This is the question that ran through my mind as I watched PBS’s Frontline “Facing Death” program about how we die in the US. It was shot almost entirely in Mount Sinai Hospital, Upper Eastside of Manhattan (exceptions were some “talking heads” such as Gerome Groopman, MD, Professor of Medicine at Harvard). It followed the stories of “actively dying” patients/their families/their physicians as they were forced to make difficult end of life decisions. As I mentioned in a previous post, this Frontline episode included only one nurse in the entire hour segment, and she happened to be a patient’s daughter. There were shadowy figures around patient beds–many with their faces erased digitally–and most with any name badges tucked into pockets. There were two apparent nurses (their backs only) in an opening scene. They are drawing curtains around an ICU bed, blocking the camera’s view of a patient being taken off of a ventilator and allowed to die. Some of these “supporting figures” had to be nurses, but none were interviewed. Hospice and palliative care “outside of the hospital” was briefly mentioned in the care of several patients. Almost all of that care is provided by nurses, but none were shown or interviewed.
The one nurse in “Facing Death” was at least a powerful nurse: Nadge Vimet, RN, younger daughter of an 86 year old woman with advanced dementia and needing a ventilator. The most riveting scenes in the episode involved Nadge at odds with her (I’m assuming older) sister, a physician, Sherley Schwartz. They disagreed about the care decisions for their mother: whether or not to put her through surgery for a trach (breathing tube in through the neck). Nadge was adamant that they shouldn’t “out of compassion for her.” Her sister the physician was equally adamant that they should do everything possible: “I don’t want to be responsible for her death.” They put it to a family vote and Nadge was outvoted, so her mother had surgery for the trach. “Facing Death” ends with a scene of her mother alone in a hospital room overlooking Central Park. She has been unconscious and on a ventilator for the past year. The voice-overs discuss the “broken survivors of intensive care” and this as a failure of our health care system.
But really–where are the nurses in this? In the hospital they spend more time with the patients than doctors do. Nurses often provide “translation” services for patients and families. Translation from doctor’s medical jargon to more understandable “lay” language. Nurses often are witness to the sheer terror or physical pain that hospital patients have–generally worst in the middle of the night.