Case narrative

The request for ethics consultation came from the trauma unit charge nurse on a Friday afternoon. My secretary, using the “Request for Consultation Information Form” my colleague and I developed, took the call. This form has space to list basic facts, including “Patient history, situation, and prognosis.” It also contains two key questions, the answers to which are to be written verbatim. First, “What is the reason for this call?” Second, “What does the caller hope to accomplish with this inquiry?”

From the form I learned the patient, Mary Jackson, was an 83-year-old recent widow in a step-down bed in the trauma unit. The reason for the call was, “The patient is DNR [do not resuscitate], but the physicians have decided to put her back on oxygen.” As for what the charge nurse hoped would be accomplished, my secretary had written, “Was it ethical for the doctor to order oxygen for the patient?” Under “Patient history, situation, and prognosis” was this:

Review of Mrs. Jackson's electronic record revealed she was admitted on Monday after sustaining a variety of minor orthopedic injuries – fractured right wrist, dislocated right elbow, broken right rib, and mandible fracture – as the result of her single-vehicle accident.