Do people really deserve this?

[TigerGalLE, BSN, RN]

There are so many days that I feel like I am just torturing people. Extending their life so they can die debilitated and miserable. Yes we do good work. We save lives. People do leave ICU and go on to live a good life. But so many patients end up trach'd, PEG's and extremely debilitated. They go on to live a miserable rest of their life where family tries to make them go through rehab. But unfortunately most of these folks are NOT rehabable.. Why do we keep Grandma with severe lung disease trach'd and on the vent when she isn't weaning and going into MSOF? At what point do we say I'm sorry but Grandma is too sick for rehab. Grandma is tired and miserable. This isn't fair to Grandma! We have awesome doctors and an awesome Palliative care team at my hospital but we still have to do what family says to do. We can't make the decisions for them. The patients are miserable and families just keep pushing them. Is it fair? Who are we treating? The patient or the family's lack of acceptance?

Sincerely,

I need a vacation... Oh and I'm going on one next week :)

[detroitdano]

This is why you fill out an advanced directive, and make everyone you know do the same.

We just had a guy we couldn't get rid of for 3 months. Every MDR infection known to man and some I'm sure were first-time discoveries. The family refused to send him back to the rehab he came from, but wanted to take him home and give him dialysis while on the vent with hospice. That's not hospice! Ethics finally stepped in and made him DNR thank God, but that was only for his stay with us. I'm sure he'll be back for round two after spiking a fever in his LTAC.

Those situations make you appreciate having a half normal family and loved ones who you know will not torture you like that.

[MomRN0913]

This is what burnt me out in the ICU. Seeing these people tortured for selfish reasons. We had one patient who only blinked ot pain, trach, vent, his whole body was a decubiti, the Peg wouldn't stay in, he had these itty bitty tiny legs from atrophy. But his dear wife kept him alive. He was spetic all the time, in and out of the ICU. Had every organizm known to man. Yes, they pumped on his chest and coded him when his time finally came after his 2 years of his being in and out of the ICU. the wifes family disowned her because she wouldn't let him go in peace.

It got to the point where we would bluntly tell her what she was doing to her husband.

My grandfather lived a long life. was partying with younger people in his NYC loft smoking weed up until he was hospitalized. Rode Harley's, hung out with some famous people, was an artist.... Had a 30 year old girlfriend at 70.

he got sick suddenly bad CHF and was hospitalized. he was taking a turn for the worse, AAO, but wasn't eating... they wanted ot PEG him. My dad says fine. Because of a hernia, they couldn't do it endoscopically. They were going to have to do it surgically. My dad called for my advice. I asked to speak to a Dr. They put me on the phone with the anestseiologist. I asked with his CHF and his pleural effusions, would he come off the vent from this surgery. he said more than likely not. SO I explained to my dad there is no sense in taking a man who LIVED like a wild spirit and putting him on a vent so he can have a feeding tube. He agreed. I also told my dad he should make him a DNR. So he did. he died of a massive MI the next morning.

I know my dad's wishes (as does his younger wife, it runs int he family;) and my dad knows mine. Advance directives must be made, and made clear!

i think an actual advance directives/DNR team in hospitals would be a good idea. To go over it at admissions and if a decision needs to be made, these patients need to be guided with information and compassion.

[CrufflerJJ, BSN, RN, EMT-P]

In the ICU, we're great at extending the dying process. Pt's families often won't let go, even when "it's time."

Unfortunately, even a clear, explicit advanced directive made by the pt is often overridden by their family members.

Sad....very sad.