By Erika Gotway

I spent my final year of nursing school in an intensive care unit in one of the nation ’ s top hospitals . For a nursing student who previously had only taken care of relatively stable medical-surgical patients , having the privilege to work alongside highly experienced nurses was a dream come true . My preceptor had been a nurse for almost 50 years , and she instilled in me as much wisdom as she could in the few months we spent together . We cared for some of the most critical patients in the region : those who had experienced massive heart attacks , undergone lung transplants , were experiencing heart failure , or could be kept alive only by machines . This ICU instilled new life into to those who were too ill to be treated successfully anywhere else . Before this experience , I had never faced the reality of a patient ’ s death .

As I grow older , I ’ ve begun to accept this inevitable consequence of being alive : all people must die . One day , I will take my last breath , my heart will beat one last time , and I will cease to remain , just as you eventually will too .

On a Monday morning , my preceptor and I were assigned to a patient whose heart was failing him . Although he was young , he was kept alive by an extracorporeal membrane oxygenation ( ECMO ) machine that pumped his blood , almost like an artificial heart . Without this machine , he would die instantly , as his heart no longer functioned . The ICU physician had explained to him the previous day that the only option left for him would be a heart transplant , although this surgery carried considerable risks , including the very real risk of death . If he even survived the surgery , the recovery would be long and painful . Knowing this information , the patient was left to make the decision whether he would like to proceed with transplant or not .

As I walked into the patient ’ s room , I noticed that he did not appear as one would think such a critically ill patient might . He was not sedated , but instead completely alert , with his eyes wide open , reading the morning paper and eating a breakfast of toast and scrambled eggs . We chatted as I performed his physical exam , discussing the recently cold weather and the three inches of snow the city had gotten that night . If it were not for the tubes protruding from under his chest pumping life-sustaining blood , one would not expect that this man was so close to death . However , overnight , he had made an informed decision .

His Decision This young man wanted the ECMO machine removed . Although he knew this meant he would die , he knew that he would be dying with dignity , on his own terms . He also had made the decision to donate his organs and tissues to those who may be awaiting a transplant . For me , listening to my patient express these desires was at first quite shocking . In my head , I was wondering why he didn ’ t want to go through with the heart transplant . Didn ’ t he want the chance to live ? He had so many years left !

However , as nurses , we are required to respect our patients ’ decisions , even if they differ from our own . One key value of the American healthcare system is that patients mentally capable of making their own decisions are allowed to dictate how , when , and if they receive medical care .

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