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. Nurses General Nursing Article

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

I think Dr. Kavorichian had it right back in the 80's when he was promoting MD assisted suicide for those patients who did not want their lives extended. Unfortunately it is true, our society has a very difficult time talking about death and preparing for death. Thankfully my sister and I approached our 89 y/o mother with what her last wishes would be and how would she want things handled. Many families avoid these discussions until it is too late. Is it because they just do not realize what will happen to their loved one or do they believe our healthcare system can heal anything?? Once a patient has 2-3 co-morbities there should be some discussion with the pt and family about how they want to handle the code process and beyond, they should be presented with the options that may be placed before them and they should be informed. The medical community avoids this as well, how many times have nurses taken the lead in discussing negative outcomes before the MDs will even discuss it with their patients?? I believe in being totally honest with my patients and often I will tell them the options that their illness may take them way before the MD will even approach the subject. Your article discusses the feelings and situations that are faced on a daily basis by ICU nurses, sometimes what we are directed to do seems inhumane. It is part of being a critical care nurse and one reason why I left critical care many years ago. Great window of what these nurses have to go through.

Specializes in hospice.
I think Dr. Kavorichian had it right back in the 80's when he was promoting MD assisted suicide for those patients who did not want their lives extended.

It's Kevorkian, and not everyone in health care agrees with pushing suicide for these patients.

Well put young man! I have never seen the passion for patients rights and dignity written so well as we usually just allow a few rogue tears out and smile thru it. I once had to advocate for comfort measures as per patients wishes who by the way was family to me by marriage and my husband's family is large scary mean alcoholics that simply frighten me however my patient clearly in her right mind stage 4 breast cancer PICC line for chemo who just wanted to be home with pain meds and her grandkids and greatgrandkids playing at her feet so I took the whole family on and 2 years later the kids finally spoke to me again and thanked me. Not necessary just doing my job.

I have only encountered DNR in my practice. I have heard that some facilities use AND instead: Allow Natural Death. This change in terms would make it a lot easier, I think, for some families to choose natural death rather than DNR, which sounds scary and harsh.

This is definitely what I have seen but I can't for the life of me understand it. How do we go through our entire lives and not ponder and prepare for the fact that everyone close to us will eventually pass on?

Because we live in a culture of advanced medicine. We no longer lose half our children to disease, because we now have vaccinations. Grandpa won't die of a heart attack; he is given bypass surgery. Women don't die in childbirth that often anymore, they get emergency c-sections.

I was suctioning a sick baby a few nights ago after yet another coughing fit, adjusting its oxygen as needed, and coordinating with the respiratory therapist on its treatments, tube-feeding it, and thinking to myself that 50 years ago this baby would have certainly died. Instead this illness was just a small bump in what will probably be a long, healthy life for this baby.

Death is no longer something the average person sees every day. When it happens it's shocking. We expect medicine to fix everything.

Specializes in hospice.
I have only encountered DNR in my practice. I have heard that some facilities use AND instead: Allow Natural Death. This change in terms would make it a lot easier, I think, for some families to choose natural death rather than DNR, which sounds scary and harsh.

If only they knew how scary and harsh resuscitation is on a fragile body riddled with cancer or ravaged by illness. But if a terminology change would help, then do it. I'm skeptical it would be that powerful but also willing to admit I could be wrong.

Specializes in hospice.

Death is no longer something the average person sees every day. When it happens it's shocking. We expect medicine to fix everything.

Exactly. We moderns like to comment on how obsessed with death medieval European art seems to be. But death was a close friend, a companion to them every day. They lost multiple family members before 20, would see half their own children die, and would be truly a rare and lucky soul to live past their 40s. As you say, death is a rare experience for us now, and we've talked ourselves into the psychotic belief that eating the right foods, taking the right pills, and avoiding the wrong toxins will allow us to escape it. I think people in affluent Western cultures are shocked when death becomes real, and offended they still have to deal with it.

Specializes in Rehab, Med-surg, Neuroscience.

Amen. I wish I could share this on Facebook. I've tried tentatively in the past to explain my views on assisted suicide but I can't find the right words and I always get shut down. Honestly my support for it is something I've learned to hide or else I get rejected. The OP's words are so true. I wish more people understood.

Specializes in hospice.
Amen. I wish I could share this on Facebook. I've tried tentatively in the past to explain my views on assisted suicide but I can't find the right words and I always get shut down. Honestly my support for it is something I've learned to hide or else I get rejected. The OP's words are so true. I wish more people understood.

The OP is not about assisted suicide, it's about not using every extraordinary means at hand to fight a gladiator battle against imminent death and causing suffering while we do it.

Allowing nature to take its course is a completely different thing from the direct, intentional taking of a human life. Don't equate them.

I am so happy someone wrote a great article about this. I couldnt agree more.

Very well written! Sometimes families just aren't ready or able to put their loved ones wishes above their own- revoking DNR's at the last minute- it's very sad that a persons suffering is prolonged at the end. I do think sometimes it's the terminology and that allow natural death seems to go over better with patients. Thank you for your article!!

Specializes in kids.

When my dad had a stroke, it was just about a year from that day, til he died. He waxed and waned over that year.... Some good days, many not so good. About 3 months after the initial event, he was choking on his food and was just not well, at great risk for aspiration.... I had to return home (4 hours away)...Even though my dad was clear on his wishes, my siblings asked if I wanted anything done in the event I would not make it there in time. I had to say no, even though it killed me. My siblings looked up to me as the oldest. But it was not about me, but him. He died about 9 months later. I was lucky to talk to and see him, but there were no heroics. He died peacefully, as we all should.