Death With Dignity? - page 3

What happened to this concept? I am NOT advocating euthanasia. I am however advocating that we take a close look at what we are currently participating in when we keep chronically ill, multi... Read More

  1. by   bunky
    Dear askater,

    Your grandmother is very lucky to have you, as was your grandmother Darla. It's such a hard time to go through. My own father's death was so sudden as he had a massive cerebral bleed and was on coumadin, it was all over by the time we got to the hospital. There was no time to say all of those last minute words that I think so many of us think we are going to have time to say to someone we love. He lost consciousness and by the time we got to the hospital his pupils were fixed and dilated. With my mother and all six of there children he died 9 hours later. Being a nurse and seeing such horrible deaths, I'd say he had a perfect death. Had we had warning, or it been prolonged by another disease, I think that our decisions would still have been to keep him comfortable.

    I wonder if our attitiudes about death don't come from childhood experience? Something my father once did for me will always stand out in my mind as such an act of kindness, and one which I will always remember. When his own father died, (I was very close to him. I was 6 and being the youngest grandchild Grandpop spoiled me rotten) my father woke me up early that next morning after hours spent crying the night before. Together, he and I went to the funeral home. Me still in my nightgown. There was no one else there except for my Granpop already lying in his casket. I wasn't scared! My father took me over to the casket and we knelt down and said a prayer for my Grandpop, then we left. Years later he explained that he didn't want me to see everyone else's tears, he wanted me to have my own memories not influenced by the sadness of others. I think it was the right thing to do. I would have been so upset had I been there to see everyone else crying, and it would have frightened me too. For me it made me realize that we can't hide from death. It is a natural thing, and while it is sad, it's something that we all must face.

    Just a thought.
  2. by   oramar
    Originally posted by JillR:
    There was a doctor that I disagreed with about telling the family the truth about their mothers impending death. The doc said to me that he didn't want to take all hope away. I told him that by not telling them the whole truth he was preventing them from going from hoping that the patient lives to hoping that their loved one dies with dignity. My point is that, in my opinion, there are all kinds of hope, and by not allowing the family to face the facts, I felt that he was keeping then from what they needed to do the most, begin the grieving process. Just my thought for the day.
    I had a patient that was my age and was diagnosed with a very advanced form of cancer. She was very lucid, totally competent. She had a daughter who was admandent with nursing staff and physicians that her mother not be told. We complied but I was not very comfortable with the situation. I felt the patient had a right to know. She was refered to a new oncologist, when he arrived we explained the situation to him. His response was that situation was not acceptable and that we could not withhold information from a person about their condition, especially when the person was lucid and had to make pertinent decisions about being treated or not being treated. He went right in and told her, she was upset but less than her daughter thought she would be. The daughter was furious and threatening to sue me and him. The daughter also demanded to know why the oncologist did not consulted with her before speaking to the patient. He told the daughter she had it wrong, that ethically he was required to speak to the mother first to get permission to tell the daughter the mother's condition not visa versa. I was relieved, I felt the oncologist was right about everything he said. He made some sort of comment that the family members feelings had to be considered in these situations but that the patients right to know came first. He also said that family members frequently tend to focus on their own needs in these situations, their primary need early on usually being the need to deny. I never heard anything else about a law suit.

    [This message has been edited by oramar (edited July 29, 2000).]
  3. by   darla80
    Originally posted by bunky:
    Dear askater,

    Your grandmother is very lucky to have you, as was your grandmother Darla. It's such a hard time to go through. My own father's death was so sudden as he had a massive cerebral bleed and was on coumadin, it was all over by the time we got to the hospital. There was no time to say all of those last minute words that I think so many of us think we are going to have time to say to someone we love. He lost consciousness and by the time we got to the hospital his pupils were fixed and dilated. With my mother and all six of there children he died 9 hours later. Being a nurse and seeing such horrible deaths, I'd say he had a perfect death. Had we had warning, or it been prolonged by another disease, I think that our decisions would still have been to keep him comfortable.

    I wonder if our attitiudes about death don't come from childhood experience? Something my father once did for me will always stand out in my mind as such an act of kindness, and one which I will always remember. When his own father died, (I was very close to him. I was 6 and being the youngest grandchild Grandpop spoiled me rotten) my father woke me up early that next morning after hours spent crying the night before. Together, he and I went to the funeral home. Me still in my nightgown. There was no one else there except for my Granpop already lying in his casket. I wasn't scared! My father took me over to the casket and we knelt down and said a prayer for my Grandpop, then we left. Years later he explained that he didn't want me to see everyone else's tears, he wanted me to have my own memories not influenced by the sadness of others. I think it was the right thing to do. I would have been so upset had I been there to see everyone else crying, and it would have frightened me too. For me it made me realize that we can't hide from death. It is a natural thing, and while it is sad, it's something that we all must face.

    Just a thought.
    Dear Bunky:

    It sounds like you had a wonderful father who left you a legacy of compassion and a well rounded view of life!!

    I think you are right. I too believe that our childhood experiences determine some of our adult perceptions. Thank you for posting your story about your grandfathers death. I am awlays trying to understand more about death. Each experience shared helps me look a little deeper at this complex facet of life. You Dad gave so much by sharing your grandfather and his death with you at such a tender age. I imagine you have many memeories of lessons learned from a Dad so wise!
  4. by   darla80
    Originally posted by askater:
    Darla80--

    Thanks a lot for the encouraging words.

    Our family is spread all over. When grandma comes to live with my mom, it'll be me, dad and mom. We'll try our best to keep her comfortable, and do as much as we can. I have a 16 month old and currently pregnant. But I only work once a week, so I'll be very available.

    The road will be tuff, but we're a very loving family. And grandma's taking it well. (that's most important)

    I'm so happy you shared your story. It was a beautiful story. Again thanks!

    Dear askatar:

    It will be much more difficult with a smalller family but it sounds like your Grandma is ready for this and you will pull together and gain strength form each other.

    Do you have hospice there? They can make a tremendous difference for everyone..an impact on Grandma and you as the caregivers!!The professional care is usually excellent and the respite care they offer can be helpful as well.

    We have a similar stroy. Last June my Moms mother was diagnosed with lung cancer. My Mom is an only chld and she has just taken my Grandma into her home.They live in PA and I am in TN. I hope there are ways to help long distance and I am going to try to garner resources for themm. After all that is an area we nurses excell in.

    Keep looking up!! Feel free to write to me at Darlazaon@aol.com
  5. by   bunky
    Thanks Darla! My Dad did teach me some very important lessons. And what a coinky-dink as today would have been his birthday! I like to think he is looking down at this and realizing he did something right!
  6. by   askater
    Thanks for all the nice comments. We have a nice group of nurses here.

    I used to work on an Oncology unit. I know an excellent Oncologist. Grandma will be here soon, and I'm sure she'll like this Dr. And being close to her family.

    I just wanted to thank everyone for their support. If I need any more support, I'll know where to turn. THANKS A LOT

    [This message has been edited by askater (edited August 03, 2000).]
  7. by   LLDPaRN
    There will be a series on PBS in September--"On Our Own Terms: Moyers On Dying". It looks like it will be a very interesting program. I thought this would be a good place to post the info. The series starts Sept 10 at 9pm (EDT) and runs for 4 nights. It has been very educational for me, reading all the posts about death, dying, palliative care, etc.
    Just to add a quick story, I recently had a patient who was diagnosed with head and neck cancer after she was hospitalized for a stroke. When she was d/c'd from the hospital, she was referred to hospice but her daughter had decided not to tell the patient of her prognosis, feeling it would cause the patient to lose hope. While it was awkward at first,not being able to tell the patient she was on hospice (she had some dementia as well), I dealt with it and actually enjoyed going to see this particular patient. As it happened, she had two nasty wounds on her legs, so during my first visit, when the patient asked why I was there, I told her the doctor had asked me to come and see her because of the leg wounds and she seemed very accepting of that. When she died (approx 3 weeks ago), her daughter was very much at peace, feeling as though her mother had lived a good life and was "with the angels".

    Just my $.02 worth!

    Laurie
  8. by   darla80
    Originally posted by LLDPaRN:
    There will be a series on PBS in September--"On Our Own Terms: Moyers On Dying". It looks like it will be a very interesting program. I thought this would be a good place to post the info. The series starts Sept 10 at 9pm (EDT) and runs for 4 nights. It has been very educational for me, reading all the posts about death, dying, palliative care, etc.
    Just to add a quick story, I recently had a patient who was diagnosed with head and neck cancer after she was hospitalized for a stroke. When she was d/c'd from the hospital, she was referred to hospice but her daughter had decided not to tell the patient of her prognosis, feeling it would cause the patient to lose hope. While it was awkward at first,not being able to tell the patient she was on hospice (she had some dementia as well), I dealt with it and actually enjoyed going to see this particular patient. As it happened, she had two nasty wounds on her legs, so during my first visit, when the patient asked why I was there, I told her the doctor had asked me to come and see her because of the leg wounds and she seemed very accepting of that. When she died (approx 3 weeks ago), her daughter was very much at peace, feeling as though her mother had lived a good life and was "with the angels".

    Just my $.02 worth!

    Laurie
    Thanks for the Moyers documentary series info. I have marked it on my calendar!!

    I hope many others wil do the same!! You are right there are some great nurses on these post boards!!

  9. by   aikmanj
    I agree that a person should be allowed to die peacefully and not go through a lot of heroic measures to prevent what is the final outcome. Where I have worked, it seems that the length of life is more important than the quality of their life. Unfortunately it is the families and not the patient that makes these choices sometimes.
  10. by   soundsLikesirens
    There is a lady on our unit that I would like to describe her situation (without violating confidentiality, of course.) She's been there 2 months - 37 years and and dying of cancer. There's no question that she's dying - except that her husband is in major denial and so is her "doctor". She hasn't had adequate pain control all through her stay - first her husband refused her pain meds, now she's got a PCA pump but guess what - she's not alert enough to use it. And the husband won't push it for her. She has suffered terribly. When I left work yesterday morning, the concensus was among us nurses that she wouldn't last the day...she looked horrible. But her "doctor" was still clinging to hope...even though she has no gag reflex...it's SO obvious. She needs a morphine drip instead of a PCA but he wouldn't give it to her because "I don't think she's in pain..."....also, she has dressing changes BID but is losing so much fluid; her bed stays wet between changes...they should never have removed her post-surg drains, even with the risk of infection, because she's never stopped gushing fluid. (When she came into the hospital, she was already eaten up with cancer. Medical care was withheld from her but that's another story.) I told her doctor that her bed is staying wet between dressing changes and can't something be done, even putting the drains back in...his reply? "Increase the dressing changes!" I said, "We CAN'T!!!" "Why not?" asks the genius MD. "BECAUSE WE HAVE ELEVEN PATIENTS APIECE!" His solution to the problem was to tell us to go in there practically hourly and do dressing changes......oh Lord. He then said he'd speak to the surgeon about re-inserting the drains but I think he was just trying to get me off his back. I have thought about calling the unit and seeing if she's still there, still alive, but I'm afraid to.
  11. by   BethanyMaya
    Originally posted by soundsLikesirens:
    There is a lady on our unit that I would like to describe her situation (without violating confidentiality, of course.) She's been there 2 months - 37 years and and dying of cancer. There's no question that she's dying - except that her husband is in major denial and so is her "doctor". She hasn't had adequate pain control all through her stay - first her husband refused her pain meds, now she's got a PCA pump but guess what - she's not alert enough to use it. And the husband won't push it for her. She has suffered terribly. When I left work yesterday morning, the concensus was among us nurses that she wouldn't last the day...she looked horrible. But her "doctor" was still clinging to hope...even though she has no gag reflex...it's SO obvious. She needs a morphine drip instead of a PCA but he wouldn't give it to her because "I don't think she's in pain..."....also, she has dressing changes BID but is losing so much fluid; her bed stays wet between changes...they should never have removed her post-surg drains, even with the risk of infection, because she's never stopped gushing fluid. (When she came into the hospital, she was already eaten up with cancer. Medical care was withheld from her but that's another story.) I told her doctor that her bed is staying wet between dressing changes and can't something be done, even putting the drains back in...his reply? "Increase the dressing changes!" I said, "We CAN'T!!!" "Why not?" asks the genius MD. "BECAUSE WE HAVE ELEVEN PATIENTS APIECE!" His solution to the problem was to tell us to go in there practically hourly and do dressing changes......oh Lord. He then said he'd speak to the surgeon about re-inserting the drains but I think he was just trying to get me off his back. I have thought about calling the unit and seeing if she's still there, still alive, but I'm afraid to.
    Hasnt this womans doctor missed the point a bit. Even If you had time to change dressings hourly, I cant imagine that many patients( or their relatives if unable to speak for themselves) would tolerate this sort of treatment.
    Give this doctor a bit of friendly advice: -
    Do unto others as you would have done to oneself ( or whatever the phrase is, Cant fully recall it just now)
  12. by   soundsLikesirens
    Update: I went into work yesterday and asked about her...she passed away after getting her first chemo. At least she isn't suffering now...glad I wasn't there when it happened as her children were there and very upset.
  13. by   darla80
    Originally posted by soundsLikesirens:
    Update: I went into work yesterday and asked about her...she passed away after getting her first chemo. At least she isn't suffering now...glad I wasn't there when it happened as her children were there and very upset.
    Dear Sounslikesirens

    I am glad you were able to go to work and ask about the patient. Sometimes it is very difficult because we care... but then again it is our ability to care about our patients and view them as "people" not just"patients" that makes us such EXCELLENT nurses!!

    I do think many times physicians have to distance themselves to stay in the field but there is NO excuse for the scenario you described.

    It is good that patients have nurses as advocates.

    Stay sensitve yet protect yourself... you sound like a GREAT NURSE!!!!

    Joy and Smiles to you!! **Darla**


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