When care equals Torture

  1. 19 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. "

    http://www.washingtonpost.com/opinio...R_story_1.html

    A similar article by the same author:
    http://www.washingtonpost.com/wp-dyn...010902298.html
  2. Visit  MunoRN profile page

    About MunoRN

    MunoRN has '9' year(s) of experience. From '.'; Joined Nov '10; Posts: 5,934; Likes: 12,344.

    32 Comments so far...

  3. Visit  Altra profile page
    1
    Excellent columns, both of them.
    annmariern likes this.
  4. Visit  EMSnut45 profile page
    13
    I cannot "like" this enough!!

    The public needs to hear this, and it isn't a pleasant discussion.

    Maryland is in the process of instituting the MOLST form, which will combine the advanced directive with the EMS DNR form. All the information will be in black and white for all chronically cared for patients (nursing home, assisted living, home care, etc.) and a permanent part of the medical record. It is finally forcing the PCP's to bring the subject up. As a result, I am seeing many more DNR/DNI's come through our unit.

    I have sat through family meetings where the family states they want everything done to save their 95 year old fraile grandmother, but once we explain exactly what CPR and intubation means, they quickly change their minds. Recusitation isn't what's on TV, and that is all the public can relate to.
    Woodenpug, imintrouble, GrnTea, and 10 others like this.
  5. Visit  bds165 profile page
    3
    We need to plaster these articles in every hospital room across the country. Thanks for sharing.

    BTW, I love your profile picture, MunoRN. "Cannonball comin'!!!!"
    lindarn, leslie :-D, and nrsang97 like this.
  6. Visit  IEDave profile page
    1
    Interesting - basically the same point that that I tried to make here on my very first post (tried to give an "attagirl" to the nurse who had to stand by and do nothing, and give kudos to the families that walked this particular fire) but got my a$$ reamed by one of the local know-it-alls for it.

    Tip of the hat to you all - hypocrites.


    ----- Dave
    lindarn likes this.
  7. Visit  MunoRN profile page
    4
    Quote from IEDave
    Interesting - basically the same point that that I tried to make here on my very first post (tried to give an "attagirl" to the nurse who had to stand by and do nothing, and give kudos to the families that walked this particular fire) but got my a$$ reamed by one of the local know-it-alls for it.

    Tip of the hat to you all - hypocrites.


    ----- Dave
    Sorry about your first-post-experience Dave. From what I saw you got 13 Kudos and even a re-post, the mother of all kudos. If your post was 'reamed' that's unfortunate and didn't appear to reflect the majority of AN.
    LPNnowRN, Esme12, annmariern, and 1 other like this.
  8. Visit  leslie :-D profile page
    16
    Quote from bds165
    We need to plaster these articles in every hospital room across the country.
    these cruel and inappropriate "full codes", have always been the bane of my professional existence.
    they truly are a form of torture for those who are ready to die.
    family members/poa's/physicians don't keep these folks alive because we all know that "life is precious".
    they/we keep them alive because WE (we we we we WE) are the ones who fear dying, not the suffering pt.
    i've seen so much projecting from those who personally struggle with death and dying...
    whether it is guilt or fear, these decisions are never/seldom made for the benefit and well being (and wishes!) of the pt.
    we treat others as we would expect to be treated - and if our families really loved us, they would continue fighting for our lives...right? :-|

    just a couple of days ago, i told both my husband and son, that in event i ever am deemed incompetent to make decisions for myself, that i am considering asking my son to be my mpoa...
    as he would honor my wishes, where i fear my husband would do everything humanly possible to 'fight for me'.
    our (western) society does everything to avoid death.
    even when our loved one is terminal and suffering, we convince ourselves that our decisions (to extend life) are altruistic and noble.
    we delude ourselves and ea other, when we insist on every available intervention to sustain their 'precious' lives.
    the greatest gift we could give our (dying) loved ones, is to concede death as the precious gift...
    enabling our loved one to die with 'merit and majesty', by acknowledging this necessary journey when it is our time to die.

    acknowledging and celebrating one's life, including its beginning...and its end...is the greatest gift of all.
    it is selfless, it is truthful, it is compassionate, it is love.
    dying shouldn't have to be considered torturous, and it is within our abilities to change.
    in doing so, we give peace to the dying, and to ourselves...
    as it should be.

    leslie
    Woodenpug, Scarlette Wings, KT17, and 13 others like this.
  9. Visit  MunoRN profile page
    10
    Quote from EMSnut45
    I cannot "like" this enough!!

    The public needs to hear this, and it isn't a pleasant discussion.

    Maryland is in the process of instituting the MOLST form, which will combine the advanced directive with the EMS DNR form. All the information will be in black and white for all chronically cared for patients (nursing home, assisted living, home care, etc.) and a permanent part of the medical record. It is finally forcing the PCP's to bring the subject up. As a result, I am seeing many more DNR/DNI's come through our unit.

    I have sat through family meetings where the family states they want everything done to save their 95 year old fraile grandmother, but once we explain exactly what CPR and intubation means, they quickly change their minds. Recusitation isn't what's on TV, and that is all the public can relate to.
    We have POLST forms in my state but I still find it underused. Reimbursing MD's for having this discussion, which in some cases can easily last an hour, would be a good step in helping encourage these conversations to happen. An attempt was made to do just that but it was termed "death panels" and has since been removed the affordable care act.

    As 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.
    canoehead, Esme12, GrnTea, and 7 others like this.
  10. Visit  merlee profile page
    3
    I got lucky - - my dad didn't want a feeding tube, he just wasn't hungry and wouldn't eat. He just wanted to be free from pain. We started him on morphine on Wednesday, Thursday he was unresponsive, Friday he was gone. Mom died in her sleep, a little unexpectedly, but not completely. No decisions.

    These decisions are so hard on the family. So hard.
    LPNnowRN, imintrouble, and lindarn like this.
  11. Visit  Pixiesmom profile page
    2
    Thank you for sharing.
    imintrouble and lindarn like this.
  12. Visit  VivaLasViejas profile page
    11
    Beautifully 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.
    Woodenpug, LPNnowRN, Esme12, and 8 others like this.
  13. Visit  annmariern profile page
    6
    so 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?
    Lovely_RN, GrnTea, wooh, and 3 others like this.
  14. Visit  tokmom profile page
    1
    Both 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!
    ohioSICUrn likes this.

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