When care equals Torture - page 3
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... Read More
0Feb 20, '12 by nursemarionVery kind of you. I just hate it when I hear nurses say things like "It would be a blessing if he would just die". Things like that. It is never a blessing to die and letting go of a loved one is exquisitely painful. I am sure nurses thought that about my mother in her darkest hours.
In hospice you learn a lot about family dynamics. You get to see how a person lives and who they are. That is a special gift. I was a hospice nurse myself for three years. And I never saw any patient who was ready to die or anxious to die. I never heard another hospice nurse say that someone needs to just die. Hospice in the right spirit values life, making time count. I mentioned death and dying to my patients when I was in hospice nursing but mostly we talked about life. How to enjoy best the time that is left. Death always comes in time whether you focus on it or not.
I do agree that there are times, and I have seen them, when a person has outlived everyone and has no one, no independent functions, no higher thought process left. Tubes, decubiti, immobility, pain. This becomes their life. Those times I wonder why, but it is not my place to decide, so I try to keep them as comfortable as I can and put it in God's hands.
2Feb 20, '12 by jbluehorseh
this is a sad state of our society in so many case we only prolong life as the quality is diminished. over the years of my career i have seen people’s life being over extended to point where the life before you is just a hollow shell of life. i truly believe quality of life more is important life itself. life is meant to be experienced and not to simply to exist.
over the weekend i cared for an elderly woman who was admitted for an infective decubitus ulcer onher coccyx it was the size of a hand. she also had may other bed sores. on topof that she had other medical problems, she was demented, almost completely death,blind. every time i had to move her was met with a fight, i can’t imagine the fear and pain she must be going through. just having to change her foley catheter took three people two hold her down and on to place it in, the alternative was to leave it out and have the urine soak the wound making a bad situation worse if that was possible. i had a change her dressing and for the first time in my life i contemplated passing out form the sight and smell; this brown puss pooling and hanging rotten flash in the wound. i could not help to ponder how many people it was going to take to hold this patient down for the picc line for the day. the plan of care was to debrisher wounds and gives antibiotics. if this patient did not have any other major problems healing and recovery would take a better part of a year. i doubt she will make it a month, but yet we aredoing everything we can for her, every hour spent in pain,confusion and torcher. so iam conflicted in what is being accomplished for this patient and the morality in prolonging this life. i have written about life, death and what is right before, but it never hits home more when you see it up close and the smell of all of it permeates your scrubs.
Last edit by jbluehorseh on Feb 20, '12 : Reason: spelling
11Feb 20, '12 by nerdtonurse?I've had patients mouthing "Please let me go" around their vent tubes -- folks who weren't in restraints anymore because they were so weak they couldn't possibly pull out their lines. While the family was too "upset" to see what their family member was having to live through to come visit, but wouldn't let us put them on hospice. Pt was on a vent for almost 3 months before they died of sepsis, kidney failure, heart failure, and inability to take any more chemo. And we coded them.
I've seen a PEG tube put into a 104 year old dementia pt who was fetally contracted -- because of the leeches living in her house, who wanted that monthly check to keep coming, and the doc said they could probably get another 6 checks -- er, months -- out of her. Died of aspiration. I can still hear the bones snapping as we tried to get her body flat enough to do compressions on.
I've seen people with gangrene, decubes the size of dinner plates, people with an EF of 15%, all while the family demands we do everything -- while they were arguing over who was going to get the car, who was going to get the truck, and who was going to get the house, an who was going to "stay with maw maw" because they weren't going to have the nursing home "get everything." And you betcha, we had adult protective services called on that one. And because of their last name, nobody did anything, and back home she went. I hope not a blade of grass ever grows on that farm from now to the end of time.
I have sat in my car after work and cried, praying, "God forgive me for what they're making me do."
We have the capacity to keep a body alive, but not the capacity to keep a person "living."
5Feb 20, '12 by Esme12, BSN, RN Senior ModeratorQuote from nursemarionI am so sorry for your loss . I lost my Dad a couple of years ago... missing them never goes away but it does get hurt less eventually.....I promise.
Very kind of you. I just hate it when I hear nurses say things like "It would be a blessing if he would just die". Things like that. It is never a blessing to die and letting go of a loved one is exquisitely painful. I am sure nurses thought that about my mother in her darkest hours.
I do agree that there are times, and I have seen them, when a person has outlived everyone and has no one, no independent functions, no higher thought process left. Tubes, decubitus, immobility, pain. This becomes their life. Those times I wonder why, but it is not my place to decide, so I try to keep them as comfortable as I can and put it in God's hands.
I think every ICU nurse knows of these patients that the family refused to acknowledge the inevitability of the situation. Tubes shoved in every orifice and a few man made ones as well. Generalized anasarca, sclera so edematous that their eye lids cannot close. The family demanding that their loved one be saved. I have wondered at times if they really LOVED this person so much that it's too painful to let them go or they were intending to torture them to pay them back for a terrible childhood. I remember when my father coded as I slept at his bedside beginning God to let him live yet praying to not let him suffer all those horrible things that we as medical people can inflict. Dad did survive the code but did not return to us, so we removed him from life support. (miss you dad)
I have had to remove a child from life support after fighting like a mad woman to save her and place her in her mother's arms to "officially" die.(thinking of you angel) I have gone into harvesting with a patient because I told his family in Mexico he would not be left alone. I have been angry that the child is dying and the 90 year old survived the code. I have seen an Oncologist stand at the bedside of a patient in Status Epilepticus with an inoperable grade 4 astrocytoma and wonder why the patient is seizing.....being sure it was hypoxia. I have seen a surgeon take a 90 year old into open heart just for the fee.
I agree with Leslie. I think as a society, with all these medical advances, we have been made to believe that death isn't a part of life anymore. That there are times that letting go is the best thing to do. Quantity is not quality. We are more humane to our pets as we love them too much to let them suffer, and we put them to "sleep" to place them out of their misery. At times I have felt we are better to animals than we are to other humans.
I think that in some ways we have gotten better at letting patients die with dignity and then other times I really miss those "slow codes" when we just went in and shut the door.......for even in doing that we did what was best for the patient and didn't have to force the family to agonize over a DNR and "letting them die".
In my state the do have what is called a "comfort care order" which allows EMS to acknowlege a DNR.....and it works well when it is used by the MD's. http://www.mass.gov/eohhs/provider/g.../comfort-care/Last edit by Esme12 on Feb 20, '12
1Mar 20, '12 by Scarlette Wingsas a side note, it looks like i've already been relegated to the relative wasteland of "nursing news". is it just me or have threads been moved out of the general nursing discussion really quick lately. it would be nice to be allowed a spot in the general nursing discussion for more than just a few hours before it gets essentially filed away.
i think it is part of the present day theme of emails and short texts and any topic that lasts longer than an hour seems "old news."
2Mar 25, '12 by aznurse1Thank God someone is able to articulate these things in such a precise manner. When I complain about this, the feedback I get is, "maybe it's a time for you to find a new job, you're burned out."
Really? Well, yes, maybe I am burned out from working with the family members who are frantically trying to induce more active care for their 90 yr+ family member. I work with mostly geriatric patients, and if I had a dime for every family member who told me that, "you are not doing enough," I would not have to work anymore.
I think we have an obligation to protect patients from the scenario described in the above columns. I don't think it should be the choice of the family!! Call me radical, they don't know what they are choosing, they don't have to deliver the consequences.
If the family makes the choice to prolong the dying process, then let them deliver the torturous care that they want for the patient.
2Mar 25, '12 by EMSnut45, ADN, RN, EMT-PQuote from aznurse1Yes, I hear that exact response as well. It only makes me feel worse. The people who respond with that are not the ones who provide the bedside care to these patients. It's the support staff (chaplain, case manager, social worker, etc.) and my family. I wonder what their feelings would be if they had to provide the "torture" to these patients.When I complain about this, the feedback I get is, "maybe it's a time for you to find a new job, you're burned out."
I recently cared for an elderly patient who had not eaten (per the family) for three months due to low appetite, nausea, vomiting, and abdominal pain. The patient was so malnurished that they had 4+ pitting edema and weeping all over. Pretty much every organ system was failing, and the CT scan showed abcesses vs mets throughout the abdominal cavity. Anyone with any medical knowledge knows that a healthy person would have difficulty recovering from a large abdominal surgery let alone multi-system organ failure. But this patient was going to have to overcome these with baseline extreme malnurishment and overall low reserve. Did the docs ever speak of this with the family? Of course not! They wisked the patient off to surgery and the patient continues to do poorly. It would have been totally appropriate to have sat down with the family prior to surgery and explained the situation, ask what their ultimate goals were, and explain that their loved one was most likely not ever going to fully recover from this if they even made it out of the ICU. These kind of talks just don't happen often enough.
Ok... I feel better now that I have vented!