Turning Point

A resident called me tonight complaining of respiratory distress and a general feeling of unwellness and restlessness. She says this has been going on for the last 4 or 5 nights. She has had renal failure for quite some time and speculates that this is probably being caused by her kidneys.

My guess would be that she's right. Her renal failure is worsening and it is causing feelings of agitation as certain bodily systems overreact to try and compensate. Her pulse rate is 97--high, but not technically tachycardia, which is over 100. Her blood pressure is also elevated, 160/72. This is high for her. This indicates that the body is trying to compensate for something. But without in-depth tests, there's no way of knowing what.

Her temperature was normal, 97.2 degrees and in spite of her respiratory distress, her oxygen levels were quite good at 95%.

So what's happening, she asks.

I can't tell her without alarming her, because its not something I can prove. So I say that given the limited scope of my equipment I really have no way of knowing what's going on and that given her respiratory distress and elevated blood pressure, I suggest that we call 911.

"Oh, I don't necessarily want to go to the hospital," she says.

I can't count the number of times I've heard this. They want us to be able to answer the why's and wherefores, but they don't want the hassle of going to the hospital where they could actually have a better chance of getting answers and treatment.

I tell her that her other option is to wait and see, and if she feels worse call me back and we'll call 911. I also advise her to schedule an appointment with her doctor to test her kidney function.

In short, this woman has made one step closer to the dying process. In a person who has a terminal illness, if they are alert, symptoms of this nature are an indicator that the body's systems are going to start shutting down. Often things speed up before they shut down. In someone with her current condition, it could be a month or possibly even up to six months. But she is definitely getting closer.

Still, I can't tell her "I've seen this before when a person's body is hurrying towards the finish line of life. Yes, your kidney failure has gotten worse. I know this without running tests. You'll be crossing over in not too long."

I'm not trained in hospice counseling and depending on a person's acceptance of their inevitable approaching mortality, telling them something of this nature would only scare the bejeezus out of them. It would also get me fired. Thanks but no. I need this job.

I hope for this resident that she is able to accept the news she receives from her doctor and that she will be able to feel at peace as the time draws closer for her to transition from a physical body into a spirit form. Nobody should have to be afraid when their time comes.