Futile Care. Dead is dead.

P_RN, ADN, RN · Nov 7, 2004

I made that decision for my father 22 years ago. I miss him, but I will never regret telling the doctor to release him from his pain.

My beloved MIL is in LTC now. Tubed, CVA, Diabetes, decubitus ulcer,Parkinson's, 2 PE, Greenfield filter, it will be 5 years next March. Why? Son with POA agreed to DNR, daughter also with POA said NO DO EVERYTHING.

Thunderwolf, MSN, RN · Nov 9, 2004

I think "all the heroics" in full codes and prolonging the inevitable with our terminal just prolongs the grief for everyone. If it should happen to me, let me go...don't prolong my agony. Don't compound my suffering with the additional burden of their grief. It would just kill me if I was conscious enough to know what was happening to me, seeing my family peering down at me during visits, seeing them grieve my long, protracted death because someone was afraid to let me go. I don't want to carry that guilt to my grave. Let me go and let my family and friends move on with their life.

tiroka03, LPN · Nov 9, 2004

I have a very difficult time with DNR. When a person signs a DNR form, why then don't we abide by it. It seems to me, it should be a personal decision, not a community one.

When my mom's time to die came, she had already signed her DNR. She was told if she wasn't transfused, she would die within a week. She refused the transfusion, saying I am ready to go to heaven.

Still the facility called my repeatedly asking my persmission for the transfusion. I refused. Mom had made up her mind and expressed it several times. Who am I to go against her wishes? I had a sister who was angry at me about this, but ultimately it was my moms choice and no one elses.

Three days before she died, she made a cassette tape saying goodbye to every person in the family individually. She stated again, it is my time to die, and I can't wait to get to heaven.

Her death still was very difficult to watch, and hurt us all terribly. But, I am glad that my mom had the forsight to spare us the additional pain of watching her suffer needlessly.

I don't understand why we take a personalized signed statement from a pt who wishes to be DNR, and make it ineffective. Why even bother with DNR. It is meaningless and usless most of the time. :angryfire

carlarn, BSN, RN · Nov 18, 2004

I was working in the ED one morning, trying to get off shift, and we had a man come in full arrest. Of course, it was a witnessed arrest and the medics worked him. When he arrived in the ED, the doc worked him some more. We called his cardiologist after having worked on this guy for over 30 minutes. I think he was shocked 30 times (I kid you not). I asked the ED doc why he just didn't let him go and he said the guy had a productive life before he arrested. I told the doc that he didn't have one now nor would he again. So, after calling the cardio doc, he finally made in to the ED another 30 minutes later. He asked if we had pronounced the guy and I said no the doc was still working him. Yes an hour and a half later, the cardio doc goes into the patient room and ceases all efforts. I was totally disgusted with my ED doc. Dead is dead and beating a dead horse won't give it quality of life. : :uhoh3:

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

nursebonkers · Nov 18, 2004

I have actually heard a story from a nurse who took care of a patient, basically dead on a vent. She went to suction him and the mucous was to hard. The doctor in the unit came over with a mixture of hydrogen peroxide and put it down the tube, and out came maggots!!! I not only see dead people, I see DUMB people.

subee, MSN, CRNA · Nov 18, 2004

You shouldn't blame the family. It can be very hard to let a loved one go, to the point of the family not thinking rationally. Their main care is to keep their love one alive at any expense because they are just not ready to let go. It's not like they are wanting all the bells and whistles for their family members just to annoy you. They are hurting and under a great deal of stress.

Families have lots of agendas and few people are educated about the subject of dying. Nurses, write letters to the editor of your newspapers, get involved with publicity for hospice care. I've been a CRNA for over two decades and I find the torturing of the frail and elderly the most emotionally stressful part of the job. Ask the surgeon if he would be doing this procedure if he had to do it for free . Feel free to be a cranky old lady because its the only way to get your voice heard.

ReinventingMyselfAgain, MSN, RN · Nov 18, 2004

you think it's bad in geriatrics, you should try peds! omg!! because they're children and have so much potential we should keep them all breathing. ri-i-i-i-i-i-ght! ... i won't even get into the whole ball o' wax we have with babies... they practicaly have to be rotting on the bed before we even broach the subject. sheesh.

i hear you jan. i supervise in a peds long term facility (where they go if they don't go to heaven). it is absolutlely heartbreaking!! they made a multimillion $$ to build a palliative care unit (about 10 yrs ago). well, the floor is filled with children who we have to do everything for to 'save' their lives. that expression 'bring them back to life' just kills me (no pun intended). bring them back to what life? sad as it may sound, the life that they once had will never be. by the time we see them in rehab (or as it is for most- the nursing home), we know what their potential is.

my word of the week is empathy. i like that word. i'm not going to lecture on how we don't know what these people are going through. but i will say this. i only hope, if, god forbid i am ever in a situation with any member of my family, that i can objectively look at the situation, and make a decision that considers their quality of life, and not just my feelings about losing a lived one :crying2:

i lost someone very close to me, and it was all over before i even found out about it. i had just graduated nursing school at the time, so these qol issues did not even cross my mind. i'm grateful that it happened so quickly, and that he didn't linger. i don't know what kind of decisions my parents would have been capable of making (it was my brother). and i know if he would have held on for any amount of time, it would have drastically changed my life, my career, and my perceptions.

ReinventingMyselfAgain, MSN, RN · Nov 18, 2004

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.

that is absolutely terrible.

that whole 'god's will' reminds me of the subject of infertility. i apologize if i offend anyone. but if you are unable to conceive by natural measures, and implant eight eggs that fertilize, is it really god's will to keep all of those eggs/embryos/babies (whatever you consider them?)

Mimi2RN, ASN, RN · Nov 19, 2004

My beloved MIL is in LTC now. Tubed, CVA, Diabetes, decubitus ulcer,Parkinson's, 2 PE, Greenfield filter, it will be 5 years next March. Why? Son with POA agreed to DNR, daughter also with POA said NO DO EVERYTHING.

I'm so sorry to read that, people can be so cruel to their "loved" ones. Can nothing be done? Does her daughter go visit? Do you have an ethics committee in LTC? Or can you have a conference with everyone involved?

Wintrsday · Nov 19, 2004

I don't know if anyone read about it but recently here in Utah a 6 1/2 year old boy with an inoperable brain tumor, a herniated brain stem and two flat line EEG's was sent home after his parents took the hospital to court to block them from taking him off of life support. The family found a hospice care company that will take care of him at home, the judge went further in making the hospital remove the certificate of brain death from the child's chart because if they left it in the insurance would not pay for the boys care. They had pictures of this sad little boy on the news here. Horror of horrors to me he looked like the pictures the police took of my son after he died of a self inflicted gunshot. That poor little boy is dead and hopefully beyond pain but his parenst insist he is getting better.

I understand how hard it is to lose a child, I am just glad that I did not have to face what this family is facing, my son was gone, but I would not have wanted to keep a child beyond help on a ventilator, the parents believe that because his heart is still beating he is alive.

Melissa

acgemt · Nov 19, 2004

I work in an ICU , and I see it on every shift. Even if the patient does make it through whatever event brought them there, think about the quality of life that the patient will be having in the future. I could not bear to see my family members in some of the situations I have seen. Furthermore, I don't ever want to be one of those patients.

ReinventingMyselfAgain, MSN, RN · Nov 19, 2004

i don't know if anyone read about it but recently here in utah a 6 1/2 year old boy with an inoperable brain tumor, a herniated brain stem and two flat line eeg's was sent home after his parents took the hospital to court to block them from taking him off of life support. the family found a hospice care company that will take care of him at home, the judge went further in making the hospital remove the certificate of brain death from the child's chart because if they left it in the insurance would not pay for the boys care. they had pictures of this sad little boy on the news here. horror of horrors to me he looked like the pictures the police took of my son after he died of a self inflicted gunshot. that poor little boy is dead and hopefully beyond pain but his parenst insist he is getting better.
i understand how hard it is to lose a child, i am just glad that i did not have to face what this family is facing, my son was gone, but i would not have wanted to keep a child beyond help on a ventilator, the parents believe that because his heart is still beating he is alive.
melissa

i think this goes beyond an ethics committee. hello, is there a pychologist in the house?? have these parents seen the negative eeg strips? has anyone sat down and told them thie child is dead???? there is something seriously wrong here. and the judge is basically telling the medical staff to change their diagnosis of brain death??? fortunately the boy feels nothing at this point.

wintrsday, my brother died the same way your son did, and i agree with you. fortunately, we were not put in a situation to make a decision. god made that decision for us. :crying2:

i heard a radio ad tooday, for a local hospice home-care service. i though, wow that must be a nice place to work in. everyone is 'on the same page'. they all know death is approaching, and want it to be a peaceful, non heroic measure-ful. but not if that's what your patients are like.