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Denying Death As A Society

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This is not meant to invoke anger or flaming like most of my articles. It is meant to make people think. I do not mean to insult or offend. Death is programmed into all of us. It comes for all of us no matter what.

Denying Death As A Society

Now mind you this is not directed at the injured or the ones that are just acutely ill.

The tear in the eye, the holding of a hand. The cry to fight harder, live longer. These are the scenes I see every day as an ICU nurse. I can understand these thoughts and even empathize with them in wanting loved ones to live longer and to fight harder, but often these muttered words are for patients that we are denying death to.

The 94 year old lady with multiple bedsores who has dementia and a whole host of medical problems, that any of which, could kill her at any time. The poor old man who has spent the last 20 years in a nursing home unresponsive to any stimuli due to a massive stroke. The heart failure patient who cannot support their own blood pressure, now we have to give harsh drugs and chemicals just to keep their heart beating, not responding in any manner to their loved ones.

These are many of the people that are kept in that state between alive and dead in my ICU. These are the people that death would be a comforting end to their struggles and problems, would bring an end to the pain and suffering they have. But yet, we as a society deny this to these people.

We say keep them alive, do everything possible, save them, Don't you dare let them die. Thirty years ago these people would have been allowed to die with dignity, to have some peace after suffering so much, but now in today's society we cannot allow death to occur. Many feel that we have to keep granny, or great uncle or mamma alive no matter what. Let me tell you something though. YOU ARE NOT DOING THEM A FAVOR!

As nurses we see it every day, people that we know are not going to make it. We talk to the families as healthcare providers and advocates. We tell them the truth, but somehow they still don't listen. They still don't accept the fate that will happen. I am not talking about uneducated people either. Many times these people have very high degrees and are extremely knowledgeable in their fields. Yet they still insist that in the face of contrary evidence and teaching that their family member is going to live no matter what we say or do.

I understand that they love them and are in a state of denial, but many times that state of denial has lasted YEARS. These are patients that have had major life threatening illnesses for many years, and are now getting progressively worse rapidly. Let me tell you, as a nurse and person, it sucks the soul out of us and robs us of our humanity to see this much suffering daily and much of it to no avail, and yet we have to continue it.

Too many times have we seen the cries and anger at us to keep someone alive when the kindest thing would be to let them die peacefully. To let them have dignity in the end, but no, that cannot happen. We all have seen too many TV shows where the person comes in practically dead to the hospital, and the wonderful doctors at the very last minute save the day and the patient walks out into the arms of their happy family. Let me tell you, it does not happen that way.

Here is what is going to happen to you: your family member will be taken to a room in the ICU, we are going to stick many, many needles in the arms and legs of your loved ones, we are going to rob them of their dignity, even though we try not too. People are going to come in and see them undressed, laying there after we stick tubes in literally every body cavity possible. There are going to be tubes going in the bladder, the rectum, the throat, into the nose even. None of these tubes are comfortable, and actually can hurt going in. We will stick IV lines into the neck, the chest even the groin. We are going to give harsh drugs that have massive side effects in the hope of keeping them alive. We will have someone like me, a 6' tall 300 lbs guy crush their chest with almost all of our might when their heart stops. Let me tell you the feel of ribs cracking under our hands is not something easily forgotten.

Great now we saved that 90 year old patient eaten up with cancer, Now let's put a tube poked through their stomach to feed them since they will more than likely never be able to enjoy a meal again. Lets cut the throat and put in a trach. That is a tube so that we can hook them up to a ventilator for the rest of their lives because they cannot breathe on their own anymore. You will never be able to hear them say I love you again.

Let's give drugs that when given long enough, will cause their hands and feet to rot off, or will cause their kidneys to fail. Well we can fix that, lets put a real long line in them so we can do dialysis. Let me tell you, hooked up to that dialysis machine 3-4 hours a day, several days a week is really living. This is just the beginning of what we do.

For all of that above, the outcome is still going to be the same. Death. We can fight it, we can try to stall it, but in the end it will always win. We have stripped away the dignity in dying, we have stripped away what it means to be alive, to love, to live. We see families deny people pain meds because they think they could become addicted or it makes them sleep too much, and lord knows we can't have mamma not totally alert and comfortable at the same time. Even though she has massive tumors all over in her stomach and bones. We can't let them rest or get some peace, we must be constantly touching them , rubbing their arms, talking to them. We can't have peace. We deny that what must be. Death. It is going to come for them. We as medical personnel see that, we try to tell you that, but yet you won't listen. We deny the natural.

We deny death as a society.

denying-death-as-a-society.pdf

Nurse

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78 Comment(s)

NurseKatie08, MSN

Specializes in Geriatrics, Transplant, Education. Has 12 years experience.

Beautifully written. I wish it were easier for family members to grasp when their loved ones' time has come. I am thankful that my last two terminal patients were able to speak their minds before it was too late for them to do so and pass peacefully.

Jules A, MSN

Specializes in Family Nurse Practitioner.

Yes our present society is the land where everything has to be perfect, bigger and better than is ever possible. Expected pain score is 0/10 and we are entitled to live forever. :(

I agree. It is one of the frustrating things I do no like about ICU.

Even more frustrating when family finally agrees to DNR then revokes it when the time comes.

Gooselady, BSN, RN

Has 23 years experience.

Don't forget the ANGRY in denial patients and family, and coping with their open hostility, barely concealed contempt as if they hope you will screw up and vindicate them. I always wondered WHAT they were vindicating.

When I worked medical oncology we did the comfort care for most of the hospital, while the patients (or more likely, their family) committed to denial end up in ICU and working in ICU must really be something else, just for this. We had a gentleman actively dying from metastatic lung cancer, had been on the floor for over two weeks slowly deteriorating. His family insisted upon full life support for him, for 'religious' reasons. I was in charge one night while we were waiting for him to code . . . and the family explained a little of their views. A DNR to them meant 'taking it out of God's hands".

MOST of our comfort care patients became such without drama, but some did. It was the minority, though. That minority ends up on ICU and I can only imagine how this is for ICU nurses. My heart goes out to you all.

It's not just denial of death. There are cultural issues too, that you won't learn on your mandatory education. From a Filipino friend I heard that to her family, a DNR means 'giving up', and you must fight fight fight to live, no matter what. My friend is a nurse and she admits she knows 'better', but this stuff goes deep down and isn't easy to change. Her mother is in her 90's and she dreads when this will be an issue for her and her family. I've been with people who truly felt assaulted when DNR was suggested for their terminally ill family member.

I've witnessed contempt and disgust from nurses and doctors when a family refuses DNR or comfort care instead of plunging on with chemo and radiation. I don't think that's right either.

We can't forget there are two sides to the patient bed. Ours is quite different, but not 'better'. We don't help anyone deal with their denial by condemning it or judging it. I don't have any answers, as if there WAS an answer to this. I don't want some nurse or doctor dictating the life and death of my child any more than the next person.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

Thanks for the reality check.

I remember reading - in a book of writings by nurses - the line "the soul that we will not let go gracefully back to God." That's what this article evoked for me.

Well and courageously done.

... . . . and the family explained a little of their views. A DNR to them meant 'taking it out of God's hands".

...

I hear this all the time. My response to this is "What if God is trying to take them and we are keeping them here?".

Fiona59

Has 18 years experience.

I remember two patients well. They were kept alive for financial reasons. One, his pension stopped when he died and his wife would have drastically reduced finances, only the basic government amount. The other because her guardian was entitled to receive her payments from a oil and land treaty.

Take a look on You Tube. An ICU nurse did a video with similar thoughts, DNR to the melody of Nickelbacks Rockstar

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 15 years experience.

Sometimes I wonder if some of this is due in part to terminology. Do not resuscitate sounds like we intentionally do nothing to help the patient. Terminology such as allow natural death makes it sound as though we know the time is here, and we're going to allow it to happen while ensuring comfort.

Great read... it really is unfortunate how much our society avoids/fears death. Sometimes it really is the best thing.

Some of the situations that I see the families feel obligated to keep trying and they need someone they respect to relieve them of the guilt and responsibility, to tell them it's time.

As much as we see end of life, not everyone has had practice in ending treatment nor feeling confident that they know when it's time. We often give them options but they still have to choose.

In simpler examples, how many times have you gone to your vet to ask for advice re your pet and they lay out every option objectively when all you want is for them to tell you it's time? I recently went through this with my older horse. My previous old wise vet would have told me straight up that it's time and taken the guilt ridden decision making off of my shoulders. But the new young vet who took his place would only lay out the options and put the entire responsibility on me, without so much as a hint as to what she would choose. Which was fine and I made the decision I thought was best for my horse, but this wasn't my first time, I've had years of experience with these ethical issues and this was a PET, not my human parent or child.

We have legal restrictions on what and how we as nurses can advise but it's something to take into consideration when we're judging people for not making the decision we think they should.

I agree with Libby.

A measureable portion of the denial we see is in part the fault of the health professionals who have interacted with these families over the course of time. Our aversion to providing the honest truth about these diseases and conditions along with responsible discussion is costing us. Our willingness to stop talking because the patient or family is uncomfortable with the facts surrounding their health is benefitting no one. Our experience and expertise in sugar coating bad news has elevated the importance of preserving "hope" above the importance of educating to promote informed decision making.

When I am dealing with patients and families with strong religious faith in a God of miracles, who also believe that they must somehow do "everything" medically to allow God time and space to perform His miracles I ask them if they think God requires that. Did God require that when He raised Lazarus from the dead? Did he require that to touch and heal the lepers or the blind man? God does not require us to put a person on a machine in order for Him to perform a miracle. He may do it at any time under any circumstance. Yes, the family and friends of the infirm often went to great trouble to bring their loved ones into the reach of Jesus for His healing; even to the point of tearing a roof off of a building. The key is the nearness to God, His touch, His healing, His love and mercy and compassion...and the family helping that the ill/dying to get near enough to experience it.

Death is not easy, but there are worse things than death. Or so I believe.

amoLucia

Specializes in LTC.

I ..... Death is not easy, but there are worse things than death. Or so I believe.
This line is so true.

And as OP commented, families 'DO NO FAVOR' to their loved one when the natural order of life and death has been altered.

Thought-provoking article.

No Stars In My Eyes

Specializes in Med nurse in med-surg., float, HH, and PDN. Has 43 years experience.

I personally truly believe that dying will be the easiest thing any of us will ever have to do......it's the 'gittin' there' that's the hard part!

ThePrincessBride, BSN

Specializes in Med-Surg, NICU. Has 5 years experience.

Ya know...it is easier said than done. As much as I would like to say that I would take a family member off life support, the selfish part of me and that little bit of hope would want to do everything possible to keep my mom, brother, or child with me for as long as possible; it is a natural feeling.

Death has a heavy finality to it and while it is a part of the circle of life, in our youth-obsessed culture, it is hard to confront and accept. Although it is frustrating for healthcare professionals, all you can do is sympathize and educate, but never judge harshly. Losing a love one is the hardest thing to go through.

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC.

I didn't read it because I've lived it. I can recall one instance where I called the doc to ask for abxs on a patient that had developed pneumonia and was older and fragile. The regular doc was gone so I talked to the on-call and boy did I get an earful. This doc informed me that there was no way he would authorize the request. He went on and on about how, if we as a society, didn't give older people abxs when they got pneumonia and infections, etc..., that the hospitals and care homes population would be reduced by 64%. This was 20 years ago, but it actually made sense. The only problem was; the older fragile women wanted to live. If they are able to say they want to live than yes but if they don't know and aren't cognitive than let them go....

qaqueen

Has 10 years experience.

This article speaks volumes!

I tried to start a community outreach project with the hospital I work at. I wanted to get people talking about end of life issues, helping the public understand and prepare advanced directives. I was saddened, but not surprised, when comments about "death panels" were made.

It is heart wrenching to see patients suffering, because family members (or doctors) are not able to accept death as a natural process.

Yes, I have been there, watching someone I love on the precipice, and yes, it was hard to accept that I would have to face the future without my loved one. These experiences are the reason that I am such a strong advocate of advanced directives. Tell me what you want! I will do my best to honor your decisions. If you want to live, no matter what, I will work to support that decision. If you have made decisions about what is and is not acceptable in regard to your quality of life, I will support that as well.

I believe in the sanctity of life, and the reality of death, I believe that peace and dignity is more important than suffering to satisfy someone else's peace of mind.

We need to accept the responsibility of making decisions for our futures.

Set aside the political rhetoric of "death panels" and the false hopes of eternal physical life. Decide what is right for you. Write it down. Tell your family!

Allow your healthcare providers to meet your needs. Allow your family to be aware of your wishes, so that they may comply.

No Stars In My Eyes

Specializes in Med nurse in med-surg., float, HH, and PDN. Has 43 years experience.

qaqueen, if i could 'like' this 100 x, I would!