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
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EMSnut45, BSN, RN, EMT-P
178 Posts
Soooo very true, and exactly why I'm taking a breather from the ICU.
Like others have mentioned, I have also found that families are more receptive if it is first presented as "it's time" rather than a laundry list of options given to an overwhelmed family. This usually comes after several previous family meetings where it is explained what heroic measures are currently being performed and the lack of response. If the groundwork is properly laid from the beginning (honesty, bedside manner, trust), then the final discussion, if necessary, is much easier for the loved ones. The nurses also play a role by re-enforcing the current condition of the patient through teaching. It really is a multi-disciplinary effort.