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

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?

I have been asking my self this why can't we just accept death. I guess it's the separation and not understanding why it's happening even though its part of life.

Having tubes in orifices or families trying everything to save a family member does not remove a patient's dignity. As long as these are done with love and respect, dignity remains.

We need to allow families time to process the impending loss of their loved one. They are the ones that are going to remain after their loved one passes on and will need to come to terms with what they did or did not do at the end of their loved ones life. We aught not hurry them through this process and respect their wishes; within reason, all the while keeping the patient as comfortable as possible. I think the patient would understand.

Specializes in Med nurse in med-surg., float, HH, and PDN.
Having tubes in orifices or families trying everything to save a family member does not remove a patient's dignity. As long as these are done with love and respect, dignity remains.

We need to allow families time to process the impending loss of their loved one. They are the ones that are going to remain after their loved one passes on and will need to come to terms with what they did or did not do at the end of their loved ones life. We aught not hurry them through this process and respect their wishes; within reason, all the while keeping the patient as comfortable as possible. I think the patient would understand.

"Pray for the dead, fight like hell for the living." (Mother Jones)

Perhaps we need to take a different approach. As nurses we have a unique opportunity to educate and coach families in end of life care/ decision making long before the critical encounter in the ICU. Imagine the power of AACN and SCCM collaborating to raise public awareness and provide tools for healthcare providers to use in wellness settings to start the conversation. Let's start working on root causes that put our Critical Care colleagues into this daily conflict.

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

Maybe there needs to be a simple book that discusses death, as in the child's book, "Everyone Poops". ......ie ,"The Only Way Out Is Through: Everyone dies."

I've posted this elsewhere, but I had a patient once who was always "in charge", the organizer,the director, the caretaker, in her previous normal, everyday life. She asked me one time, "But what will I do if I die?"

Uh, hon, once you die, you don't have to DO" anything!

Specializes in Dialysis.

As a former Acute Dialysis Nurse, I performed treatments on patients that were literally brain-dead, because the family wouldn't let go. It was very difficult for me. as I knew there was no saving these patients.

I now only do chronic outpatient dialysis, I feel I'm helping these folks have a better life.

My husband and I have put our wishes in writing so it will be clear to our family that we don't want prolonged futile procedures done on us if we are in the hospital. I want to donate any parts that I haven't worn out, and be cremated and scattered on the beach!

I have worked 38years in the same nursing home. I also had two parents with serious long term medical conditions. I cannot understand people who are so selfish as to watch their loved ones suffer. When I have opportunities I preach about my experiences in the nursing home and in my life. I had a patient with a g-tube, non verbal and only rare visits from the family. They wanted God to make the decision on whether she lived or died... Really? God didn't decide to put the g-tube in her. When my mom had reached her limit of admissions to the hospital, the doctor gave the speech and he was brutal. I left all this up to my mom, but in a way I was brutal too, explaining to her the end game and she decided no more hospital. She went back to the nursing home and when she had another flair up I was unavailable and she was sent to the hospital on her request... the doctor called and ranted at me! I would have had his job if I could have. There is a compassionate way and compassionate words you can use when talking about someone you have loved your entire life. He was out of line! All these things should be decided by the individual and it's never too early to make your wishes known, but when the time comes be unselfish, be strong and let them go because you love them!

I absolutely agree with you and often see the same thing where I work. I think it's never too early to talk about your own end of life decisions. I also find as I get older that wish to live forever is fading.

Having tubes in orifices or families trying everything to save a family member does not remove a patient's dignity. As long as these are done with love and respect, dignity remains.

We need to allow families time to process the impending loss of their loved one. They are the ones that are going to remain after their loved one passes on and will need to come to terms with what they did or did not do at the end of their loved ones life. We aught not hurry them through this process and respect their wishes; within reason, all the while keeping the patient as comfortable as possible. I think the patient would understand.

Emphasis is mine.

Neither one of these statements is necessarily true.

Specializes in TELE, CVU, ICU.

As much as you want us to understand your perspective, we want you to understand ours. To you, she may be your patient.... She may have been admitted for 3 days... She's an 86 year old hispanic female with a hx of chronic renal failure, (dialyzed MWF) hx of CHF, s/p CABG x4 (10 years ago) . You notice the early stages of skin breakdown, she is non verbal... albumin level is awfully low, LFT's elevated...... She is a frequent flyer, with intractable infections, she was brought in via EMS and is now hooked up to a vent... You have known her for 3 days......

But.. She is my grandma...., I have known her my entire life... She raised me... Up until last week she was still full of life, she loves me as much as I love her. I care for her 24/7.... She is independent at home, ambulated without the assistance of a walker, she is able to cook. I accompany her to dialysis 3 times a week where we use those 3-4 hours to talk, crack jokes and watch whatever is on the TV monitor- after dialysis we go to her favorite Restaurant where she orders her usual.. I take her to all her doctors appointments... Cardiologist, Hemotologist, Nephrologist, PCP- I know last week's lab results off the top of my head, I am her historian I can tell you about the appendectomy that she had in 1965- I can tell you that her hemotologist just adjusted her last dose of EPO.... I can tell you that last week I helped her with gardening and she talked about wanting to work on getting her strength up- she wants to beat this..... she wants to feel as strong and as healthy as she possibly can.. she knows shes aging, but she is trying.. I drive her to the healthfood store where she stocks up on her natural Omega fat supplements, her superfoods etc....

But now... It seems that her health has taken a turn for the worse, the pulmonary edema, VRE in her urine, and we are waiting for her stool culture to Rule out C. Diff.... This has happened to her before, and she pulled through it....

But now her hospitalist and social worker come in to drop the bomb on you.... to tell you that she is not going to make it, some of the doctors even have the nerve to ask us why we are "torturing her" they question why we are letting her suffer... They want us to put her on hospice - stop all curative treatments and let her die... No matter how you disguise the words "comfort care" "dying with dignity" all I hear is you telling me you want me to make the decision to stop all medical treatments and let kill her... because that is what will happen.. The hope of her going home, the hope of her getting better.. the hope.. you are taking away my hope..

... Wait.. Maybee the doctors are right, after all they are doctors..... Wait, but maybee they are wrong... again, because the last time they had this conversation with her she bounced back.... She returned home, finished her physical therapy and she had a brand new lease on life.. How can I trust these doctors? I called her PCP that has known her for years, and he tells me that managed care plans always try to do this to patients who they feel are "expensive".. she old, on dialysis, taking a bucket load of meds.. Frequent flyer- Hmmm.. Lets just be cost effective and put her on hospice......

Wow... now im really confused... I feel attacked, this is all too sudden.. I need time to let it soak in.. I need time to make a decision without all these judgemental insensitive jerks pushing me around.. I feel like im being bullied, I feel too much pressure to have to make the decision now.. What if I make the wrong one.. what If I let her go, and maybee she would have recovered... What if... Would I be able to live with myself if I listened to the doctors and let her go- I killed her and I gave up on her.. I give her an opportunity to come back.. I know she's a strong women.. she's a fighter.. let me hold onto hope for just a few more days...

It kills me to see her suffer, it will kill me to see her go....

You are a medical professional... I have brought her to " your place" to help her.... I have brought her to your place to save her life- to prolong her life, to try to avoid death one more time- If I felt the need for advice, I would ask you... Thank you for being upfront and honest about her prognosis.. but this is my person... I know her best, and I know that I am making the right decision for her.. she trusted me with this for a reason... If she pulls through and recovers, she will thank me.. and we will talk about it.. I might have her for another year or 6 months... If she dies in the midst of life saving treatment- I guess it was meant to be.. God wanted her home- At least I know I tried everything in my power to save her, I tried everything in my power to give her a CHANCE to pull through.....

I am very sorry that it hurts or bothers you to see your patient- that you have known for 3 days go through this.. but I ASSURE you it hurts me more... If you find yourself biased- and not in agreement with my choices- please feel free to ask off the case... If you find yourself emotionally attached to my family member, and you want me to let her go- please walk away...

I am bringing her here to keep her from dying... So please do your job...

But advice... is not what im seeking at the moment...

Your's truly,

The Very Confused family member.

As much as you want us to understand your perspective, we want you to understand ours. To you, she may be your patient.... She may have been admitted for 3 days... She's an 86 year old hispanic female with a hx of chronic renal failure, (dialyzed MWF) hx of CHF, s/p CABG x4 (10 years ago) . You notice the early stages of skin breakdown, she is non verbal... albumin level is awfully low, LFT's elevated...... She is a frequent flyer, with intractable infections, she was brought in via EMS and is now hooked up to a vent... You have known her for 3 days......

But.. She is my grandma...., I have known her my entire life... She raised me... Up until last week she was still full of life, she loves me as much as I love her. I care for her 24/7.... She is independent at home, ambulated without the assistance of a walker, she is able to cook. I accompany her to dialysis 3 times a week where we use those 3-4 hours to talk, crack jokes and watch whatever is on the TV monitor- after dialysis we go to her favorite Restaurant where she orders her usual.. I take her to all her doctors appointments... Cardiologist, Hemotologist, Nephrologist, PCP- I know last week's lab results off the top of my head, I am her historian I can tell you about the appendectomy that she had in 1965- I can tell you that her hemotologist just adjusted her last dose of EPO.... I can tell you that last week I helped her with gardening and she talked about wanting to work on getting her strength up- she wants to beat this..... she wants to feel as strong and as healthy as she possibly can.. she knows shes aging, but she is trying.. I drive her to the healthfood store where she stocks up on her natural Omega fat supplements, her superfoods etc....

But now... It seems that her health has taken a turn for the worse, the pulmonary edema, VRE in her urine, and we are waiting for her stool culture to Rule out C. Diff.... This has happened to her before, and she pulled through it....

But now her hospitalist and social worker come in to drop the bomb on you.... to tell you that she is not going to make it, some of the doctors even have the nerve to ask us why we are "torturing her" they question why we are letting her suffer... They want us to put her on hospice - stop all curative treatments and let her die... No matter how you disguise the words "comfort care" "dying with dignity" all I hear is you telling me you want me to make the decision to stop all medical treatments and let kill her... because that is what will happen.. The hope of her going home, the hope of her getting better.. the hope.. you are taking away my hope..

... Wait.. Maybee the doctors are right, after all they are doctors..... Wait, but maybee they are wrong... again, because the last time they had this conversation with her she bounced back.... She returned home, finished her physical therapy and she had a brand new lease on life.. How can I trust these doctors? I called her PCP that has known her for years, and he tells me that managed care plans always try to do this to patients who they feel are "expensive".. she old, on dialysis, taking a bucket load of meds.. Frequent flyer- Hmmm.. Lets just be cost effective and put her on hospice......

Wow... now im really confused... I feel attacked, this is all too sudden.. I need time to let it soak in.. I need time to make a decision without all these judgemental insensitive jerks pushing me around.. I feel like im being bullied, I feel too much pressure to have to make the decision now.. What if I make the wrong one.. what If I let her go, and maybee she would have recovered... What if... Would I be able to live with myself if I listened to the doctors and let her go- I killed her and I gave up on her.. I give her an opportunity to come back.. I know she's a strong women.. she's a fighter.. let me hold onto hope for just a few more days...

It kills me to see her suffer, it will kill me to see her go....

You are a medical professional... I have brought her to " your place" to help her.... I have brought her to your place to save her life- to prolong her life, to try to avoid death one more time- If I felt the need for advice, I would ask you... Thank you for being upfront and honest about her prognosis.. but this is my person... I know her best, and I know that I am making the right decision for her.. she trusted me with this for a reason... If she pulls through and recovers, she will thank me.. and we will talk about it.. I might have her for another year or 6 months... If she dies in the midst of life saving treatment- I guess it was meant to be.. God wanted her home- At least I know I tried everything in my power to save her, I tried everything in my power to give her a CHANCE to pull through.....

I am very sorry that it hurts or bothers you to see your patient- that you have known for 3 days go through this.. but I ASSURE you it hurts me more... If you find yourself biased- and not in agreement with my choices- please feel free to ask off the case... If you find yourself emotionally attached to my family member, and you want me to let her go- please walk away...

I am bringing her here to keep her from dying... So please do your job...

But advice... is not what im seeking at the moment...

Your's truly,

The Very Confused family member.

It's the responsibility of the care team to bring these issues to your attention. You've spoken a lot about what YOU want for grandma. Does she really want to go through all this hell to survive with questionable quality of life for another six months to a year so that YOU don't miss her? She's clearly never going back to her healthier, younger self. What is aggressive treatment going to give HER? That's really the important question to ask and it takes courage to truly listen to the answer.

Most of the health care team are not insensitive jerks. Most, if not all of them, have been in your shoes.