Advice needed - withdrawing life support & how to deal

dgudmestad · Jan 23, 2007

I think your perfectly normal. I've been a nurse for many years and in the ICU also. I, too, have difficulty when certain patients die. It is especially difficult if they're young. It's also hard when a pt comes in talking to you and spirals down the tubes or when you get close to the family. I think its hard when pts are near our own age because it makes us think about our own mortality. And I know after I work down in the trauma unit I am almost paranoid to drive home...and my daughter will NOT get her license until she's 50! Does it bother you more when you withdraw support? Even if your brain says you are alleviating their sugffering, maybe you feel like you are bringing about their death and have guilt? I don't know if that's the case. Might be important for you to sit down with yourself and sort out your feelings. I don't know if you're a spiritual person or not, but it has always helped me to think of withdrawing life support in this way: Man placed those machines to prolong life. All I am doing by removing those manmade machines, is allowing nature to take its course. Inevitably, we are not the ones in charge, no matter how much we would like to believe we are. If it is Gods will that he will live...he will...and if not, he will pass. In either case, my duty is to keep that patient as comfortable as possible and surrounded by those dearest to him. Many times I have cried with the family throughout the whole process. If it helps you to show your emotion, by all means, it is ok. I have found that families react positively to us when they see that we've been affected as well. I don't know if that helps... and certainly you are not alone.

Dinith88 · Jan 23, 2007

Hey everyone!
I am a new grad RN and I'm working in a 25-bed MICU at a university hospital system. I LOVE my job and am done with orientation next month - WOOHOO! :) I am nervous but excited at the same time - I work with a very supportive, helpful staff.
I wanted to ask for some advice, though, because these past few weeks I have come across my first real bump in the road as a new nurse, and I'm just kinda struggling with it. The past few weeks on my unit we have seen many very young patients, like my age or younger, die. Most have been withdrawal of life support situations, but it's been hard on everyone. I took care of a couple of these patients, and it's still on my mind. Does anyone else feel this way? Is this normal? I worked in an open heart SICU as a tech before graduation and witnessed several codes and many deaths there. It's not like this is new, but being the nurse resposible for a dying patient IS new and very emotional for me. Sometimes I worry about my family now, and worry that they will die a traumatic death like some of these patients. I am feeling much better this week and I did fine two nights ago when one of my DNR patients with pulmonary fibrosis was dying...I was okay afterward, too. I love what I do and my preceptor says I am doing fine. I don't want to change areas, but I didn't think I would be hit this hard. Any advice on how to deal with this more effectively?? I would really appreciate any words of wisdom. :)
Thanks everyone.

It sounds like you're emotionally 'together'...as these feelings are normal and you're able to recognize them.

If you are a nurse (especially critical-care or ER nurse) you'll never get away from tragedy. This is an aspect of our profession that seperates us from everyone else. It's a cause of burn-out, accelerated aging, ulcers, anxiety and hypertension :) but...it also forces us to keep things in perspective...makes us appreciate life...and seperate what is really important from what is not. (You may have to force yourself to see it this way sometimes...)

And...you'll find your own 'method' for dealing with this stuff eventually. (If not, you're in for a short and/or awful career in ICU.) Just make sure to avoid the unhealthy ones.

nurseuser · Feb 13, 2007

Nicely put.

gradcare, LPN · Feb 21, 2007

It can be sad when you "let patients go". Most people feel bad whenever they are present when the choice is made to "let go". Me I try to focus on giving the patient back to the family and returning them their dignity which can get stripped away a little in the rush to try and save their life. I still feel bad when they die but I also take a little satisfaction in the little things like obtaining hair / footprints or hand prints for those who are "left behind". Personally when I stop feeling bad or sad then I think it is time for me to change and do some other type of nursing......clinics perhaps.

chris_at_lucas_RN, RN · Feb 21, 2007

Exactly--I agree when we stop feeling sad/bad at the suffering or death of our patients, we need to go do something else, at least for a while.

As a hospice nurse, I was confronted right away, not with removing of artificial supports, but with the end of one life and the changing of all the others around that life. I saw amazing transitions, and I realized that part of my strength lies in having made peace (mostly) with my own mortality and having developed a settled and comfortable belief about what happens, for me, next.

When it is helpful, I share a little (or some) of that with my clients and their families. When it is not, I just stand still and strong, and give them what I have that they can use. At the end, I can feel very good--I limited or eliminated suffering. I comforted. I made someone's day better. I gave something from deep inside myself that will be carried by someone else and passed along who knows how many times.

And I recall the advice of Carl Whitaker, a family therapist early in the development of that field, who, when asked about avoiding burnout, said, among other things, hold a baby, be good to yourself, seek out the support and ear of others, and lend your own.

And I hug my sister and my dogs a lot.

Good for you to be in this work, and even more good for you that you are thinking and feeling as you are. What a wonderful addition you are to our profession.

Trauma Columnist · Feb 21, 2007

Ten years in the ER and I saw every imaginable death - it was very traumatic for me too. What helped was being able to vent with staff. I still worry about my family but have learned to distance myself a little better with time. Please take care of yourself so that you can help others. That was the best piece of advice I've ever received.

LadyNASDAQ · Feb 22, 2007

I've been in Nursing 28 yrs where 25 have been in ICU/CCU. I can tell you that it is a very sad day to see young people code and die. Very frustrating but I have to tell you that you may NEVER be conditioned for this at all. You may just wnt to walk away and cry but as time goes on, you learn to accept and to be supportive to family and friends.

It's out of your hands sometimes no matter what you do. Just keep your professional distance and lend support. Later on you can cry.

ro'naeirann · Feb 22, 2007

Dear Peachy,

I have been a hospice nurse for 6 years and it is never easy to watch someone die everyone is loved by someone in saying that it is harder with younger people. I still cry sometimes and i have been through this many times. Being sad is only human and caring that is ok. what makes me feel better sometimes is i like to ask myself if the patient is really living or is just suffering and alot of times the latter is true . Their physical body is there but they are not truly living only existing. it never gets easy but it does get easier to deal with. Good luck

suetje · Feb 27, 2007

As degudmestad said...we all have inner conflicts occasionally about withdrawl. I also have been a nurse in the ICU for many many years, and in addition, my Father recently fell and sustained a subarachnoid hemmorhage and died from increased ICP. Unfortunately, he was in respiratory distress, (with DNR) and I requested the docs to write for a morphine drip. They did, but the staff was so hesitant to turn it up...'You know, he had some apnea earlier." What the HECK do they think is going to happen ultimately??? Same thing with my pts. The dying process is very hard not only on the patient (and therefore the Society of Critical Care Medicine has started to define end of life issues.) and on the family. The family deserves to be able to be around the pt in their last moments, WITHOUT seeing them gasp and be in pain. My Mom was so shook watching my Dad that she couldn't stand to sit there. It was horrible! So even though we may feel like we might be 'acting to shorten life' we are merely letting these people have a death with dignity and without discomfort. It seems most humane to me and after what i witnessed, I KNOW my Dad would have wanted to be more comfortable than he probably was. THAT is caring, in my book! I have also never had a family tell me they were unhappy with doing things this way.

LuvMyGamecocks · Feb 28, 2007

I lost my grandfather this past Thursday (2/23). He was 73, had COPD, a recovering alcoholic (had been clean 20+ years), diabetic, arthritis....

The ICU nurses worked feverishly (and I really mean FEVERISHLY) to take care of him right up until we pulled one aside and begged her to call the doctor to just stop. She knew the critical state he was in (the doc said he had a 1% chance of pulling through, but only b/c his mom taught him never to say never), but she worked and worked and worked (and worked) until we pulled her aside. She was very respectful, very informative.

A few things...after calling the doctor, she asked up to step out of the room so they could remove all of the 15 IV lines and the NG tube. She told us the reasoning for leaving the vent in when we returned. When we returned, there were 6 chairs for family around the bed, no IVs, no beeping, just the vent. He passed peacefully 2 1/2 hours later. After he passed, the nurse kicked us out again to remove the vent and clean him up. She brought us back in and told us to take all of the time we wanted. We sat there and mourned together as a family in the ICU without all of the "stuff" going into him. An hour after he passed, we left together as a family.

In the week before all of this, this nurse told us to ignore the scheduled visiting times. We stayed hours at a time and never a word was said.

I wanted to be an ICU nurse before this, but this only validated it for me. The thing to think about is "What would I want for my family if it were me?" I would want to see them whenever I could, regardless of scheduled visiting times. I would want some time without all of the IVs before they passed.

The fact that you are concerned about this says a LOT about you. Thank you for that concern.

ICU_floater · Mar 1, 2007

well 12 years in, you'll find some deaths you can deal with, some take hold of you and stay with you for no reason. It could be a 15 yr. old trauma today, a 90 yr. old tomorrow. So I'm not going to tell you it gets any easier. I've grown to the point where I'm ok to be professional, efficient and then grieve or even cry with family after. I'm ok where I'm empathetic, sympathetic but not moved to ponder after. I've just let the feelings exist when they do. If I'm frustrated over not being able to do anything more to change outcomes, I then focus on changing the outcomes of the families death experience and nurse the family. For me this helps.