Denying Death As A Society

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.

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

Specializes in retired 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.

Specializes in Med nurse in med-surg., float, HH, and PDN.

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!

Specializes in Med-Surg, NICU.

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.

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....

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.

Specializes in Med nurse in med-surg., float, HH, and PDN.

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

Specializes in Family Nurse Practitioner.
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.

While it is likely that there are probably some people who are looking for the OK to stop treatment I don't think it is our place to do any more than lay out the options and offer support with whatever their decision may be. I think this goes back to our society's unrealistic expectations of life and death and it is sad. I have taken care of elderly people and their families who truly seem shocked that they are having to deal with catastrophic illness such as cancer, stroke, Alzheimer's etc. I mean really do people actually think there is a decent chance most of us are going to live to 95, remain in our own homes and die peacefully in our sleep? Not that it doesn't happen but seriously, how often?

As a provider I do not think I have the right or duty to encourage someone with regard to this decision either way. In my personal experience I don't need a veterinarian or physician to tell me when it is time. Our family philosophy is well known to us and although devastating when I have had to make the decision to end care for a loved one, human or one of my beloved animals, it is one I have made swiftly and without regret, even before I became a nurse.

Specializes in hospice.
While it is likely that there are probably some people who are looking for the OK to stop treatment I don't think it is our place to do any more than lay out the options and offer support with whatever their decision may be.

.............

As a provider I do not think I have the right or duty to encourage someone with regard to this decision either way.

I think you have a little more obligation than you describe. You know more than the patients and families most of the time. You need to use that to give them a realistic idea of the outcome of each choice, how it will look, what they'll live through. Nothing upsets me more than the doctor "God complex" but a balanced, truthful picture of each choice should be given based on your knowledge of the patient. People say "do everything" from a place of ignorance about what that looks like, and realize too late after grammy's 90-something ribs are broken and she's got a rectal tube that maybe they should have chosen differently.

While it is likely that there are probably some people who are looking for the OK to stop treatment I don't think it is our place to do any more than lay out the options and offer support with whatever their decision may be. I think this goes back to our society's unrealistic expectations of life and death and it is sad. I have taken care of elderly people and their families who truly seem shocked that they are having to deal with catastrophic illness such as cancer, stroke, Alzheimer's etc. I mean really do people actually think there is a decent chance most of us are going to live to 95, remain in our own homes and die peacefully in our sleep? Not that it doesn't happen but seriously, how often?

As a provider I do not think I have the right or duty to encourage someone with regard to this decision either way. In my personal experience I don't need a veterinarian or physician to tell me when it is time. Our family philosophy is well known to us and although devastating when I have had to make the decision to end care for a loved one, human or one of my beloved animals, it is one I have made swiftly and without regret, even before I became a nurse.

That is why I included our restrictions in my post.

While you might be right and you would have handled my personal experience better than I (not likely but I'll humor you) my example wasn't to provide an opportunity of how some of us are superior at it but simply to offer an empathetic angle.

Specializes in Family Nurse Practitioner.
I think you have a little more obligation than you describe. You know more than the patients and families most of the time. You need to use that to give them a realistic idea of the outcome of each choice, how it will look, what they'll live through. Nothing upsets me more than the doctor "God complex" but a balanced, truthful picture of each choice should be given based on your knowledge of the patient. People say "do everything" from a place of ignorance about what that looks like, and realize too late after grammy's 90-something ribs are broken and she's got a rectal tube that maybe they should have chosen differently.

I agree 100% and while I didn't elaborate in my response yes they deserve a detailed explanation of the entire process so they can make an informed choice.

Specializes in Family Nurse Practitioner.
That is why I included our restrictions in my post.

While you might be right and you would have handled my personal experience better than I (not likely but I'll humor you) my example wasn't to provide an opportunity of how some of us are superior at it but simply to offer an empathetic angle.

Since there is no "better" way to handle a personal experience I wasn't trying to be superior just adding my personal experience and preference.

One of the ED docs I work with is really good at towing the line based on the family's presentation and has gently said "its ok if you decide she has had enough". I thought that was supportive without insinuating her opinion on them.

Specializes in Family Nurse Practitioner.

People have to learn how to live.