[janfrn]

Originally Posted by 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."

You took the words right out of my mouth, Thunderwolf. If families knew how many ribs we break doing compressions, and how much pain broken ribs can cause to someone who already has enough on their plate, and how frightening it is to "wake up" intubated, unable to speak and often very confused, they might think again. Television has such a huge influence on how people think and I just wish we could get mainstream TV to show more realistic portrayals of emergency and intensive care so the general public understood how it works and oftentimes doesn't.

And then naturally we have to get into the "faith" thing. Several years ago I had a patient who had an unidentified progressive neurodegenerative problem who went from a CP-like picture of recognizing his parents, smiling and breathing room air to fully ventilated with zero resp drive and no interactions with his environment other than to cry when turned or suctioned... no obvious etiology identified... when he was 13 years old. The parents are devout Catholics who go to church every Sunday and whose priest comes once a week to visit the boy. Numerous blessed icons are placed around the room. This boy deteriorated rapidly once he was trached and lost his resp drive. His heart rate would spontaneously and routinely drop to the 20s and his sats would follow. After much discussion it was decided that we would not give any cardiac meds and we would not do compressions. The family refused to call it a DNR order, and we went along with that. One evening while the parents were with the boy, he bradyied to the teens, and when nobody moved, the dad jumped on the bed and started compressions... URRRRRRRCHHHHHHHH! Code status reversed. When the dad was asked why he got in God's way when God was calling the boy home, he said that if God wanted that boy, he wouldn't have allowed science to invent all the technology we use for advanced life support, and we darned well had better be using it. "God put all this stuff here so that Sammy could live." This was about 4 years ago, and to the best of my knowledge, they are still ventilating that body somewhere.

[dazzle256]

Originally Posted by Trauma-tizedRN

One of the most challenging ethical dilemmas for me. I just HATE participating in it. We get so many patients in the ICU setting that prove to us in so many ways that it is JUST TIME TO DIE! But no, for whatever reasons ie: Doc is a super god..saves everyone, doc is too wimpy to call it to a stop, families running the show and docs letting them...and other various reasons, we get to come to work everyday and poke and prod these poor souls. Costs the system alot of money too. I don't go home feeling like a good nurse when having to do this. In fact I feel really bad. I am pretty aggressive about it and corner these docs and families for a "chat" to help bring some reality to play, but sometimes have to get ethics involved to make any headway....docs don't appreciate it either. But geez people...we are maintaining dead or dying people with all the bells and whistles, for weeks on end. Can't we just let people die when they ARE. Treat pain and suffering....not cause more. Never a good day when you get to work and the buzz phrase on the unit is "I see dead people"

I did homecare about 6 years ago for a 12 year old severely retarted girl trached and on a vent.... anyway long story short.....mom told me that when she was born (a preemie) mom and dad didn't want her resusitated (pardon my spelling) but had on say in the matter. The little girl was in the hospital for the first two years of her life. Mom said back then she had no choice and... that was in the late 80's I guess. Has things changed .....did families not have the choices they have now?

[Trauma-tizedRN]

Originally Posted by dazzle256

I did homecare about 6 years ago for a 12 year old severely retarted girl trached and on a vent.... anyway long story short.....mom told me that when she was born (a preemie) mom and dad didn't want her resusitated (pardon my spelling) but had on say in the matter. The little girl was in the hospital for the first two years of her life. Mom said back then she had no choice and... that was in the late 80's I guess. Has things changed .....did families not have the choices they have now?

I've been in healthcare for over 20 years (CNA..LPN...then RN for the last 17) And patients have ALWAYS had no code rights, as well as family wishes if patient unable to say. I don't know what to say about this one. Doesn't sound like a good prognosis was ever part of the quotient.

[Town & Country]

I understand that people can be in denial, and that they don't want to "let go" of their loved one.

But does it really take a rocket scientist to see that someone is ALREADY DEAD?

Literally: I would not TREAT A DOG like most of the people who are in ICUs.
At least when dogs are euthenized, they just "go to sleep."
They are not tortured for months on end......I've seen people lie there on vents....week after week.....their skin splits open and weeps.
Would anyone do a dog like that?

That is cruel. When it's time to die, let them die!

[Trauma-tizedRN]

Originally Posted by SunStreak

I understand that people can be in denial, and that they don't want to "let go" of their loved one.

But does it really take a rocket scientist to see that someone is ALREADY DEAD?

Literally: I would not TREAT A DOG like most of the people who are in ICUs.
At least when dogs are euthenized, they just "go to sleep."
They are not tortured for months on end......I've seen people lie there on vents....week after week.....their skin splits open and weeps.
Would anyone do a dog like that?

That is cruel. When it's time to die, let them die!

The down and dirty truth. Wish we could make a pamphlet of your posting to hand out in ICU. Sometimes, when it gets beyond ridiculous, ya just gotta tell it like it is.

[reprise]

During the time I worked in the HIV/AIDS field, I found it quite puzzling that often it was the families of those who'd been suffering a terminal illness for a considerable period of time who were most reluctant to discontinue futile treatment. Intuitively, I would have expected the families of those who'd suffered unexpected, catastrophic events to be the ones who had the most trouble "letting go", and yet time and time again they seemed to cope far better (perhaps because they were buffered by shock) than families who'd had a long time to prepare themselves for the inevitable.

Has anyone else noticed somethign similar?

[aimeee]

Originally Posted by reprise

During the time I worked in the HIV/AIDS field, I found it quite puzzling that often it was the families of those who'd been suffering a terminal illness for a considerable period of time who were most reluctant to discontinue futile treatment. Intuitively, I would have expected the families of those who'd suffered unexpected, catastrophic events to be the ones who had the most trouble "letting go", and yet time and time again they seemed to cope far better (perhaps because they were buffered by shock) than families who'd had a long time to prepare themselves for the inevitable.

Has anyone else noticed somethign similar?

I think when they have gotten that terminal diagnosis and then received numerous bouts of therapy that have made things better for a time, they find it hard to believe that the patient won't improve again. This is particularly true when they outlive their prognosis. They think, "the doctor was wrong before, he may be wrong now".

[mattsmom81]

I relate 110% to all the posts here. We shoot suffering horses and euthanize our beloved dying pets but look what we do to our human family members.

I too have been accused by doctors of overstepping my bounds but I have a policy of trying to 'reach' family members with the realities of futile care, the undignified aspects of codes, the ravages the body endures in our efforts to 'save' at all costs..

Recently had such a sad experience...a woman in her 50's perfed her bowel and over the next few months endured surgery after surgery to clean out abcess, etc. She septic shocked and MSOF'd, chronic ICU psychosis, improved a short time only to fail and need surgery again and the whole roller coaster ride repeated. Her poor husband. He watched as she wasted away and died inch by inch, surgery after surgery to cut out more bowel. Docs couldn't give upcuz of her young age..and family couldn't bear to set any limits either. She was still 'alive' but looked like a yellow trached skeleton with hanging edema and eyes like Aushwitsch prisoners. Hubby told me he wanted to carry her out and drive them both over a cliff. I just cried with him. I cry thinking of them now. Nah...I'm not burned out am I.

This situation has a different twist than the brain death/vegetative state and some may not consider this futile care, but I guess one has to see the ravages the body and soul endures to understand...how and when do we draw lines regarding the quality of a human life? Many doctors will not leave their safe 'perch' inside the science of what they do to see the other side.

[debbiemig]

Last December my hubbies dad fell off of a ladder in the garage and onto his head.He was airlifted to the trauma center where he was placed on life support. EEG showed no activity( there was brain matter at the scene). He had very clear advance directives drawn up by a lawyer a few years prior.After a week, the family was brought together to discuss taking him off the support. My husband and his brother were against it. My sister in law and I tried to make them understand that he went to all the trouble and expence to make his wants known." He really did you a favor and took the desicion away from you, HE made the desicion already!"The grand daughters finally convinced them to let him go. So even with very specific advanced directives there is still an issue. I told my daughter that SHE was in charge if anything like that happens to me. NOT my husband. He'd keep me alive forever no matter what! My desire to be creamated is also an issue with him, but that's another story!

Originally Posted by Jo Anne

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.

[Trauma-tizedRN]

Originally Posted by mattsmom81

I relate 110% to all the posts here. We shoot suffering horses and euthanize our beloved dying pets but look what we do to our human family members.

I too have been accused by doctors of overstepping my bounds but I have a policy of trying to 'reach' family members with the realities of futile care, the undignified aspects of codes, the ravages the body endures in our efforts to 'save' at all costs..

Recently had such a sad experience...a woman in her 50's perfed her bowel and over the next few months endured surgery after surgery to clean out abcess, etc. She septic shocked and MSOF'd, chronic ICU psychosis, improved a short time only to fail and need surgery again and the whole roller coaster ride repeated. Her poor husband. He watched as she wasted away and died inch by inch, surgery after surgery to cut out more bowel. Docs couldn't give upcuz of her young age..and family couldn't bear to set any limits either. She was still 'alive' but looked like a yellow trached skeleton with hanging edema and eyes like Aushwitsch prisoners. Hubby told me he wanted to carry her out and drive them both over a cliff. I just cried with him. I cry thinking of them now. Nah...I'm not burned out am I.

This situation has a different twist than the brain death/vegetative state and some may not consider this futile care, but I guess one has to see the ravages the body and soul endures to understand...how and when do we draw lines regarding the quality of a human life? Many doctors will not leave their safe 'perch' inside the science of what they do to see the other side.

I had a patient quite similar to this..in addition, CRF with hemodialysis for the prior 2 years. Why!?