Ruptured AVM

In these cases most of the docs I have worked with wait three days to really sit down and talk to the family. It is of interest that Lazarus incurred the same three days. Perhaps it is a social custom that we don't recognize. I usually start talking to the family about what we would look for as signs of meaningful neurological activity and then let them spend some time checking for themselves. I also start to involve them with hygeine care of the patient. It is a subtle way to let them prepare their loved without being obvious. This seems to be appreciated later on and I have often had family tell me that they found themselves saying goodbye as they washed. They start to see that there are no reactions and the human touch connects them with the reality. I then start talking about how fortunate they are to have this time to be with their loved one as so many families are not with a loved one during "this time." I also start asking if there is extended family who might want to express their love and how long it might take for them to arrive and that even if it is late at night I will get them in. This process has always worked and is appreciated when the time comes to discuss if their loved one had ever considered gifting so that their loving spirit can go on. They always understand that gifiting is a reference to donation. After this I always assigned a newer nurse to the case. This helps the family to recognize that the aquity of care is changing without being blunt. In these cases you are really taking care of the family and helping them to heal.

have seen this situation occur many times and during these times you are caring for the family as much as you are caring for the pt. the family is going through the stages of death and dying--remember denial, anger, bargaining, etc .... and each person/family does this at their own pace. i am not sure if you have children--but that gives you a different perspective. sometimes in the morning when i come on to the unit and i see organ donation--i get a pit in my stomach--i think the vultures are circling!! (even though i am an organ donor and think they do wonderful work.) i think what if that was my son or daughter--if they were in an accident and i saw organ donation i would tackle them and tell them to get away from my child--but then again--i would need time

where i work, brain dead = dead. you can turn off the monitors, etc... you do not need the families permission. its a matter of "do you want to be here when she has CARDIAC death WHEN take the tubes out?" its the same as keeping a body with cardiac death on the unit waiting for them to resurrect.

Initially, I did not look at your name. Best advice i could give you is put your child in that bed--your 19 yo son or daughter who is laying in that bed through no fault of his or her own. Even as a nurse--it would be so hard. I agree the patient shouldn't be laying there for a week--but a few days? Part of being a nurse is being empathetic.

I would absolutley call the pastor in to talk with them. I'm in the bible-belt here and this is a situation I am anticipating coming across several times as an ICU nurse. I am Christian but by no means well versed in Christian doctrine but I think I could do a fairly good job of explaining their loss in terms of their beliefs. I had a friend in the exact same situation as you described. She politely asked the doctor if he could break it to the family in a more religious way. He was cruel to her and exclaimed how science has nothing to do with religion. Needless to say, we have pastoral care in hospitals for this reason.

What a tough situation you were in. Don't be hard on yourself for feeling the way that you did. You were not in denial about the situation and your concern was where it should have been -- with the patient.

No response to cold colourics...she unfortunately is dead. What the family needs to hear is the truth. In a quiet respectful way. They have to be told about the flat EEG etc etc. But to make it simple you need to break it down into a way that they can comprehend in this horrible time. They are loosing a young family member. They need to hear what these tests really ...realllllyyy mean. They need to hear that the part of her brain that controls the essence of "who" she was is profoundly irrepairably damaged. They need to hear that the part of her brain that controls her personality is gone, the part of her brain that controls her thoughts, memories is gone. They need to hear that the part that controlled her speech is gone. And once it is gone there is no coming back. They need to hear that you need for them to make some tough choices that you would find difficult in their situation. They need to hear that if that were your daughter lying there that you would want to " hold on " to them for YOU. That you would not want to let them go. But that eventually you would realize you were holding onto her for "yourself" and not for her...bc all the things that made her so special and unique are gone ....and that eventually you would hope that you would reach a point that you could let her go. that you would feel like letting her go would be the last "gift " you could give her. They need to hear that some families never reach a point to where they can give their family member that one last gift. The gift of being able to let them go......and that some families do reach that point to where they can give them that last final gift and it brings them peace. You need to tell them whatever their decision is you will abide by it , and that even if they cant "let them go" it will slowly be taken out of your hands as eventually the only small part of her brain that is mildly functioning ( brainstem) will cease despite your efforts. Usually.....99% of the time......my families come back and withdraw care. What I have found is that they want to hear that you see her as a person and that you realize how very special/imp he/she was to them. Once faced with this little above speech,....it is easier for them to grasp....and they do a DNR. If you allow the docs to spill out - ICP out the roof , severe brain edema,...blood pressure unstable ....futile care etc....it doesnt mean anything to them....but if you break it down .....to what is important to them that they can grasp at this emotional time it sinks in. Like the part of her brain that controlled her speech is gone.....the part here ( point to the CT) that controls her memory is calle dthe temporal lobe....it is as you can see gone. These things make it "click". Hope this helps.

Hmm...if a pt is declared brain dead, they are dead. Either the team is trying to keep their other organs going for donation or we're just waiting for all the family members to get there before we turn everything off.

Maybe the physicians weren't clear with the family.

this article in the Nytimes may provide some insight
http://www.nytimes.com/2009/03/18/he...%20life&st=cse

maybe it can be applied to the family as well