Some days I just wanna bang my head against a wall

Specialties LTC Directors

Published

Specializes in LTC, Hospice, Case Management.

Just venting...

Resident with metastatic cancer. Husband decided (or Dr. told him?) 6 months ago that there would be no further treatment. Resident has done remarkably well and remained fairly stable and is just now starting to show signs of decline. She remains a full code. She has suddenly begun to have problems with urinary retention (being st. cathed, awaiting U/A and other lab results, etc). Other issues going on as well and I just sense we are at the beginning of the end.

Explaining all this to the family and gently trying to being to educate them regarding end of life process, Do not resuscitate orders, etc. Family goes on a tangent about this has to be the beginning of renal failure..."What's the protocol for dialysis"? "How do we go about getting her on a transplant list"?

Now I understand families have a tough time accepting end of life. I don't agree, but understand someone's desire to be a full code...but thinking they can get on a transplant list? First of all - it's probably a UTI. Second of all - Turn off the TV - this doesn't work like it does in the movies.

OK - back to my sweet little understanding self.

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Specializes in ED/ICU/TELEMETRY/LTC.

God bless this poor woman. And heaven help this poor family.

I really don't get it when people don't get it.

I have had residents whose family would decline a feeding tube when the resident would no longer eat and leave Mama a full code.

So we are going to let her starve to death and then code her? Good grief.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Where is the husband that decided no further treatment for the chemo indicating that this is a terminal diagnosis. Dialysis will not cure her cancer. She is not a candidate for transplant because of the cancer....she can't take the anti-rejection drugs. It never ceases to amaze me, this wish for loved one to live forever. I miss my Dad so much, it hurts everyday. But I didn't want to see him to be the Dad he would have been if he lived....that wouldn't have hurt...... it would have killed me.

:hug: I hate days like that.

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Specializes in Pedi.

It's so difficult when the family refuses to make an end-of-life patient a DNR. I work in pediatrics so one can imagine that parents often have a hard time letting go but sometimes we do too much to these kids. We had a patient several months ago with a terminal brain stem cancer (a tumor that no one survives) and she ended up trached and vented at the end because her family was convinced that there was going to be a divine intervention at the 11th hour. She ended up being declared brain dead and the hospital had to tell the parents support was being withdrawn. Another of my patients with a terminal brain cancer died in a similar way. We had done everything we could to get her home on hospice and the intention was to keep her home... and then when she began desatting (don't ask me why they were even monitoring her sats), her mom called 911 and she ended up on BiPap and died later that day in the ICU when support was withdrawn. This particular patient had officially been a DNR for about 6 months at that point... but every time she tried to let go, her parents reversed the DNR and insisted on intubating her and pursuing interventions that kept her alive in the short term but prolonged her suffering in the long term.

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Specializes in LTC Rehab Med/Surg.

Hope. It's unreasonable. It's almost impossible to let go of. It's like a light bulb that nobody wants to turn off.

Hope makes you cling to the 1% chance, and ignore the 99% reality.

Even when that 1% involves pain and suffering.

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Specializes in ICU.

I was not aware that human beings died. When did this start happening?

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Specializes in nursing education.

Right! How come coding isn't an opt-in, rather than opt-out? When you remove a mole, or an ingrown toenail, or whatever, you have to sign a form indicating you have been warned of the possible risks.

CPR- "you will have someone forcibly pounding on your chest. They will likely crush your ribs. You will have an tube put into your throat. You will be given lots of medications. You are highly unlikely to survive or be in a better state after this procedure than you were before."

Crazy.

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This is so sad. My grandpa was a DNR, signed all the papers at the SNF but somehow someway they sent him to the ER, ER was not aware of code status, he was coding and they tubed him ect ect. Papa spent 4 weeks in a coma in ICU, when he could have died peacefully, it is a shame.

It sounds like a visit from chaplain and the MD are in order to reiderate the end of life process. Since they are still thinking that treatments are going to save her, maybe they do not understand the gravity of the situation.

Also, it could just be a UTI, which can be treated non-invasivly (hopefully). Maybe they will have the time they need to grasp the situation, and their loved one will not have to suffer in the process.

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Specializes in MDS/Office.

Perhaps the resident's Dr. needs to have a talk with this family....and suggest a referral for Hospice. :rolleyes:

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Specializes in LTC, Hospice, Case Management.

Husband was in today (really nice guy. The kind you wish all family members could be like). I chatted with him a bit about his concerns, tried to ignore the tears he was trying to hide from me. After letting him talk a bit about what he wants it became pretty clear - these are lay people....they just don't understand how things work...they don't understand the consequences of treatments. I think so many of us just take our knowledge for granted and assume that everyone else "gets" what is so obvious to all of us.

I started with baby steps today, ie: CPR is very tramatic, broken ribs are likely with osteoporosis, survivial rate with all of her comobidities will likely be nil. He was taking it all in pretty well but still not sure he understands. Encouraged him to speak to his adult kids this weekend and all of them come see me next week so we can come up with a plan they feel comfortable with and avoid the pressure situation that is sure to come.

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Specializes in acute care and geriatric.

I blame Dr House!! I've been told that when kidney and liver failure kick in that is when the miracle cure is found !!

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