ennifer: Ending of One Life, Beginning of Another Case Study

Jennifer is a 26-year-old woman who gave birth three days ago to a healthy 9 pounds 2 ounce baby girl. The vaginal delivery was uneventful. Two hours after the birth, Jennifer began to complain of an “excruciating headache.” Within one hour of receiving acetaminophen for her headache, Jennifer became unconscious and suffered from a respiratory arrest. She was coded, placed on a ventilator, and sent to the ICU. A CT scan revealed that she had suffered from a massive cerebral hemorrhage. After it was determined that the damage to the brain was irreversible and that Jennifer would be unable to breathe on her own, her husband, Brett, made the decision that his wife should be removed from life support. “Our neighbor had Lou Gehrig’s disease and Jennifer would go visit with him and his wife. She always said she would never want to live like that,” stated Brett. However, Brett was not quite ready to have the ventilator removed. The Palliative Care team was called to visit with Brett, and also Jennifer’s parents. It was decided that Jennifer would be moved from the ICU down to one of the two new palliative care suites, and have the ventilator removed there.

Upon arriving to the palliative care suite, Brett and Jennifer’s parents were introduced to Nancy, the nurse that would be taking care of Jennifer and her family. Nancy was sensitive in talking with the family and had a great desire to find out what they wanted. The family agreed that the ventilator would be removed at noon the next day, to give family and friends an opportunity to say good-bye. Throughout the rest of the day, evening, and the next morning, over 75 people came to say good-bye to Jennifer.

Brett’s mother requested to stay with the new baby in the newborn nursery. Brett was so torn between spending time with his new baby girl and his wife. Nancy agreed that it was a good plan to have Brett’s mother care for the baby, while Brett concentrated on making decisions regarding Jennifer. Per Brett’s request, his mother brought the baby to the palliative care suite two times.

Jennifer’s pastor came by to spend time with Brett. He supported Brett in this very difficult decision. The hospital chaplain was also present. Nancy suggested some memory-making rituals such as taking a clipping of Jennifer’s hair, so her baby girl would have for later on. Footprints and handprints were made of Jennifer, per her parent’s request. A hand mold of the baby’s hand in her mother’s hand was made. Both Jennifer and the baby’s hospital name bands would be removed and placed in a memory box. Jennifer’s mother requested to bathe her. Brett brought in Jennifer’s favorite college sweatshirt to put on her. CDs of some of Jennifer’s favorite music were brought in and played.

The next day, as per the request of the family, the palliative care team reviewed with Jennifer’s family how they would extubate her. They talked about possible symptoms and how they would treat those. Brett, Jennifer’s parents, two brothers, and 12 other close friends were all together with Jennifer in the palliative care suite. The nurse from the newborn nursery brought the baby and laid her on Jennifer’s abdomen, per the family’s request. They were all reminiscing and telling Jennifer how much they loved her and how much she had meant to all of them. The palliative care nurse, physician, and chaplain were all present in the room and encouraged the family to take as much time as they needed. At 2 pm, the family reluctantly requested that the ventilator be removed.

When Jennifer was extubated, she turned cyanotic and began gasping for air. The team administered supplemental oxygen and morphine. Jennifer continued to gasp for air, and the morphine was doubled. This was repeated one last time until Jennifer was no longer dyspneic. Unfortunately, Jennifer remained cyanotic. Jennifer died 15 minutes, after she had been extubated. The palliative care team stayed with the family during the entire process.

The palliative care nurse made arrangements for Jennifer’s body to be picked-up by the funeral home directly from the palliative care suite. The family had requested that she not be taken to the hospital morgue. The team remained with the family, until the funeral home came. Once Jennifer’s body was removed by the funeral home, Brett left the palliative care suite to visit his new daughter in the newborn nursery. “One life so precious is gone, and yet, God has blessed me with another new life.”

Discussion Questions

1. Would you consider the death a "good death"?  Why or why not?  Were the patient's and family's wishes followed?  Were pain and other symptoms well-controlled?  How were ethical and/or legal issues handled?
2. Discuss the collaboration among team members.  Who else could have been collaborated with and how would that have improved the death?
3. Was there anything that could have been improved?  Were there issues that could have been prevented?