When care equals Torture - page 2
by MunoRN, ASN, RN | 5,937 Views | 32 Comments
I thought this article did a good job of describing what many of us in healthcare deal with on a regular basis. "At a certain stage of life, aggressive medical treatment can become sanctioned torture. " A similar... Read More
- 11Feb 19, '12 by VivaLasViejas, ASN, RN GuideBeautifully and wisely stated, Leslie, as usual.
During the course of my career thus far, I've seen only two people die who truly were not ready to go......who feared death for reasons known only to them, and sheer terror was in their eyes as they were overtaken by the darkness of the great unknown. I have often wondered why they were so afraid, and what---if anything---they saw as the life left their bodies.
The rest, however, have been not only ready, but willing. They were worn out; their bodies, and in many cases, their minds, had given up the ghost long before their souls followed. Most have enjoyed long and fruitful lives and, like tired but trustful children, known that it was time to leave the party and "go home with the one who'd brought them", as one 94-year-old said to me just before she died of kidney cancer. Some have had families who wanted everything done to keep them alive as long as possible, although to what end differed with each situation.
With one memorable family, it was sheer greed---as long as Grandma was alive, they could live on her money and use her property, all of which was to be given to her church upon her death. She was a wreck of a human being who could not walk, talk or ask for anything; she had a feeding tube and chronic decubiti on her coccyx and heels; she aspirated and got pneumonia at least twice a year; she had brittle diabetes, was blind in one eye, and had gangrene in one leg. For the four years I knew her, she ping-ponged back and forth between the hospital and her nursing home.......no one wanted to let her die on their watch, because we knew the family would sue. But we were not God, and finally she defied everyone and slipped away quietly while in the hospital. She was 98 years old and had spent more than a decade lying mute and helpless in a bed.
But with most, it's as Leslie said........Americans tend to believe that death is a defeat, not a natural process, and that they're failing their loved one if they don't "do everything" for him/her. I myself have asked my oldest daughter to be my healthcare POA, because I know my husband wouldn't be able to let me go, no matter how many times I remind him of the DNR order I have on file. Even at 53, I share with my elder brothers and sisters the satisfaction of having had a good run, and if something were to happen to me even now, it wouldn't be a tragedy. After all, I've been blessed with great love, a beautiful family, good friends, a strong faith, and enough material goods to make life even more enjoyable. I don't want to "go" yet......but I'm not afraid of what I'll find on the other side when my time does come.
Maybe it won't take a think tank, or a group of physicians and scientists, to change the way death is viewed by our society. Maybe our current economic crisis, combined with the crush of some 76 million Baby Boomers entering our twilight years, will be enough to make people stop and think about the wisdom of pushing costly and painful "lifesaving" interventions on those who don't want them, or when death is inevitable without them. Or just maybe, it will take nurses and patients sitting down together and talking about death, honestly and without the influence of politics and money, to show the world how things should be done for the greater good of all.
- 6Feb 19, '12 by annmariernso many pts tortured because family, usually with psychosocial issues just wont let go; one son, elderly, alzhiemer dad, fx hip, every complication you can think off; We had to intubate, put chest tubes in and well torture him...because the son couldnt make the mortgage without his SS check and said so. One finally got her 90 year old, vented, paced mother to be dc'd off a vent when we brought her in to witness the pus pouring out of her abdomen and she threw up. Great article, spot on; its time people just faced up to the fact we die; every single one of us, but when theres a choice, shouldn't we choice the "with dignity"option instead of the kids ned my money/are too crazy to face it option?
- 1Feb 19, '12 by tokmom, BSNBoth very good articles. I really do wish MD's were to the point with family members. It drives me nuts! I'm tired of pt's being able to have a buffet of choices when it comes to DNR's. Last week we had a pt that wanted CPR but no intubation or drugs. The week before it was drugs but no CPR/Intubation. Why aren't these MD's being truthful?? Buffets belong in restaurants. Not in life saving measures.
Our pt's wear purple no code bands. It used to be that if a pt had the purple band on and you found them, that was it. No heroes to save the day. Now if we run across the same situation, you have to know exactly what they want. Better hadn't do compressions if all they wanted were drugs!
- 3Feb 19, '12 by SappyRNQuote from MunoRNI am a Hospice nurse and it is really nice to see such an eloquently written opinion that mirrors how I feel. This is why I ro the type of nursing that I do. I'm just not as good at saying it bI thought this article did a good job of describing what many of us in healthcare deal with on a regular basis.
"At a certain stage of life, aggressive medical treatment can become sanctioned torture. "
A similar article by the same author:
- 4Feb 20, '12 by nursemarionIt is hard to even talk about this since I lost my mother not long ago. Thankfully she was in control of her decisions up until the end. If it had been up to me I might have had hospice a year or two before even, but she had to decide when enough was enough. Truthfully that is how it should be. None of us has the right to decide for another person, yet we are often left in that position. It is a terrible place to be in.
Months before she asked what I thought she should do, and I said maybe Hospice would be good now. She seemed shocked. A woman who had been through major close to death illnesses numerous times in the past few years, and she was a retired nurse. She was shocked. I felt awful. Why can't doctors approach these things with their patients? Why should it have to be family? I felt like I was telling her to just let go and die already. Awful. No one wants to lose their mother. I would have given her a kidney, a lung, anything to keep her. But watching her slowly lose her independence was awful too.
Dad was different, terminal cancer does not give you too many options. When chemo is not working they stop it. You must choose death. It was a hard road but a more natural one since I knew where it led and so did he. He had time to prepare.
Even when we have talks and living wills and MPOA assigned it is not easy. But those last days my mother still had not given up. She was still making plans for when she got better. After so many brushes with death you begin to think you may keep fighting it off until you are "really old". She dies at 72. Would be 73 this week.
We have to be careful not to impose our own values on others. My mother had personal work to do and her life though a struggle was important up until the end. Many people who cared for her probably thought she should have died way before she did, but she hung on for a reason. There were still people who needed her. I do not regret all the hospital stays and rehabs, equipment and work that went into her last few years. It was well worth it. She was important.
- 2Feb 20, '12 by damrcngrl95I have long talks with my mom about this. My grandma is 91 and is a pleasant alzheimer's patient. She is the last of my mom's family. All of her siblings and father is long gone. It breaks my heart for her, but I remind my mom that there are worst things than death. Thankfully she has taken my advise and will let my grandma go when it's her time. We as humans are selfish to a degree. It is hard to let the person who loved and raised you go. I wish we had less choices so this was easier.
- 4Feb 20, '12 by leslie :-DQuote from nursemarioni think it important to note, that when we speak of allowing loved ones to go, we are referring to either a very advanced age, or very advanced stage of illness.We have to be careful not to impose our own values on others. My mother had personal work to do and her life though a struggle was important up until the end. Many people who cared for her probably thought she should have died way before she did, but she hung on for a reason. There were still people who needed her. I do not regret all the hospital stays and rehabs, equipment and work that went into her last few years. It was well worth it. She was important.
i cannot envision people thinking your mom should have died any earlier than when she was ready for.
and, your mom was still young, in terms of age for dying.
admittedly, i get my shackles up when i see a terminal 93 yo being fully coded.
as a hospice nurse, i've always seen hospice as the "let's wrap this up" chapter(s) of one's life.
for many, there is still lots to do, and often, is a predictor of how much longer one will/can live.
i guess i am not understanding why "regrets" of yours, would even be a consideration.
again, she was young and all hospitalizations would seem appropriate...
especially in light of it all being her wishes.
i'm sorry if the following is a repeat:
but when i was in nursing school, towards the end, we had to shadow a nurse in the specialty we believed we wanted to work in.
i shadowed a hospice nurse for a day.
at ea and every visit, this nurse would purposely...willfully...use the word "die" or "dying" in reference to her pts.
"since you are dying, i agree you should..."
"don't worry, you'll die ok."
"you're dying - go for it."
now i know there are people who endorse such bluntness...
that we shouldn't tippy toe around the usage of this word.
personally, i winced.
and it was that day of shadowing her, where i promised myself that i would exercise more sensitivity in my interactions with dying pts.
don't misunderstand me - i have consciously used these words (die, dying) to those family members who were in total denial.
it was important that my terms were concrete and absolute.
but my poc always reflected where my pts were, in their journey towards death.
i guess my point is, there is lots of work in dying.
it is soooo not about being a passive consumer...
many pts make goals/wishlists, and set out to do them.
others just want to snow themselves until they die.
but if one is cognizant and receptive, yes - lots of work to be done (generally speaking).
and it sounds like your mom, marion, was cognizant, receptive, and proactive in how she lived...and died.
please, and i may be jumping the gun...
but no regrets.
of course your mom was "important".
i am sorry for your loss, and hope you are healing.