Neuro ICU - Do you talk to brain-dead patients? - page 5

I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients (oh the joys of ethics approval committees!). My interest in this started when I read 'Rethinking life... Read More

  1. by   Kyriaka
    Just a quick question, as I don't have much experience with the Orthodox religion at all. I understand that some cultures are seriously against organ donation, which they see as mutilation of the body. But what if you needed an organ? Would you not want a transplant?
    _________________
    Not all Orthodox are Greeks so I cant speak for the other cultures.

    The only restriction is against the harvesting of the heart. However, there are concerns with organs that are not "double". For us much is a personal issue.

    Unlike Roman Catholics, Canon Law for us only applies to salvation. So, of course, this issue doesnt fall under such. Much is personal conviction.

    Obvouisly, nurses/staff cannot know what people's personal convictions are but when dealing with a differant culture to step lightly is only showing good manners.

    For most, personal beliefs are wound up in mutilation of the body with autopsy issues. I would never have an autopsy or authorize for one to be done. Or cremation.


    Because I've met plenty of people (who aren't Orthodox) who are totally against donating their own organs upon their death, but admit that they'd definitely want an organ transplant should they need one at some point. And that's not right!
    _______________
    It might not be right. However, there is a differance between mutilation of a dead body and operating on a live human being.


    Do people of the Orthodox faith accept blood transfusions and donate blood as well? I'm just trying to gain some insight here, so please no flames.[/QUOTE]
    ____________________
    There is no problem with blood transfusions. The only people I know who are against that are Jahovah Witnesses and they would not donate either.
  2. by   Kyriaka
    I think most of the problem was that this was seen as money grabbing to my family at the sacrifice of human beings.

    And not accepting the answer as NO and just accepting that and not walking away offended them greatly.

    My personal belief is that I am very warry of it because the boundary between life and death is so very fuzzy. But also because the official line is that wealthy and famous people are not at an advantage...but I dont believe it. I do think it gives them an advantage over others.
  3. by   NeuroICURN
    Quote from Kyriaka
    Part of the problem here was having no concept of cultural differences. You would never ever approach an Orthodox family about this. The organ people pretty much were asking my family was it ok to mutilate my children (and me). And make money at the same time!

    Are they given no training in cultural differances? Religious beliefs??
    Oh yeah, because that's what it's all about....mutilating bodies and making money! :angryfire

    Nevermind the 50 year-old man who was born with a congenital defect of his mesenteric arteries and now needs a cluster transplant....nevermind the 25 year-old woman who just gave birth to twins, now has a rare and lifethreatening form of cardiomyopathy and needs a heart transplant! (Yes, these are two cases that I have been closely associated with.)

    It's hypocritical beliefs like that that make me SO angry! You will take, but do not give? (No, I'm not just talking about your personal case anymore.)

    And how are we supposed to know your personal beliefs??? I may know that the Jewish faith is listed....but does that mean that you are a practicing Jew? And....what's the harm in asking??? Just because you are Orthodox...does that mean that we should automatically not even ask??? How ridiculous is that? How ridiculous of you to even suggest it!

    Now....I will state again, perhaps the person that did it was overzealous, but I cannot give an opinion on that, because I was not there. All the CORE people I have dealt with (and that's a lot) are all very professional, kind and are wonderful in how they deal with the families.

    All statements above are my humble opinions! So....don't bother with flaming!

    NeuroICURN
  4. by   Kyriaka
    [QUOTE=NeuroICURN]Oh yeah, because that's what it's all about....mutilating bodies and making money! :angryfire

    _____________
    I never said that it was all about money. But in MY humble opinion you cannot seperate medicine from business. It is a business. Right or wrong. Good or bad. Money is a part of medicine.
  5. by   Energizer Bunny
    Of course business is a part of medicine. I think that's a given, but I still can't imagine not giving something of myself or someone I love to help save another human. That's just me of course and to each his own. (though I might hesitate to allow my organs to be donated to someone who wouldn't donate his own now that I think about it)
  6. by   talaxandra
    Quote from NeuroICURN
    Sounds to me like these cases, if true, then the MDs need a lesson in not only properly declaring brain death, but also on what brain death is. In the case of the person breathing spontaneously.....well that is one of the criteria, the person CAN NOT be breathing spontaneously....if they are, they are NOT brain dead, yet.
    As for the third case you cited...you did not say that she was ever declared brain dead....more sounds like they were withdrawing care. Also, one CANNOT be declared brain dead, when there are certain things in the bloodwork that could even just possibly explain them not responding normally.
    I'm sorry if I misrepresented the authors' position in this article, or my own - the point was not that these were case where brain-dead patients became "un-brain-dead" (for want of a less clumsy phrase). Rather it is that determinations of brain death are sometimes made when patients don't fit the criteria. In the cited cases, these reasons may have included inevitable somatic death (or perceived inevitable somatic death), a viable recipient in the wings, or perhaps even financial aspects (this last is not explicit in the text).
    I agree with you, NeuroICURN, that these cases describe patients who are not brain-dead - that was the point of the article. The reason I posted it is that, if relatives are told that a patient is brain-dead and s/he isn't, or isn't yet, or is brain damaged, then this muddies the waters for everyone. The term 'brain dead' is thrown around a lot, and as we can see from the discussion thus far, informed and interested health professionals are not always any clearer about it than lay people. For example, on my unit (which incorporates neurosciences), staff refer to patients as being 'brain dead' when they mean unconscious, unresponsive or hypoxically brain damaged, although they know that part of the definition of brain death is that the patient is ventilator-dependant.
    About the third case: although van Norman does not specify that the patient had been declared brain dead, she does say: "On the day of anticipated organ collection..." and "Vital organ collection was canceled..." These phrases seem to indicate that organ collection was planned, timed, rather than related to withdrawal of treatment. It is possible, of course, that treatment was planned to be withdrawn that day, with post-mortem organ retrieval, which would seem to be premature. However, as the article is specifically about declaring brain death, I think it's safe to presume that the third patient had been declared brain dead like the other two.
  7. by   StephanieMc
    [QUOTE=Kyriaka]
    Quote from NeuroICURN
    Oh yeah, because that's what it's all about....mutilating bodies and making money! :angryfire

    _____________
    I never said that it was all about money. But in MY humble opinion you cannot seperate medicine from business. It is a business. Right or wrong. Good or bad. Money is a part of medicine.
    I tend to agree with this to a point, from my personal experience with my son. We took him to Chicago University for his transplant and that is where we stayed for 4 months until he died. I had some altercations with the doctor there but that happens when you know to much about what is going on and dont agree with his care. After he died I had kept in touch with the transplant coordinator and one day I got his bill after my insurance paid. The whole bill was greater then $900,000.00. I called the coordinator having a balance of $70,000.00 for some medications that was $10,000.00 a dose. She returned my call after talking to the transplant MD who was in charge of the whole operation and theri response was...and I quote" Dr _______ says we have made more then enough moeny off of you and Brian so we are going to just erase that balance and we will call it even" My son had not been deard 2 weeks ...and they had made enough money and were going to call it even????? MY son gave his life I hardly call that an even exchange.
    So yes....sometmes I too think things like this are a "money racket" but then nothing in life is free and every one is out to make a million$.
    Get me off this soap box I feel flames. NOt at you guys but at what happened in Chicago. MOre then enough money my heiney!!!!!
  8. by   Tweety
    Quote from Kyriaka
    _____________________
    My 7 year old passed away. I have now been single for over 10 years and always new things down the road. Although these things are not easy I can honestly say even at 37 years old that I have learned a great deal:


    I never understood the handicapped, until I had a handicapped child.

    I never understood what it was like to be heavy until I weighed 280 lbs.

    I never understood grief until my children died.

    I never understood pain until I was burned 60% in a house fire.

    I never understood perseverance until I lost 150 lbs.

    I never understood desperation until I was infected with Lyme Disease.

    I never understood gratitude until I no longer had to take medication for Lyme.

    I never understood trust until I lost my job.

    And I never understood my future until I decided to go back to school to be a nurse to work critical care burns.

    ***
    You never know what life will give you.
    What a courageous and inspiring story. Life's lessons come from experiencing life. Sometimes you can't experience joy until you learn to cry from the depths of your soul.
  9. by   Tweety
    Quote from StephanieMc
    Dr _______ says we have made more then enough moeny off of you and Brian so we are going to just erase that balance and we will call it even"

    What a cold hearted response. I won't even get on my soap box either.
  10. by   Elenaster
    Quote from NeuroICURN
    Talaxandra.....I believe what you are referring to in this case is organ donation after cardiac death (formerly called non-heartbeating donors). What this is is when a patient is not expected to progress to brain death (as in a case of mine where a man had been shot in the head and while his brain had partially herniated, it could not completely herniate and cause brain death...because of the hole in the head that allowed brain tissue to come out). Anyway, what they do here is take the patient to OR, remove support and if the patient goes asystole within 30 minutes, then organs can be harvested. If not, well then after the person dies, they can still harvest tissues, corneas, etc. usually.

    I work a LOT with organ donation in my unit, so if any of you have questions concerning organ donation and how it REALLY works (not some of these misconceptions that have been posted here), PM me and I'll answer questions as best as I can.

    Anyway, some of you people are missing the point that brain death is really NO different than being asystole. There is NO coming back from being brain dead....as a matter of fact, once you are declared brain dead, your death certificate is signed because you are DEAD!!! Yes, there is specific criteria that must be met, different tests, so that there is no mistake.
    I completely agree with everything you've said, and I too, often work closely with the Organ Procurement Organization in my area. I've actually done a donation after cardiac death case, and as you said, it was a GSW to the head that would never recover function of anykind, but would not progress to brain death prior to cardiac death occuring.

    Brain death= dead, and as a wise, old neuro nurse once told me, as your brain dies, your body tries to die as well. We do several tests to conclusively diagnose brain death, including apnea tests and nuclear flow studies.

    Referencing the OP's original question, I do talk to my deeply comatose and severely brain damaged patients. However, for patients that are asystole or have been declared brain dead, I tend to be silent and pray for the patient and their families, wishing them peace and comfort.
  11. by   Dixiedi
    [QUOTE=talaxandra]I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients ....QUOTE]

    I always talk to all patients. We do not know enough about the brain to be sure. We also do not know enought about an after-life (if there is one.)
    Simple fact is... if you don't know, cover it. Talk, the worse thing that could happen is they'd talk back and scare the begeebies out of ya. The best thang that could happen is they will understand what is being done before it is done.
  12. by   Rhoresmith
    More than 18 years ago as a Resp Therapist I took care of a comatose man, he was a very large man and others were comment about his size ect when we were caring for him. I always talked to him and usually touched his arm or stroked his forehead when I was with him. When he woke up and I mean woke up ( he opened his eyes and just tried to talk he was oriented and alert but on a vent) when I came in to take him off the vent he knew me by my voice. I still to this day get Christmas cards from him and his wife, he told me that I made him feel like a person not a slab of fat (since he heard himself be called that he weighed over 300lbs) and he would never forget me for that reason. I have let that be my reminder when ever I deal with consious and unconsious patients. I have always been proud of myself about this because I was very young 23-24 and working with much older more experianced people who gave me a hard time about this patient and I stuck to my guns Rhonda
  13. by   NeuroICURN
    Quote from Rhoresmith
    More than 18 years ago as a Resp Therapist I took care of a comatose man, he was a very large man and others were comment about his size ect when we were caring for him. I always talked to him and usually touched his arm or stroked his forehead when I was with him. When he woke up and I mean woke up ( he opened his eyes and just tried to talk he was oriented and alert but on a vent) when I came in to take him off the vent he knew me by my voice. I still to this day get Christmas cards from him and his wife, he told me that I made him feel like a person not a slab of fat (since he heard himself be called that he weighed over 300lbs) and he would never forget me for that reason. I have let that be my reminder when ever I deal with consious and unconsious patients. I have always been proud of myself about this because I was very young 23-24 and working with much older more experianced people who gave me a hard time about this patient and I stuck to my guns Rhonda
    Good for you....NOTHING ticks me off more than when people talk about a COMATOSE patient as if they don't hear it....I never say anything to or about them that I wouldn't say directly to their face because we don't know how much a comatose patient can hear.

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