The Patient I Failed: A Nurse's Reflection on Delayed Comfort Measures

As nurses, we are trained to advocate for our patients and manage their care with empathy, expertise, and professionalism. We are often their voice when they cannot speak for themselves. However, there are moments in our careers when we feel we have fallen short — times when we regret not acting more decisively, not speaking up more forcefully. This is the story of one such moment, a moment where I failed to protect a patient from unnecessary suffering, and the lessons I learned from it.

The Patient: A Battle Against Heart Failure and Air Embolism

Mrs. Patterson (not her real name), an elderly woman in her late 70s, was admitted to the hospital with advanced congestive heart failure (CHF). Her heart had been struggling for years, gradually growing weaker until it could no longer effectively pump blood throughout her body. Fluid was accumulating in her lungs, her legs, and her abdomen, causing extreme discomfort. Her labored breathing and constant fatigue were only compounded by the emotional toll of facing the end of her life.

But Mrs. Patterson’s condition took a sharp and tragic turn when an air embolism was discovered in her left ventricle. This rare and often fatal condition occurs when air enters the bloodstream, causing a blockage that can disrupt the heart’s normal function. In her case, the air embolism was irreparable. Her heart was already failing, and this new complication left her with very little time.

When we first learned of the air embolism, I knew there were no treatments that could save her. It was only a matter of time before her heart gave out. I could see the desperation in her eyes and hear the pain in her voice. She requested, repeatedly, that we let her go, that we stop the aggressive treatments and simply allow her to pass away peacefully. She asked to be placed on comfort care, but her family wasn’t ready to accept the reality of her condition.

The Family's Refusal to Let Go

Mrs. Patterson’s family, particularly her daughter, who was her power of attorney, was not prepared to let go. Despite her clear wishes to transition to comfort care, her family clung to the hope that something could be done. It’s a common scenario in healthcare — the reluctance of families to accept the inevitability of death, especially when the loved one is still conscious and asking for relief. I understood their pain. I understood the gut-wrenching desire to do something to save her, even when nothing could be done.

But in Mrs. Patterson’s case, the treatments being pursued weren’t helping her. They were only prolonging her suffering. The medications, the diuretics to remove fluid from her body, the oxygen to help her breathe — they were all futile. The air embolism had taken away any chance of recovery. Her heart was failing, and no intervention would change that. All she wanted was to be comfortable, to stop the endless barrage of medical interventions, to have her pain relieved and her dignity preserved in her final days.

Yet each time I spoke with her family about comfort care, they hesitated. Palliative care was consulted. They were not ready to accept that their mother’s suffering was no longer going to end with a cure but with a peaceful passing. They refused to let her go, and I, as a nurse, struggled with how to honor her wishes while balancing the family’s grief and hope.

The Prolonged Suffering

I am deeply regretful that I did not act sooner. The delay in transitioning Mrs. Patterson to comfort care meant that her suffering continued for days, longer than it needed to. Despite her requests, her family’s refusal to switch to comfort measures prolonged the agony of her final moments. She continued to endure treatments that were both futile and painful — her body and her heart growing weaker and her mind increasingly worn down by the relentless reality of her condition.

As a nurse, I should have done more to advocate for her. I should have been firmer with the family, reminding them that their mother’s quality of life had deteriorated beyond repair and that her suffering was becoming unbearable. I should have emphasized that the greatest gift we could give her was the peaceful death she so desperately wanted.

The Final Transition

Finally, after several days of futile treatments and mounting pressure from the medical team, the family reluctantly agreed to switch Mrs. Patterson to comfort care. By that point, however, she was already slipping away. Her heart, burdened by both heart failure and the air embolism, could no longer sustain her. The medications we finally administered to ease her pain seemed like a drop in the ocean of suffering she had endured.

In her final hours, I could see that Mrs. Patterson had been waiting — waiting for permission, waiting for release. When she was finally made comfortable, her breathing became less labored, her pain finally diminished, and she passed away peacefully. But I couldn't shake the feeling that we had failed her. Her suffering had been prolonged for too long, and it was clear to me that she had asked for comfort care long before the family was ready to hear her.

The Lessons Learned

Reflecting on this experience, I have come to understand several profound lessons. The first is the importance of listening to the patient. Mrs. Patterson had asked for comfort care for days, and her wishes were clear. As a nurse, I should have done everything in my power to help the family see that her comfort and dignity were more important than false hope.

I also learned how difficult it is to navigate the intersection of family dynamics and patient care. When families are unwilling to accept the inevitable, they can sometimes cause more harm than good, prolonging the suffering of the patient in the process. It’s a delicate balance — advocating for the patient while still being compassionate toward the family’s grief. But ultimately, our responsibility lies with the patient’s well-being.

Finally, I learned the importance of not delaying difficult conversations. We are often afraid of confrontation, of making families feel like we’re rushing the inevitable. But the truth is, the more we delay those conversations, the more we prolong our patient’s suffering. Sometimes, we must be the ones to push for change, to guide families to the difficult realization that continuing to fight will only bring more pain.

A Heartfelt Reflection

Mrs. Patterson’s story will stay with me for the rest of my career. Her suffering, her quiet pleas, and the regret I feel for not advocating more forcefully for her comfort weigh heavily on me. But I also know that it is in these moments of reflection that we grow as caregivers. I hope that by sharing this experience, I can help others recognize when a patient needs comfort care sooner rather than later and urge healthcare providers to be stronger advocates for the dignity of the patients in our care.

In the end, no treatment or intervention could have saved Mrs. Patterson. But with comfort care, she was finally able to pass away peacefully, and for that, I found a small measure of solace. It is a painful reminder of the responsibility we carry — not just to heal but also to listen, to comfort, and to always prioritize the patient’s wishes, even when it’s difficult for the family to accept.