Futile Care. Dead is dead.

[Gompers, BSN, RN]

What about the ones the families say do everything possible.........and never come to visit them. As far as costs to the system I find this usually to be the case of people with no insurance and no way of paying. Just let their family member vegetate on a vent. I just hope these people don't feel pain.

This is one of my biggest aggrevations in the NICU. Parents who beg us (over the phone, no less) to do everything possible, but very rarely visit, and often don't end up taking the baby home themselves. Usually these are the kids who go to nursing homes, and we find out later that the parents visit even less THERE. And about half the time these are baby boys named after fathers that have never once visited them.

:angryfire

[Gompers, BSN, RN]

On a lighter note about patients in their 80's/90's having surgery? We recently had an 82 year old woman, in GREAT health (I should have her energy NOW...let alone at 82! And her figure! Oy! We should all be so lucky!) come in for breast implants! *L* She respected her husbands wishes...not to alter her body for years and years...despite the fact that she always longed for larger breasts. Well, her husband passed a year ago...and she said she is ready to have "the boobs of a 20 year old!" Good for her, I say!!! :chuckle

She said, after the surgery..."won't he be surprised when I meet him in heaven!"

She's a hoot.

You only live once, right? Great story!!!

[Thunderwolf, MSN, RN]

It amazes me when I come across "but dad was healthy as a horse" before his massive stroke, comatose, and 98 years old, and the family insists on "all efforts" and refuses DNR. Its just a plain crime. A part of me wants to just shake them and say "enough is enough, the good Lord is calling him home...let him go!" Sometimes, I think families need to sit in on a code and see what really happens to a 98 year old body going thru all that. Families just don't have a clue. When faced with this type of situation, sometimes I turn to the deceased (after the code and everyone is gone) and say, "I'm sorry pal for putting you through all that...I really am. You deserved better."

[obeyacts2]

Oh what a timely thread!!!!!! I am assigned to a poor woman that I sincerely hope will not wake up, and soon. Family(lives next door) left on vacation, left Auntie (widow, no kids) with moderately advanced dementia, CHF AND (drum roll) leukemia alone except with 6 hrs a day home care. I asked them to leave a copy of her advance directives in case of emergency and wouldnt you know she was FULL CODE (at 89, with the aforementioned problems)!!!!! I was just appalled. They can go out of the country on exotic vacations, but won't arrange proper care in the meantime. :angryfire :angryfire :angryfire

I just don't understand people.

laura

[Elenaster]

Another aspect of this that I really struggle with is when "higher power" issues come into play. I realize this statement could be easily misinterpreted, and don't get me wrong - I'm all for patient's and families utilizing whatever spiritual beliefs that will help them get through the stress of being in the ICU. I often pray for peace for them myself. However, when the patient is s/p multiple codes, RF, maxed out on pressors, poor neuro prognosis, etc., etc., and the family won't consent to withdraw support because we would "kill" them and that's "immoral." I just don't understand how they can't realize that the patient would have been dead long before we ever approach them about withdrawing and what we're doing is cruel. If we were supposed to live forever, there would be little need for ICU care IMO.

I can't even imagine how those of you in peds, especially NICU, deal with some of these ethical issues. I can remember when I was a nursing student, I was doing a rotation in NICU and there was this poor little baby there, born extremely premature (maybe 24 weeks) to homeless, drug-addicted parents. He was so small they couldn't place a VP shunt for his hydro and his head was bigger than his entire body. The nurses said he was going to be blind, profoundly developmentally disabled, and a whole host of other terrible things. I left there completely freaked out and really sad for that pitiful little creature, knowing I could never work in that environment. I really respect those of you that can.

[URO-RN]

My brothers well 100% against letting my dad go. My sister and I were for letting him die in peace. We knew that nothing could be done. I was accused of wanting him to die. This was probably because my brothers were not ready to let him go. They were just not comfortable with the idea and they were not ready. Big time denial.

To make a long story short, my dad was in and out of ICU. The only thing keeping him alive were the ICU drugs. He would get "better", according to my brothers(no quality of life), go to the floor, get d/c to a nursing home, go home, get sick again in less than 72 hours, back to ICU, back to the floor....you get the picture.

This went on for a year. In and out of hospital, in and out of nursing homes. The fire department guys and my dad got to know each other very well.

This whole ordeal came to an end when I asked one of the intensivist md's I worked with at another hospital (and who had priveleges at this hospital)to intervene. My dad and bros needed to hear the truth. No sugarcoating. My brothers never really accepted the reality of the situation. Anyway, by the 50th or so hospitalization, when my dad had to be admitted to the hosp., he was admitted to a medical floor. "Finally", I thought "someone out there has gotten it". Let him die in peace. Keep him out of the ICU. The nurses and docs have done everything that they can.

His last days were painful. He was tired. He died May 9, 2004. Mother's day.

[NotReady4PrimeTime, RN]

it amazes me when i come across "but dad was healthy as a horse" before his massive stroke, comatose, and 98 years old, and the family insists on "all efforts" and refuses dnr. its just a plain crime. a part of me wants to just shake them and say "enough is enough, the good lord is calling him home...let him go!" sometimes, i think families need to sit in on a code and see what really happens to a 98 year old body going thru all that. families just don't have a clue. when faced with this type of situation, sometimes i turn to the deceased (after the code and everyone is gone) and say, "i'm sorry pal for putting you through all that...i really am. you deserved better."

you took the words right out of my mouth, thunderwolf. if families knew how many ribs we break doing compressions, and how much pain broken ribs can cause to someone who already has enough on their plate, and how frightening it is to "wake up" intubated, unable to speak and often very confused, they might think again. television has such a huge influence on how people think and i just wish we could get mainstream tv to show more realistic portrayals of emergency and intensive care so the general public understood how it works and oftentimes doesn't.

and then naturally we have to get into the "faith" thing. several years ago i had a patient who had an unidentified progressive neurodegenerative problem who went from a cp-like picture of recognizing his parents, smiling and breathing room air to fully ventilated with zero resp drive and no interactions with his environment other than to cry when turned or suctioned... no obvious etiology identified... when he was 13 years old. the parents are devout catholics who go to church every sunday and whose priest comes once a week to visit the boy. numerous blessed icons are placed around the room. this boy deteriorated rapidly once he was trached and lost his resp drive. his heart rate would spontaneously and routinely drop to the 20s and his sats would follow. after much discussion it was decided that we would not give any cardiac meds and we would not do compressions. the family refused to call it a dnr order, and we went along with that. one evening while the parents were with the boy, he bradyied to the teens, and when nobody moved, the dad jumped on the bed and started compressions... urrrrrrrchhhhhhhh! code status reversed. when the dad was asked why he got in god's way when god was calling the boy home, he said that if god wanted that boy, he wouldn't have allowed science to invent all the technology we use for advanced life support, and we darned well had better be using it. "god put all this stuff here so that sammy could live." this was about 4 years ago, and to the best of my knowledge, they are still ventilating that body somewhere.

[dazzle256]

One of the most challenging ethical dilemmas for me. I just HATE participating in it. We get so many patients in the ICU setting that prove to us in so many ways that it is JUST TIME TO DIE! But no, for whatever reasons ie: Doc is a super god..saves everyone, doc is too wimpy to call it to a stop, families running the show and docs letting them...and other various reasons, we get to come to work everyday and poke and prod these poor souls. Costs the system alot of money too. I don't go home feeling like a good nurse when having to do this. In fact I feel really bad. I am pretty aggressive about it and corner these docs and families for a "chat" to help bring some reality to play, but sometimes have to get ethics involved to make any headway....docs don't appreciate it either. But geez people...we are maintaining dead or dying people with all the bells and whistles, for weeks on end. Can't we just let people die when they ARE. Treat pain and suffering....not cause more. Never a good day when you get to work and the buzz phrase on the unit is "I see dead people"

:angryfire

I did homecare about 6 years ago for a 12 year old severely retarted girl trached and on a vent.... anyway long story short.....mom told me that when she was born (a preemie) mom and dad didn't want her resusitated (pardon my spelling) but had on say in the matter. The little girl was in the hospital for the first two years of her life. Mom said back then she had no choice and... that was in the late 80's I guess. Has things changed .....did families not have the choices they have now?

[Trauma-tizedRN]

I did homecare about 6 years ago for a 12 year old severely retarted girl trached and on a vent.... anyway long story short.....mom told me that when she was born (a preemie) mom and dad didn't want her resusitated (pardon my spelling) but had on say in the matter. The little girl was in the hospital for the first two years of her life. Mom said back then she had no choice and... that was in the late 80's I guess. Has things changed .....did families not have the choices they have now?

I've been in healthcare for over 20 years (CNA..LPN...then RN for the last 17) And patients have ALWAYS had no code rights, as well as family wishes if patient unable to say. I don't know what to say about this one. Doesn't sound like a good prognosis was ever part of the quotient.

[Town & Country]

I understand that people can be in denial, and that they don't want to "let go" of their loved one.

But does it really take a rocket scientist to see that someone is ALREADY DEAD?

Literally: I would not TREAT A DOG like most of the people who are in ICUs.

At least when dogs are euthenized, they just "go to sleep."

They are not tortured for months on end......I've seen people lie there on vents....week after week.....their skin splits open and weeps.

Would anyone do a dog like that?

That is cruel. When it's time to die, let them die!

[Trauma-tizedRN]

I understand that people can be in denial, and that they don't want to "let go" of their loved one.

But does it really take a rocket scientist to see that someone is ALREADY DEAD?

Literally: I would not TREAT A DOG like most of the people who are in ICUs.

At least when dogs are euthenized, they just "go to sleep."

They are not tortured for months on end......I've seen people lie there on vents....week after week.....their skin splits open and weeps.

Would anyone do a dog like that?

That is cruel. When it's time to die, let them die!

The down and dirty truth. Wish we could make a pamphlet of your posting to hand out in ICU. Sometimes, when it gets beyond ridiculous, ya just gotta tell it like it is.

[reprise]

During the time I worked in the HIV/AIDS field, I found it quite puzzling that often it was the families of those who'd been suffering a terminal illness for a considerable period of time who were most reluctant to discontinue futile treatment. Intuitively, I would have expected the families of those who'd suffered unexpected, catastrophic events to be the ones who had the most trouble "letting go", and yet time and time again they seemed to cope far better (perhaps because they were buffered by shock) than families who'd had a long time to prepare themselves for the inevitable.

Has anyone else noticed somethign similar?