Published Nov 4, 2004
You are reading page 2 of Futile Care. Dead is dead.
Tweety, BSN, RN
From the med-surg perspective I hear you loud and clear. I feel like I'm torturing human beings when I have to call a futile code, or intubate and send to ICU in an effort to prolong the inevitable.
I don't always blame the docs for being whimpy. In this society where families and patients sue for outcomes that don't suit them we must be heroic at all costs. I recently heard a doc point blank ask a women why she was continuing on with futile efforts for her husband "I need his check". Seriously. That woman should be sent to jail.
Anyway, we've gone way to far and I don't like participating in it and too feel frustrated at the end of the day some of those days.
I've seen so many 'selfish' family members that just can't make the decision to take Mom or Dad off the vent. "It's just too hard", they say. To me, it would be even harder to see my parent go through the tortuous futile care. I just don't understand sometimes. Makes me glad my mom is VERY up front about what she wants and DOESN'T want when it comes to that time in our lives. I'm also POA. I just wish my husband and his parents would talk about it - at least ONCE!
Our unit is gearing up to take Intra-Aortic Balloon Pump patients. Interesting device, but, I can see the same 'ole discussion with a family member discussing when to take Mom or Dad off the balloon pump because they can't be weaned. Ugh. Just like when it's discussed to take someone off a vent or not. I'm not really looking forward to that.
There was actually an article in the American Journal of CC about perceived futility in care r/t job stress in the ICU. There was quite a correlation between the two (I know you're shocked). I think it contributes heavily to ICU burnout as well.
I was just going to mention this article- it is a must read. I am a floor nurse myself, but I did a very involved case study in nursing school on the effects of a patient such as described above on the atmosphere of an ICU. Case was very sad- had been in a coma for several years after an accident, was coded several times, last code before I saw her, the resident was in the midst of calling time of death when a MED STUDENT THOUGHT he felt a pulse, so they resumed compressions and she came back, albeit even more brain damaged than before. Talk about frustrated ICU nurses!
From the med-surg perspective I hear you loud and clear. I feel like I'm torturing human beings when I have to call a futile code, or intubate and send to ICU in an effort to prolong the inevitable. I don't always blame the docs for being whimpy. In this society where families and patients sue for outcomes that don't suit them we must be heroic at all costs. I recently heard a doc point blank ask a women why she was continuing on with futile efforts for her husband "I need his check". Seriously. That woman should be sent to jail. Anyway, we've gone way to far and I don't like participating in it and too feel frustrated at the end of the day some of those days.
I don't think all the docs are wimpy either..like I said, various reasons...but, when you have a pt. that has been clinically dead for several days, still on the vent, maxed on pressors, labs, various other meds, feedings, extremeties black, etc. and the doc won't call it because the family insists "dad responds to our voices"...it's either whimp syndrome or doesn't want the hassle (apathy). Lawsuit concerns? EEG will tell the whole story, among other tests of viability. Not an issue.
Still the doc can't pull the plug without the family's consent. Because then the family can claim it was docs lack of treatment that killed the person. Better to continue with heroic measures and let the patient eventually die, then everyone's conscious is clear. (sarcastic smile here). Doc can request they find another doc because it's against his principles. But docs are caught between a rock and a hard place.
As nurses we can help and encourage the family to let go.
Isn't it more common though, rather that brain dead, heroic measure are done on persons in the process of dying, or in permanent vegetative states?
Still the doc can't pull the plug without the family's consent. Doc can request they find another doc because it's against his principles. But docs are caught between a rock and a hard place. As nurses we can help and encourage the family to let go. Isn't it more common though, rather that brain dead, heroic measure are done on persons in the process of dying, or in permanent vegetative states?
i brought up this very same subject under the hospice forum, as to why doctors/families wait until the very last minute before their loved ones are able to die peacefully....i do think doctors are afraid of lawsuits, should they go against the family wishes; too many families in denial; often the patient will just go along with what the family wants rather than express their own wishes, and then of course, there are those mds who play God, but at whose cost?
i wish the mds had much more education in end of life care rather than these futile, invasive heroic measures....
CoffeeRTC, BSN, RN
Just now am I going thru a situation like this. DH's elderly aunt was transfered from a LTC to hospital ICU for sepsis. She was 78 a&O diabetic, peritoneal dialysis with a right bka. The good leg had a cyst that they were watching for infection....well after almost 2 weeks in the ICU being treated for infection....her renal doc decided and councelled the family that knowing that aunt didn't want another amputation transfering her back to the LTC with hospice was the best option. My MIL and FIL, POAs and primary caregivers, understood this and aunts wishes. DH's other uncle....wanted everything done (even though aunt didn't)...very mad and unaccepting.
Aunt Jean was sent back to the LTC yesterday am....we got the call that she died at 9pm. Thank goodness her doc wasn't one to do all the heroics. I am still grieving, but soooo happy she died in her "home" on her conditions.
hoolahan, ASN, RN
I can so relate to what you all are saying. I did critical care for 17 years, and it did finally burn me out completely. I went into home care and I really loved it. It was so nice talking to my patient's, and very rewarding to see them actually get well.
I don't think I could go back to ICU again. I did moonlight for awhile when i first started HH, but then a week or so agao, a friend called me to see if I'd want to pick up some shifts, told me I could "Name my price," but truth is I just don't feel like a critical care nurse any more. I'm OK with leaving it behind now.
God bless you all.
zambezi, BSN, RN
I too relate with what is said here...we had one patient, came in pretty much gone...ruptured aortic aneurysm up though his carotids...first symptom was when he blew his pupils at home and went down, gases on admit had a po2 of 33...ph 7.0something- not good (and this was vented 100% O2)...family wanted everything done...surgeon took him down (???), repaired aorta...never stopped bleeding...I took him back after surgery...have never had someone bleed so much so fast and not stop...we were cell saving every twenty minutes...blood out, retransfused- for four hours...we ended up opening him back up in the unit...twice (all this with a very poor neuro prognosis prior to even going to surgery)...finally after a few days the family starts to accept the fact that patient is nto going to make it...doc comes in and also starts to accept that fact...then another doc comes in a tries to talk the primary into hanging on for a couple of day...the nurse that had that patient that day BLEW UP...she couldn't believe it (eeg at this point showed no activity). Started in on the doc about what all would discuss (calmly) with him...he talked with the family and it was decided to pull life support...
sometimes i think that our docs just won't let go (at least a few won't...thankfully most can see reality). A few of our docs have a "live for at least 30 days after surgery" policy...even if all systems are shutting down after a horribly rocky post op course, poor neuro status, RF, etc...I just don't get it. Personally I would never want my family to have to go through that...sometimes people are supposed to die- and we keep them alive in miserable ways...
Now I am not insensitive to familys needs...if a family wants everything done...i support them but also try to educate them about the situation, I talk with the docs to be up front about outcomes, etc...It is a tough situation all the way around. I don't like it when patients pass on but so many of these patients have horrible outcomes after anoxic events, rough post surgical courses, etc...I know you all know what I mean.
This is a hot topic where I work to. I think that in medical school there should be a course that discusses that not all deaths are medical failures...sometimes it is just a person's time to go--no matter what is done to prevent it.
I think it comes down to EDUCATION for families, doctors, social work, nurses, etc. A tough concept because it is a sensitive topic and usually when you are wanting to discuss it it is an emotional time for families (and docs & nurses).
101 knowledge there....
(in response to previous posting by LPN to RN)
no one is "annoyed", no one is being insensitive to family struggles, we as nurses DO understand grieving in relation to death and dying, and no one is BLAMING families. I am a patient advocate, and prefer to advocate for dignity in death and unnecessary pain. Even if it means having to nudge the family in the right direction when the time has come. And yes, we DO ease our families down this road, not shove them as you might believe we do. I hope this clarification makes sense.
How about a family that finally signs the DNR. He's deteriorated to the point he's going soon, the wife calles 911 and has them take him to active treatment! They're going he's DNR, she changed her mind.
The facility refused to take him back after he was "saved" by acute. Last heard of she had home care, because the Palliative unit wouldn't accept him because of her stunt with 911...
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