Laura Kierol-Andrews, PhD, APRN, ACNP: the Hospital of Central Connecticut: New Britain General Campus, New Britain, Conn.

Mrs. C, a 90-year-old patient, was admitted to the ICU with end-stage heart failure and was dying. I called her family. Her oldest daughter Nancy arrived at the hospital first. The ICU intern wanted to listen to how I talked with families about end-of-life care. I told Nancy that her mom was dying and that her wishes were to not have life supportive therapies continued. She agreed, but was concerned that her sister Patty "won't be unable to let Mom go." This became obvious to me, as we had to call Patty several times to get her to come to the hospital. I talked with Nancy about Patty's personality and relationship with her mom. I needed to understand the family dynamics to be able to talk with Patty. When she arrived I spoke with them, but focused on helping Patty understand her mother's wishes. I chose my words carefully so that she knew the decision to withdraw support was not hers, but her mother's. I reiterated that our goal would be to respect her mom's life and provide her with comfort and caring. With tear-filled eyes she agreed to comfort measures only.

Mrs. C died a few minutes after we withdrew therapies and her family had the chance to say their goodbyes. Her family hugged me and thanked me for caring so much. Later that day, I got a hug from my intern. He said, "They don't teach us this stuff in medical school." When people talk of the successes in intensive care units, they talk of saved lives. As an acute care nurse practitioner, I know this is not always the case. It is recognizing that patients' outcomes are not always measured in lives saved. Success is often measured by lives touched.