Does TPN prolong life?

Agnus · Nov 21, 2005

What an interesting situation! My first thought was why didn't the doctors talk to the family first and let them know what they were planning for the patient's treatment before even writing the TPN order.

Unfortunately I have learned as have many of you the hard way that physicians are not educated in end of life care and more importantly they are not educated in talking to patients and families about end of life.

Our medical mindset is to save lives. It is not to respect the fact that everyone will die inspite of any medical intervention. It is not to respect the fact that our interventions can and often are harmful to a person's spirit, dignity and even the physical body which we are attempting to fix.

Nurses on the other hand have more of a humanistic aproach. THat is not to say even our so called hollistic view is more times then not tainted by the medical view point.

We are taught to talk to patients and families or at least learn much earlier then physicians about these things.

What is more the OP mentioned this was in an ER. It is my experience that the ER Doctor is usually a young doctor more times than not one who has never had a practice out side the hospital. One who has little experience with actually having to spend time with patients and families actually talking. They know least how to talk to a person about such things. They know least about options available. Options like palliative care, hospice etc.

I had a difficult time convincing a 40 year old physician that we had not one but 4 hospices in our area ready to serve a patient that clearly needed their services. Further more these docs do not know what hospice and palliative care really is. They have very superficial knowledge.

Some doctors never seem to learn how to talk to people when it really matters. That is why we step in and say the really hard words to the family and patient. That is why we know when a family really needs to hear that stuff and the doc's are scared until we have cleared the path for them.

That is why doc's routienly second guess wishes and declaire that, THe patient or family would never go for a no code status or never go for a comfort care etc. They second guess because they are scared out of thier witts. They are scared that if they suggest they can do no more and the patient is going to die that a great catostrophy will befall the doctor if he speaks the truth. That catostrophy bieng in the form of people getting angry with him.

The doc's do not understand that it is not about the doc. They truly have been brainwashed into believeing that they are expected to perform the impossible miracle.

When a patient experience a good death it is usually because a nurse not a physician made it happen. Doctors who terminally wean patients off ventilators (who have a lot of experience with terminal weans) do not stick around once the order is written. Even when a family requests the doc's presences they are "much too busy". They say as little as they can and take off. They let the nurses carry the bag. These are experienced docs. They never learned to be human and they never learned it is ok to show they are human.

Katillac, RN · Nov 21, 2005

Had a situation that I've heard about - I was not involved in it and only know hearsay. A patient was prescribed TPN. A nurse went and spoke with the family, including the patient's power of attorney before the TPN was started and before the doctors involved had a chance to explain thier reasoning. The patient was NPO. The patient was non-responsive. The nurse opposed TPN, feeling the patient was dying and this would prolong suffering. The TPN was ordered on Saturday, the patient passed several days later. The family, based on the nurse's explanation declined the TPN. My question is, was the patient starved? Resource articles would be appreciated. Thanks.

I'm afraid I have no peer-reviewed medical research to offer, only my experience as a hospice nurse. However the answer to your question is that it is unlikely that the patient starved. I have seen people who made the decision not to eat who were with us for months after they stopped eating.

Perhaps the unspoken question is whether this nurse's actions were appropriate, and given what you have provided for background, it's all but impossible to say. I know that you don't have any more information, but we would want to know what caused the nurse to determine that the patient was dying and what the suffering was that she felt he would experience and whether there was a means to address it. If she felt she needed to advocate for him, perhaps the better course would have been to alleviate his suffering. We would want to know whether there were advance directives that covered this circumstance and the MDs reasoning for starting the TPN. Just too many things we don't know.