[Trauma-tizedRN]

Originally Posted by Elenaster

Oh ladies, you're preaching to the choir here. I'm really contemplating leaving ICU because of so many of the reasons you've stated. I'm so tired of taking care of "corpses," coding dead people for hours, avoiding brain-death testing just because no one wants to tell the family the truth, administering unholy amounts of pressors and watching their limbs turn black.....Futile care is one of the most stressful parts of my job, it's so draining to deal with the families when you have nothing but bad news.

You gotta love those DNI codes Personally, I don't know who decided that was acceptable, but I've never seen anyone come back without a freakin' airway - the patient is completely purple, but we'll go ahead and dose her up with epi and atropine, in the meantime, jack that levophed up to 500 mcgs

There was actually an article in the American Journal of CC about perceived futility in care r/t job stress in the ICU. There was quite a correlation between the two (I know you're shocked). I think it contributes heavily to ICU burnout as well.

My exact experiences and sentiments....worst part of ICU

[Elenaster]

I can count the number of times on one hand that I've actually had a family that has the good judgement to say that their loved one has had a good life and he/she wouldn't want to be like this. It's pathetic how few people realize that humans were not designed to live forever. It's even more pathetic when we do everything possible and then some, and then the hospital gets sued anyway because of some unforseen complication (i.e. MRSA, sepsis, etc) in a patient that had an extremely poor prognosis to begin with.

[Tweety]

From the med-surg perspective I hear you loud and clear. I feel like I'm torturing human beings when I have to call a futile code, or intubate and send to ICU in an effort to prolong the inevitable.

I don't always blame the docs for being whimpy. In this society where families and patients sue for outcomes that don't suit them we must be heroic at all costs. I recently heard a doc point blank ask a women why she was continuing on with futile efforts for her husband "I need his check". Seriously. That woman should be sent to jail.

Anyway, we've gone way to far and I don't like participating in it and too feel frustrated at the end of the day some of those days.

[NewNurse2003]

I've seen so many 'selfish' family members that just can't make the decision to take Mom or Dad off the vent. "It's just too hard", they say. To me, it would be even harder to see my parent go through the tortuous futile care. I just don't understand sometimes. Makes me glad my mom is VERY up front about what she wants and DOESN'T want when it comes to that time in our lives. I'm also POA. I just wish my husband and his parents would talk about it - at least ONCE!

Our unit is gearing up to take Intra-Aortic Balloon Pump patients. Interesting device, but, I can see the same 'ole discussion with a family member discussing when to take Mom or Dad off the balloon pump because they can't be weaned. Ugh. Just like when it's discussed to take someone off a vent or not. I'm not really looking forward to that.

[eak16]

There was actually an article in the American Journal of CC about perceived futility in care r/t job stress in the ICU. There was quite a correlation between the two (I know you're shocked). I think it contributes heavily to ICU burnout as well.[/quote]

I was just going to mention this article- it is a must read. I am a floor nurse myself, but I did a very involved case study in nursing school on the effects of a patient such as described above on the atmosphere of an ICU. Case was very sad- had been in a coma for several years after an accident, was coded several times, last code before I saw her, the resident was in the midst of calling time of death when a MED STUDENT THOUGHT he felt a pulse, so they resumed compressions and she came back, albeit even more brain damaged than before. Talk about frustrated ICU nurses!

[Trauma-tizedRN]

Originally Posted by 3rdShiftGuy

From the med-surg perspective I hear you loud and clear. I feel like I'm torturing human beings when I have to call a futile code, or intubate and send to ICU in an effort to prolong the inevitable.

I don't always blame the docs for being whimpy. In this society where families and patients sue for outcomes that don't suit them we must be heroic at all costs. I recently heard a doc point blank ask a women why she was continuing on with futile efforts for her husband "I need his check". Seriously. That woman should be sent to jail.

Anyway, we've gone way to far and I don't like participating in it and too feel frustrated at the end of the day some of those days.

I don't think all the docs are wimpy either..like I said, various reasons...but, when you have a pt. that has been clinically dead for several days, still on the vent, maxed on pressors, labs, various other meds, feedings, extremeties black, etc. and the doc won't call it because the family insists "dad responds to our voices"...it's either whimp syndrome or doesn't want the hassle (apathy). Lawsuit concerns? EEG will tell the whole story, among other tests of viability. Not an issue.

[Tweety]

Originally Posted by Trauma-tizedRN

I don't think all the docs are wimpy either..like I said, various reasons...but, when you have a pt. that has been clinically dead for several days, still on the vent, maxed on pressors, labs, various other meds, feedings, extremeties black, etc. and the doc won't call it because the family insists "dad responds to our voices"...it's either whimp syndrome or doesn't want the hassle (apathy). Lawsuit concerns? EEG will tell the whole story, among other tests of viability. Not an issue.

Still the doc can't pull the plug without the family's consent. Because then the family can claim it was docs lack of treatment that killed the person. Better to continue with heroic measures and let the patient eventually die, then everyone's conscious is clear. (sarcastic smile here). Doc can request they find another doc because it's against his principles. But docs are caught between a rock and a hard place.

As nurses we can help and encourage the family to let go.

Isn't it more common though, rather that brain dead, heroic measure are done on persons in the process of dying, or in permanent vegetative states?

[Trauma-tizedRN]

Originally Posted by 3rdShiftGuy

Still the doc can't pull the plug without the family's consent. Doc can request they find another doc because it's against his principles. But docs are caught between a rock and a hard place.

As nurses we can help and encourage the family to let go.

Isn't it more common though, rather that brain dead, heroic measure are done on persons in the process of dying, or in permanent vegetative states?

Yes, way more common in dying and vegetative situations but I have seen this with actual brain death situations on rare occasion. Docs don't have to treat dead people, and yes they can pull the plug once confirmed and documented. Ethics can get involved on all the cases where futile care is being demanded by family. Usually though, once the doc finally adresses and urges the issue, the families tend to back down. Haven't seen a case yet that required legal involvement to end care, however, it would lead to that if necessary. If they can go to a LTC facility on a vent and feedings, no problem. In ICU, the issue is resolved and care is stopped, or eventually the patient just dies. (A tortuous death) Docs usually just start to DC everything.

[earle58]

i brought up this very same subject under the hospice forum, as to why doctors/families wait until the very last minute before their loved ones are able to die peacefully....i do think doctors are afraid of lawsuits, should they go against the family wishes; too many families in denial; often the patient will just go along with what the family wants rather than express their own wishes, and then of course, there are those mds who play God, but at whose cost?

i wish the mds had much more education in end of life care rather than these futile, invasive heroic measures....

leslie

[michelle126]

Just now am I going thru a situation like this. DH's elderly aunt was transfered from a LTC to hospital ICU for sepsis. She was 78 a&O diabetic, peritoneal dialysis with a right bka. The good leg had a cyst that they were watching for infection....well after almost 2 weeks in the ICU being treated for infection....her renal doc decided and councelled the family that knowing that aunt didn't want another amputation transfering her back to the LTC with hospice was the best option. My MIL and FIL, POAs and primary caregivers, understood this and aunts wishes. DH's other uncle....wanted everything done (even though aunt didn't)...very mad and unaccepting.
Aunt Jean was sent back to the LTC yesterday am....we got the call that she died at 9pm. Thank goodness her doc wasn't one to do all the heroics. I am still grieving, but soooo happy she died in her "home" on her conditions.