Challenges of caring for a hemophiliac patient with HIV nephropathy.

Throughout his life, J.G. sought control over his hemophilia, often putting himself at risk by playing sports and trying to live as normal a life as possible. He actively directed his life and decided what risks were worth taking and in the end, he directed his death. Outcome goals originally formulated in J.G.'s plan of care were met. Active bleeding was controlled. The vascular access was free of complications and in the end was used as the only way to administered medications to provide comfort. Was the decision to dialyze worth it? The answer varies from hostility at the effort and valuable resources used, to apathy, to collective support for complying with the patient's informed decision. As nurses we actively participated in a plan of care to keep him alive, and altered our plan when the decision was made to withdraw treatment. A sense of sadness remains, but also a sense of closure without guilt, frustration, or remorse for having had the chance to participate. It was worth it for J.G. and his wife.