[valkyria]

I can tell you that as a coma patient who came back after I was resusitated twice, I thank you nurses who do treat all your patients as if they are really there. In case you are not sure, what harm would it do? For those who get the willies with post mortem care, talk to them about how wonderful the journey is they are on, it really is. Talk about how beautiful the place they are going is, it really is.THat will make them human again and you will not be nervous anymore. I had to do post mortem care on a patient the day I came back to work after I held my grandmothers hand as she died in our home. I talked. Trust me. When I was chosen to pack my grandmothers things away, I talked to her as if she were still there. She may not have been but it made what I was doing easier for me. They do not stop being our patients after they are gone. THat is perhaps the most important nursing care we will ever do for our patient or their family. We must care for the living that are left behind. Those are the memories I hold most dear in my short career. Now I am doing research, that sensitivity is still important to hold on to when talking to patients and their families.

[Zookeeper3]

After organ percurment comes and we're harvesting, family says goodbye and leaves... it's just me and the brain dead patient... fighting to keep every organ going... to keep another alive, what an outstanding process!

Might sound creepy, but I give encouragement, talk... rub an arm.... talk about continuing to live through another... giving life to another. I KNOW, the brain does not compute and I'm not religious but a part of me believes in a soul... a part of a human being living on. Don't we all have hopes that that finality isn't that final? Don't we all worry that this can't just be it?? We're done and gone?

I am unable to do anything to a "living" body, sentient or not.. and not explain my actions in advance. We lack so much truth and understanding that to not do so, to me, would be well strong word forgive me for it, but violating my pt. And Yes, I know they are brain dead.. but I still am caring for a physical body and I've been taught better than that. Until I know for certain brain death is the end all and be all and that's it... ashes to ashes.... no more.... we'll I'll just chat away mean while in attempts to provide comfort, no matter how ill placed it may seem. It didn't cost me any more work or time and I feel better about myself for the effort.


I love this thread, read it twice, responded twice. It reminds me of why I clock in... I'm a better person with these experiences and I'm proud of my practice. Maybe talking to brain dead patients gives me personal closure, but I've never felt incomplete when I've left.

[NurseCutie]

I speak to all my patients regardless of brain death or not. It just seems so cold and unlike me not to. I don't like treating people like a slab of meat. This person was once alive a mother, daughter, father, son....They deserve respect in life and death. What harm may arise? None.

[judytheoldrn]

NurseCutie, I agree, I talk to all - I don't believe in any way that they will hear me, but it's a way of cleaning out all the debris in your head before you move on to the next poor guy. I do, however, make it a point to not talk to my brain dead patient in front of family, especially if they are having a hard time realizing the person is really dead. Like in the case of a family who is resistant to removing life support once brain death has been confirmed. I feel like if I talk to that patient, it will just reinforce to the family that the patient is NOT dead!

[NurseCutie]

I understand what you are saying about not talking to them around families who are in denial about brain death. That would confuse them even more. I always talk to my families too. I ask them if there is anything I can get for them and explain the whole process. Even though I may not speak to the pt in the families presence I still give the body the upmost respect, considering they were once a living, breathing person.

[judytheoldrn]

Absolutely, they are the ones we are caring for, rather than the patient once brain death has been established.

[sarahrain]

There is a 4 year old boy was confirmed brain death few days ago. Everyone of the family members want to stop all the support except his mother. She said she dreamed that the boy would return on Monday. And she played his favourite songs, talked to him.. And still cling on the a slight chance of him coming back to life..

[judytheoldrn]

OK, this is what I don't get. Why are these people given a choice? If he's dead, he's dead. You can't treat dead. Why put the burden of choice on the family? You tell them you are taking him off the vent and then you do it - it doesn't solve anything to leave him on.

[judytheoldrn]

valkyria - thankfully you were not brain dead. Coma is soooo different. I of course always talk to my comatose patients and encourage the families to do so as well - with good aliquots of rest!

[talaxandra]

Originally Posted by judytheoldrn

OK, this is what I don't get. Why are these people given a choice? If he's dead, he's dead. You can't treat dead. Why put the burden of choice on the family? You tell them you are taking him off the vent and then you do it - it doesn't solve anything to leave him on.

If this is in response to the post above, I imagine it's because allowing a grieving mother to think for the rest of her life that, if only she'd pushed harder, her son might still be alive seems more important than vacating the ICU bed as soon as possible.

I once withheld morphine from a woman in great distress, minutes before death, even though I strongly believed it would make her last moments more comfortable, because her son was in such concrete denial about her dying. I was certain that if I gace the morphine he would forever believe that, if only he'd been more forceful about stopping me, his mother would have survived.

I once looked after a young Indian guy who'd drowned at a local pool. He had an unknown down time and massive hypoxic brain damage - GCS of 3 and a rapidly increasing core temp (by the end, when he was 42oC/107.6F, you could feel it when you entered his room). His family said they understood he was, to all intents and purposes, already dead and that there was no hope. But several years earlier he'd had a very vivid dream that he's drwoned, the doctors said he'd die, and six days later he woke up. He made his family promise that, if he ever did drown, they would do everything to keep him alive until the sixth day. Even though they knew if was futile (one brother was a neurologist, another a neurosurgeon) they asked if we could do everything possible to extend his life until that sixxth day. We did, he didn't wake up, and we pulled out.

Maybe the mother in sarahrain's story needs that much time to come to terms with what is undoubtedly a shocking loss. Maybe this is a form of bargaining, and when Monday comes she picks a new deadline - in which case withdrawal anyway is reasonable. But when the media's full of stories about people being told their loved ones will die, are already really dead, and the patient survived, it's not too hard to understand why some people are reluctant to accept this as fact.