Subsequent Care: Part 4


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Later, Mr. Moua did go to the ER, and was admitted for intravenous antibiotics for a bacterial pneumonia. The admitting unit nurse, Ms. Jones, greeted him, his wife, three sons and 2 daughters-in-law, on the floor.

“Hello again, Mr. Moua. I remember you from 5 years ago. I am sorry that you’re having hard time breathing, but with these antibiotics you’re going to feel great again in 1-2 days,” replied Ms.Jones.
After she got him settled into bed with oxygen, an IV and medications, she asked a daytime Hmong interpreter to join her.

Sitting in a chair beside the bed, she said, “Mr. Moua, can we talk about your preferences for treatment while you’re here at the hospital? We want to please you, and help you get better as fast as you can. What kinds of treatment do you want, and don’t want?”

Mr. Moua, “I appreciate everything you’re doing for me. I want the oxygen, IV fluids, and IV medicines. But this time, I really don’t want to be on a ventilator. I did that before, and I have had five good years with my children and grandchildren, but I no longer have the strength that I used to have. I can’t go anywhere without my oxygen and without someone pushing me in the wheelchair. I have had a long and good life. If my lungs can’t sustain my life, then I don’t want to be on the ventilator. A ventilator would just be punishing me needlessly, like prolonging my death, and I don’t want that. Last night I already told my family how I feel, and they understand. They told me they will not make any decisions that disagree with my wishes.”

Ms. Jones, “Thank you for expressing yourself so clear to me. I understand and will make sure that other hospital caregivers understand also. I am optimistic that you will get better, go home, and live to be 120 years of age, so you can still be with your family for a long time. We do have an Advance Directive, with a list of items that you and your family can consider together in order to clarify all of your wishes.

“We have a Hmong language videotape with written materials in Hmong and English. Perhaps you and your family could look at it together.”

Mr. Moua, “Thank you. Not today, as I am too tired, but maybe we could do that before I go home.”

Conclusion

Three days later his pneumonia had improved, and before he was discharged, they held a family conference with Mr. Moua, his wife, and 3 of his 7 sons. They watched the Hmong videotape about Advance Directives, and went through the options in the written notebook, making each decision. Most of the written replies were, “I will defer to my family”, but Mr. Moua had the opportunity to tell his family how he felt about each option.

However, with the question about intubation and ventilation, Mr. Moua clearly chose “DNI” as he had before. When he returned home, he set up a videocamera and made a tape, which his family could listen to after his death.

He told his family how much he loved them, and how he wanted them to live together in peace and harmony. Finally, he admonished them to love and help each other throughout their entire lives.


Questions for Discussion

Questions for Discussion

1. How did this discussion of DNI/DNR in the hospital contrast with the initial hospitalization? Why do you think it was different?

2. Why do you think the discussion of Advance Directive seemed to be easier in the hospital than when the home care nurse had
addressed it at home?

3. What emotional reactions do you have to the videotape that Mr.Moua made for his family?