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Discussion

Futile Care

Hello everyone, I just wanted to get some feedback.

I work in a long term acute care ICU. I've been there for over 3 years. Something is starting to bother me more and more each week. The patients that I'm seeing are getting older and sicker. SO, you say, I'm in ICU, I should expect that right? Well, our facility takes long term critical care patients.

But, more and more, I'm seeing very old nursing home patients that are severely contracted, demented, can no longer move their extremeties or function in ANY manner, sometimes not even opening their eyes. The families keep them alive by dialysis, feeding tubes, and ventilators. Even when they have MASSIVE skin breakdown from laying in a nursing home for years,,, even when they have NO SACRUM left at all because it has long been rotten and they have a colostomy bag and urostomy because there are no orafaces down there anymore.

I find myself getting very upset seeing these patients on levophed and ventilators while the family pretends that they will live forever. Grandma has not been awake in years.

These patients get infections, they get septic and we continue to use aggressive measures to keep them alive. This upsets me.

But, I tell myself, what if I was in that situation? I have never had to make a decision like this before, so how can I judge anyone??? But it becomes sooo depressing at times. I just want to ask the family... WHAT ARE YOU DOING???

I hope this doesn't make me a bad nurse. I mean,,, I feel like I am a very good nurse. I nurse not only the patients, but thier families also. I do and say everything that I can to help them feel better about the situation they're in. I try not to paint a rosey picture, but I am not going to stand there and tell them,,, grandma has been dead a long time, whey don't you let her go now!... I would never do that. I just get so frustrated sometimes.

Edit: I just wanted to add that I really like my job. It can be very rewarding at times. I don't really want to change direction in my nursing career, I just wish I felt better about all of this.

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I don't get it either. I'm a CNA in LTC/rehab facility and a lot of patients in much better shape than that have told me that they're depressed, they wish they had died a long time ago, they feel they're of no use to society anymore, etc. etc. It sucks! How do you respond to that without invalidating their feelings? Usually I just say "Well I understand WHY you feel that way and you're not the first one to tell me the same thing, but if you ask me, you're old, you put in your time [doing whatever I know they did in life] and you deserve to be happy." and then I hope they don't have one of those clueless families who tries to keep them alive as long as possible. People do seem to hang on longer when their families haven't given "permission" to die.

I could not do long term acute care because of the very situations you describe.

  • Author

Like I said before, I really like it. I don't know exactly why, but I am very good at it. There is just this issue, and I guess you could say it is a big issue. Where does the doctor draw the line and say to the family 'it's time to let her go' and encourage them to sign a dnr or withdrawl? I have even heard rumors about families prolonging the life of their loved one who is suffering terribly because they want to wait until after the first of the month to get the next ss check.:crying2:

  • Author
People do seem to hang on longer when their families haven't given "permission" to die.

I have actually had a patient who was hanging on for days,, and the last day of her life (she was all alone this whole time) I told her,,, "it's okay, I'm right here with you. Don't be afraid of what's happening to you, it's alright,, you can go, I'll pray with you"... and I kept talking to her... well, she died a little while after that...

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I"ve seen that happen more times than I care to count. I'll be in a resident's room when the family, who's been flogging their loved one's dying heart/brain/lungs/fill in the blank for years, leaves the building for the last time........"I just can't be here when Mom/Dad/Aunt Bessie dies, I wouldn't be able to stand it." Yes, and that's why you wouldn't let go until your relative was little more than a pain-wracked mass of flesh lying in a nursing-home bed with tubes coming out of every possible orifice.....but of course, I don't say that. I merely nod and say good-bye, knowing I will have to stop doing whatever I'm doing and make that phone call sometime during the course of my shift.

If death is near and I know the dying person to be a man or woman of faith, I often tell him/her, "Jesus loves you and is waiting for you, right now. Go to Him, He's holding out His arms to you. Run!" I have rarely known anyone to hold onto life when they 'see' what's waiting for them across the divide........and that includes people with such severe dementia that they haven't spoken or fed themselves in years.

But, that's just me.........and I hope my family will love me enough to NOT be selfish and try to keep me here when my body and/or brain have worn out.

I really miss East Texas, and every time I see your name, it's like a little piece of home.

I got a phone call from E. Texas, the other night. It's almost as if you're talking about the subject of my call.

A family friend's mother, aged 98, is not in good shape. Basically unconscious these last few weeks, bowels/bladder not working, not eating, of course...you know the routine.

Well, the family friend calls, and is telling me that her mom's physician, the nurse on days, and several more people have begun to encourage her to stop the interventions and let the LOL go.

When she told me that part, I thought "great!", as I've known the patient for the entirety of my life, and I know she'd not want to live as she is.

Not so fast, however.

She followed up with, "But, her physical therapist told me I should never give up...keep bringing her to therapy and they'll get her back to normal!".

This friend has, within the last 2 years, lost an adult daughter (2 years ago, drug OD) and her husband of 56 years. Losing her mother now is not desired, to say the least.

So, of course, she latched on to the therapists advice, and ignored all the healthcare workers who suggested contrary to him.

I, luckily, have known this dear woman for a very long time...she is my mother's best friend...so, I felt very much authorized to tell her exactly what I thought of what she was doing to her mother. I reminded her that this isn't about HER, it's about caring enough for her mother to release her from the pain and suffering she's living with.

The patient is one of the most devout Christians I've ever known. She was the pianist at my little church for most of my childhood. She's waited 98 years to get to heaven...let her go, for God's sake@!

I truly hope she heeds my advice. When I hung up, my wife (long-time nurse) and I had a pretty lengthy discussion about this very subject. I'm like you...I can't understand it and couldn't work in an environment where it happens all the time.

I'm just a naive student...but, I hope there isn't a lot of this going on in the field of infant/neonate nursing...

Good luck to you, maam, and give East Texas a kiss on the cheek for me. I miss her.

This is why it is so very important that each and every one of us has that conversation, more than once, with our family members. We should have advance directives in place that outline what our wishes would be in the event that we cannot speak for ourselves. Just as we plan for births, we should plan for death.

I have actually had a patient who was hanging on for days,, and the last day of her life (she was all alone this whole time) I told her,,, "it's okay, I'm right here with you. Don't be afraid of what's happening to you, it's alright,, you can go, I'll pray with you"... and I kept talking to her... well, she died a little while after that...

You sound like a wonderful, compassionate nurse. I know how frustrating it is to keep these folks hanging on. But you sound like you are doing a great job.

Oldiebutgoodie

  • Author

Thank you very much. I do my best, even when other nurses around me are not... maybe that too is what's bringing me down.

We had a gentleman whose family stated he "had to suffer to pay for mistakes in a past life. If he doesn't suffer in this life, he can't move on". I can't remember his religion - it might of been Hindu- but the nurses caring for this pt had a very hard time with this. Of course, they had to respect the pt's beliefs and wishes, but it was difficult. He was a Full Code and finally coded - and then finally died.

  • Author
We had a gentleman whose family stated he "had to suffer to pay for mistakes in a past life. If he doesn't suffer in this life, he can't move on". I can't remember his religion - it might of been Hindu- but the nurses caring for this pt had a very hard time with this. Of course, they had to respect the pt's beliefs and wishes, but it was difficult. He was a Full Code and finally coded - and then finally died.

This is strange, I have never heard of this before. But if it is religion, I am not suprised. Now, I have seen one case in particular that the father was VERY abusive to the family his whole life, and when it came down to him being ill and needing a ventilator, dialysis, tube feeding and the whole works,, the family seen what agony he was in. One of them actually told me the history and then said that they wanted their dad to stay alive like this and suffer, that he deserved it!!! That shocked me.

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