ICU stay before death common in the U.S.

Yup. God forbid anyone, you know, dies.

I occasionally work prn on a gero-psych unit within my employer's "healthcare system." I was working there one Sunday afternoon when one of the clients was a v. seriously demented little old lady who had recently dramatically deteriorated physically (she had come in to the unit weeks earlier ambulatory, feeding herself, interacting, etc., but was now just lying in the bed nearly unresponsive). On Sunday afternoon, she was looking so close to just "slipping away" quietly that I kept popping into her room just to make sure she was still breathing. (Needless to say, she was a full code -- probably mostly because no one had discussed this with her family -- it was clear she was not going to last much longer, in any case.)

When the med-psych doc on call that weekend came around to make his rounds for the day, I reported on this client's apparent condition and his immediate response was, "OMG, She's going to die! We've got to transfer her! She's not going to die on this unit!" (Like it makes any real difference which unit of the hospital she dies on ... And this outburst was in a loud voice, standing in the center of the unit -- I'm sure every female client on the unit was cringing in her room, thinking, "OMG, are they talking about me????") Although the unit's attending psychiatrist had been unsuccessful during the week in getting her transfered to a medical bed (she had been deteriorating for some time), this guy got on the 'phone and got one of the medical docs who owed him a favor to agree to accept her into the medical service -- only, when the medical guy came up and looked at her, he decided that a standard medical bed wouldn't be sufficient, she needed to go to the ICU. So, by the time my shift was over and I was leaving for the night, she had been transfered to ICU and they were busy putting in a Foley, central line, monitor, etc., etc., etc. And what earthly difference was any of this going to make, other than making her miserable? (And I heard she was still able to put up quite a fight, once they started trying to do stuff to her ... ) It's not like anybody was going to be able to "cure" her ...

I really hope when the time comes for any of my loved ones I have some wits about me. Of course neither of my parents will discuss "heroic" measures, neither has a will...it is going to be a mess.

Yupper. Same boat here. My parents already decided that "you don't let me die whatever you gotta do."
Joy Joy Joy...

Great article. Thanks for sharing. I like the territory this research is exploring. I externed in an ICU for a year and have seen two patients (& their families) who, I feel, would have been better served had they been referred to or went for palliative care in a hospice.

I think a portion of the issue lies with unclear code status and lack of understanding by family members when placed in these difficult decision making situations. Add to that living in a litigious society where healthcare professionals must cover their tails by performing all available tests and procedures regardless of the outcome. Working in an ICU I have witnessed many families basically giving their loved ones a "million dollar funeral". End of life care is a difficult and uncomfortable subject. I do feel as if the article posted above was a bit scewed to present this issue being caused by the current healthcare system rather than presenting it as a multifaceted problem.

if you really want to get the convo going....tell them what will happen if they DONT tell you any different

In England we had the guts to refuse admission to ICU, to put people on a DNR status, here we admit everybody, doesn't matter ......and many families do want that, not facing reality, threatening with lawyers etc, still a very strange odd culture for me, and something I don't like.

5cats

I've had that discussion with my parents, husband and kids. I've already told them about the realities of "doing everything" and how I would not want to put them through that if there was no hope for recovery or extension of BOTH quality and quantity of life. My parents agree with me and do NOT want "everything done". Then again, my dad's father suffered from dementia, lingered and suffered, and eventually died in a nursing home. My mom's mother died in intensive care due to complications of seasonal flu. They don't want either fate to happen to them and, when the time comes, I think the best way to honor them is to allow them peaceful deaths with dignity.

I would feel very afraid if my parents felt otherwise. I would, of course, honor their wishes to be best extent possible, but in the case of the inevitable---it would still be difficult. I am sorry you are in this uncomfortable situation with your folks.

And Elkpark---that doctor's behavior was outrageous. Totally outrageous.