The Ethical Nurse Diaries: Entry #1

The Note I Couldn't Write. By: A Nurse Practitioner That Still Gives a Damn

This is the first in a new series I’m starting here on Prescribed Chaos. It’s called The Ethical Nurse Diaries. These aren’t fictional stories. They’re real. They’re painful. And they’re the things I carry home in silence after every shift. I can’t name hospitals or departments—but I can speak the truth. And the truth matters.

I was sitting at my desk when the rapid was called.

By the time I made it to the bedside, the patient was completely unresponsive. No reaction to sternal rub. She would end up intubated to protect her airway—an emergency that didn’t need to happen.

The chart told the story before anyone at the bedside did. She had dangerously high ammonia levels. Encephalopathic. And the unopened bottle of lactulose—sitting untouched on the counter like a silent confession—told the rest.

When I asked the nurse why it hadn’t been given, she shrugged and said, “She couldn’t drink it.”

No NG tube. No rectal route. No page to a provider. Just silence. A silent assumption that if a patient can’t drink it, they don’t need it. Or maybe—more likely—a silent decision that the mess of lactulose just wasn’t worth it.

I get it. The constant bowel movements. The workload. But this isn’t about inconvenience. This is about function. Lactulose isn’t a laxative—it’s life-saving. It clears ammonia. It prevents this very thing. It’s basic nursing school.

But here we were. Staring at a woman slipping into a coma because the system had failed her long before her liver did.

And that wasn’t even the hardest part.

This patient was a Jehovah’s Witness.

She had a GI bleed. Her hemoglobin was tanking. Two separate physicians documented—in no uncertain terms—that even if her life were at risk, she did not want a blood transfusion. She was alert when she said it. She meant it.

It’s not my job to agree or disagree with her beliefs. It’s my job to honor them.

I never got the chance to meet her as the woman she was—only as the body that remained after her autonomy was stripped away. But I read her words, her wishes, and I believed her.

Her children did not. They weren’t Jehovah’s Witnesses. They were just desperate. Grieving. Pleading. They wanted their mother alive—at any cost.

And that’s when the system folded.

Legal. Risk. Administration. Lawyers I never saw made decisions I’ll carry for the rest of my career. The hospital, fearing a lawsuit from the living, ignored the documented wishes of the dying.

They gave her the blood.

I had to order it. I had to type in the request I knew violated her sacred boundaries with her God. I was sick inside. And the worst part?

She died anyway.

This is the note I couldn’t write in the chart:

“The patient’s wishes were documented, clear, and ignored. Her body was saved briefly. Her soul? I don’t know.”

I couldn’t write that. But I can write this.

To the healthcare worker reading this who’s had to betray their ethics to keep their job—
To the patient who wonders if anyone will honor their voice—
To the family who thinks love means override—
And to the hospital that protects itself before it protects humanity—
This is for you.

Because someone has to say it:
A patient’s dignity doesn’t disappear when they lose consciousness.
And when we treat it like it does, we fail them—utterly.

I couldn’t write that in the chart.

But I’m writing it here.

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📣 If this hit you where it hurts—don’t stay silent.

You’re not alone.
Not the only nurse holding it in.
Not the only provider who’s lost sleep over what they couldn’t chart.
Not the only one trying to do what's right in a system that rewards silence.

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Let’s break the silence, together.

This isn’t just a diary.
It’s a documentation of what it costs to care in a broken system.