom is awake and alert, I suggest we just ask her what she wants," I said.


Kristen agreed to this, but she wanted me to see her mother alone so she wouldn't influence her decision.


I entered the room, wove my way around numerous machines, and stopped at the head of the bed. Eileen opened her eyes and, using a magic slate, wrote, "Who are you?"


I introduced myself, explaining that I work exclusively with patients who are seriously ill.


"I'm terribly sorry that we can't make you well. You've been such a trooper through all this."


Eileen squeezed my hand as if to comfort me. And then she wrote, "I know I'm dying. Stop everything."

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It was declarative, not questioning.


"I'm so sorry," I said. We were quiet together for a moment. Then a soft knock announced her daughter. "I'll leave you two alone," I said. "But I'm just down the hall if you need me."


As Eileen wished, all treatment, including ventilator support, was withdrawn later that day.


After her mother's peaceful death, Kristen thanked me for my forthrightness. "You made a difficult experience so much easier."