[hoolahan]

I can so relate to what you all are saying. I did critical care for 17 years, and it did finally burn me out completely. I went into home care and I really loved it. It was so nice talking to my patient's, and very rewarding to see them actually get well.

I don't think I could go back to ICU again. I did moonlight for awhile when i first started HH, but then a week or so agao, a friend called me to see if I'd want to pick up some shifts, told me I could "Name my price," but truth is I just don't feel like a critical care nurse any more. I'm OK with leaving it behind now.

God bless you all.

[zambezi]

I too relate with what is said here...we had one patient, came in pretty much gone...ruptured aortic aneurysm up though his carotids...first symptom was when he blew his pupils at home and went down, gases on admit had a po2 of 33...ph 7.0something- not good (and this was vented 100% O2)...family wanted everything done...surgeon took him down (???), repaired aorta...never stopped bleeding...I took him back after surgery...have never had someone bleed so much so fast and not stop...we were cell saving every twenty minutes...blood out, retransfused- for four hours...we ended up opening him back up in the unit...twice (all this with a very poor neuro prognosis prior to even going to surgery)...finally after a few days the family starts to accept the fact that patient is nto going to make it...doc comes in and also starts to accept that fact...then another doc comes in a tries to talk the primary into hanging on for a couple of day...the nurse that had that patient that day BLEW UP...she couldn't believe it (eeg at this point showed no activity). Started in on the doc about what all would discuss (calmly) with him...he talked with the family and it was decided to pull life support...

sometimes i think that our docs just won't let go (at least a few won't...thankfully most can see reality). A few of our docs have a "live for at least 30 days after surgery" policy...even if all systems are shutting down after a horribly rocky post op course, poor neuro status, RF, etc...I just don't get it. Personally I would never want my family to have to go through that...sometimes people are supposed to die- and we keep them alive in miserable ways...

Now I am not insensitive to familys needs...if a family wants everything done...i support them but also try to educate them about the situation, I talk with the docs to be up front about outcomes, etc...It is a tough situation all the way around. I don't like it when patients pass on but so many of these patients have horrible outcomes after anoxic events, rough post surgical courses, etc...I know you all know what I mean.

This is a hot topic where I work to. I think that in medical school there should be a course that discusses that not all deaths are medical failures...sometimes it is just a person's time to go--no matter what is done to prevent it.

I think it comes down to EDUCATION for families, doctors, social work, nurses, etc. A tough concept because it is a sensitive topic and usually when you are wanting to discuss it it is an emotional time for families (and docs & nurses).

[Trauma-tizedRN]

101 knowledge there....
(in response to previous posting by LPN to RN)
no one is "annoyed", no one is being insensitive to family struggles, we as nurses DO understand grieving in relation to death and dying, and no one is BLAMING families. I am a patient advocate, and prefer to advocate for dignity in death and unnecessary pain. Even if it means having to nudge the family in the right direction when the time has come. And yes, we DO ease our families down this road, not shove them as you might believe we do. I hope this clarification makes sense.

[Fiona59]

How about a family that finally signs the DNR. He's deteriorated to the point he's going soon, the wife calles 911 and has them take him to active treatment! They're going he's DNR, she changed her mind.

The facility refused to take him back after he was "saved" by acute. Last heard of she had home care, because the Palliative unit wouldn't accept him because of her stunt with 911...

[Gompers]

Originally Posted by dazzle256

What about the ones the families say do everything possible.........and never come to visit them. As far as costs to the system I find this usually to be the case of people with no insurance and no way of paying. Just let their family member vegetate on a vent. I just hope these people don't feel pain.

This is one of my biggest aggrevations in the NICU. Parents who beg us (over the phone, no less) to do everything possible, but very rarely visit, and often don't end up taking the baby home themselves. Usually these are the kids who go to nursing homes, and we find out later that the parents visit even less THERE. And about half the time these are baby boys named after fathers that have never once visited them.

[Gompers]

Originally Posted by Cherybaby

On a lighter note about patients in their 80's/90's having surgery? We recently had an 82 year old woman, in GREAT health (I should have her energy NOW...let alone at 82! And her figure! Oy! We should all be so lucky!) come in for breast implants! *L* She respected her husbands wishes...not to alter her body for years and years...despite the fact that she always longed for larger breasts. Well, her husband passed a year ago...and she said she is ready to have "the boobs of a 20 year old!" Good for her, I say!!!

She said, after the surgery..."won't he be surprised when I meet him in heaven!"

She's a hoot.

You only live once, right? Great story!!!

[Thunderwolf]

It amazes me when I come across "but dad was healthy as a horse" before his massive stroke, comatose, and 98 years old, and the family insists on "all efforts" and refuses DNR. Its just a plain crime. A part of me wants to just shake them and say "enough is enough, the good Lord is calling him home...let him go!" Sometimes, I think families need to sit in on a code and see what really happens to a 98 year old body going thru all that. Families just don't have a clue. When faced with this type of situation, sometimes I turn to the deceased (after the code and everyone is gone) and say, "I'm sorry pal for putting you through all that...I really am. You deserved better."

[obeyacts2]

Oh what a timely thread!!!!!! I am assigned to a poor woman that I sincerely hope will not wake up, and soon. Family(lives next door) left on vacation, left Auntie (widow, no kids) with moderately advanced dementia, CHF AND (drum roll) leukemia alone except with 6 hrs a day home care. I asked them to leave a copy of her advance directives in case of emergency and wouldnt you know she was FULL CODE (at 89, with the aforementioned problems)!!!!! I was just appalled. They can go out of the country on exotic vacations, but won't arrange proper care in the meantime.

I just don't understand people.

laura

[Elenaster]

Another aspect of this that I really struggle with is when "higher power" issues come into play. I realize this statement could be easily misinterpreted, and don't get me wrong - I'm all for patient's and families utilizing whatever spiritual beliefs that will help them get through the stress of being in the ICU. I often pray for peace for them myself. However, when the patient is s/p multiple codes, RF, maxed out on pressors, poor neuro prognosis, etc., etc., and the family won't consent to withdraw support because we would "kill" them and that's "immoral." I just don't understand how they can't realize that the patient would have been dead long before we ever approach them about withdrawing and what we're doing is cruel. If we were supposed to live forever, there would be little need for ICU care IMO.

I can't even imagine how those of you in peds, especially NICU, deal with some of these ethical issues. I can remember when I was a nursing student, I was doing a rotation in NICU and there was this poor little baby there, born extremely premature (maybe 24 weeks) to homeless, drug-addicted parents. He was so small they couldn't place a VP shunt for his hydro and his head was bigger than his entire body. The nurses said he was going to be blind, profoundly developmentally disabled, and a whole host of other terrible things. I left there completely freaked out and really sad for that pitiful little creature, knowing I could never work in that environment. I really respect those of you that can.

[URO-RN]

My brothers well 100% against letting my dad go. My sister and I were for letting him die in peace. We knew that nothing could be done. I was accused of wanting him to die. This was probably because my brothers were not ready to let him go. They were just not comfortable with the idea and they were not ready. Big time denial.

To make a long story short, my dad was in and out of ICU. The only thing keeping him alive were the ICU drugs. He would get "better", according to my brothers(no quality of life), go to the floor, get d/c to a nursing home, go home, get sick again in less than 72 hours, back to ICU, back to the floor....you get the picture.
This went on for a year. In and out of hospital, in and out of nursing homes. The fire department guys and my dad got to know each other very well.


This whole ordeal came to an end when I asked one of the intensivist md's I worked with at another hospital (and who had priveleges at this hospital)to intervene. My dad and bros needed to hear the truth. No sugarcoating. My brothers never really accepted the reality of the situation. Anyway, by the 50th or so hospitalization, when my dad had to be admitted to the hosp., he was admitted to a medical floor. "Finally", I thought "someone out there has gotten it". Let him die in peace. Keep him out of the ICU. The nurses and docs have done everything that they can.
His last days were painful. He was tired. He died May 9, 2004. Mother's day.