Death With Dignity?

BethanyMaya · Nov 17, 2000

Originally posted by soundsLikesirens:
There is a lady on our unit that I would like to describe her situation (without violating confidentiality, of course.) She's been there 2 months - 37 years and and dying of cancer. There's no question that she's dying - except that her husband is in major denial and so is her "doctor". She hasn't had adequate pain control all through her stay - first her husband refused her pain meds, now she's got a PCA pump but guess what - she's not alert enough to use it. And the husband won't push it for her. She has suffered terribly. When I left work yesterday morning, the concensus was among us nurses that she wouldn't last the day...she looked horrible. But her "doctor" was still clinging to hope...even though she has no gag reflex...it's SO obvious. She needs a morphine drip instead of a PCA but he wouldn't give it to her because "I don't think she's in pain..."....also, she has dressing changes BID but is losing so much fluid; her bed stays wet between changes...they should never have removed her post-surg drains, even with the risk of infection, because she's never stopped gushing fluid. (When she came into the hospital, she was already eaten up with cancer. Medical care was withheld from her but that's another story.) I told her doctor that her bed is staying wet between dressing changes and can't something be done, even putting the drains back in...his reply? "Increase the dressing changes!" I said, "We CAN'T!!!" "Why not?" asks the genius MD. "BECAUSE WE HAVE ELEVEN PATIENTS APIECE!" His solution to the problem was to tell us to go in there practically hourly and do dressing changes......oh Lord. He then said he'd speak to the surgeon about re-inserting the drains but I think he was just trying to get me off his back. I have thought about calling the unit and seeing if she's still there, still alive, but I'm afraid to.

Hasnt this womans doctor missed the point a bit. Even If you had time to change dressings hourly, I cant imagine that many patients( or their relatives if unable to speak for themselves) would tolerate this sort of treatment.

Give this doctor a bit of friendly advice: -

Do unto others as you would have done to oneself ( or whatever the phrase is, Cant fully recall it just now)

soundsLikesirens · Nov 19, 2000

Update: I went into work yesterday and asked about her...she passed away after getting her first chemo. At least she isn't suffering now...glad I wasn't there when it happened as her children were there and very upset.

darla80 · Nov 19, 2000

Originally posted by soundsLikesirens:
Update: I went into work yesterday and asked about her...she passed away after getting her first chemo. At least she isn't suffering now...glad I wasn't there when it happened as her children were there and very upset.

Dear Sounslikesirens

I am glad you were able to go to work and ask about the patient. Sometimes it is very difficult because we care... but then again it is our ability to care about our patients and view them as "people" not just"patients" that makes us such EXCELLENT nurses!!

I do think many times physicians have to distance themselves to stay in the field but there is NO excuse for the scenario you described.

It is good that patients have nurses as advocates.

Stay sensitve yet protect yourself... you sound like a GREAT NURSE!!!!

Joy and Smiles to you!! **Darla**

mustangsheba · Nov 19, 2000

Bunky: I just this morning discovered this conversation. Pain management both chronic and dying are special interests of mine. Twenty years of dealing with families and doctors have just made me more determined, but it's one step forward, two steps back as the governing agencies become increasingly paranoid about addiction. We must remember that MOST medical students are quite young and, let's face it, impressionable. By the time they become licensed physicians they have a lot of theory but very few have any real life experience. And they would be the last to admit to that. I have worked with some MDs who had understanding and compassion and, of course, I have had my share of those other ones. The good ones have outweighed the bad, but when we have one patient that has to suffer, it leaves an indelible impression. I don't work in the ER because of the predominant focus on "saving" everyone who comes in the door. In my experience, patients who are in pain have great difficulty in dying; pain is a stimulant. As someone mentioned previously, once a level of comfort is achieved, patients can relax and let go. I don't worry about being accused of overdosing as long as respirations are not

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ktwlpn, LPN · Dec 22, 2000

Originally posted by bunky:
What happened to this concept? I am NOT advocating euthanasia. I am however advocating that we take a close look at what we are currently participating in when we keep chronically ill, multi problem, end stage patients in a hospital without any hope of improving their quality of life many times doing more to add to the suffering of their death than to the quality of their life. Is anyone else out their seeing this? What have we accomplished when we admit an elderly person whose life consists of lying in a bed, unable to speak or respond to anything but painful stimuli with more than a blink? Unable to eat, or drink or sustain themselves in any way except breathing. Their quality of life is not one that any of us would wish to live. If you asked the family, I feel certain that they'd agree that they themselves would not like to be in this condition either. What are we accomplishing when we care for these patients beyond comfort care? I have to stress that I myself could not EVER administer a medication that would end a life. I couldn't live with myself. But what I am speaking of is not even about witholding basic life sustaining treatment such as IV fluids. It is the pervasive practice of sending these people for invasive procedures even surgeries, inserting tubes in every orifice, and subjecting them to blood test after blood test as though we are looking at curing them when we know it is not possible to do so. More importantly what do you feel is the motivation for this prolongation of a death? Is it all the family? If so, do you think it is an uniformed choice made by the family or a display of too much trust in medicine? Is it the physician? Where do we as nurses fit in this familiar picture?

I am very interested in what everyone else has to say on this subject, and if any one else has a problem with seeing this like I do.

It has become clear to me over the years that since most physicians I have come into contact with were unable or unwilling to deal with these issues that it is our duty as nurses to help the patient and family members accept the impending death of a loved one whenever possible.I think it is most important that we talk openly about death and dying-it should not be such a taboo subject.But how do you deal with ignorance without burning out? " I don't want Momma to starve to death" is a phrase I have heard dozens of times-and get chills down my back every time...Momma may be 96 and bedridden,blind and deaf-and in considerable pain-but some folks just don't get it.And it is a personal thing-both of my parents died of cancer relatively young(50 and 67)-when I see an 88 yr old going out I want to rejoice that the family had each other for so long-and make sure the death is as painless as possible.And call me a communist-I think the time will come that controls are put in to place to stop the health care system from pouring millions of dollars down these black holes-how many times should we hospitilize and treat aspiration pneumonia in an eldery pt. with a living will stating no artificial feedings?