What a life...

[amanda1229]

After being a LTC CNA for only four months, I am officially sickened by people who support this!

We had a new admission Friday evening. I'll call him Herbie. Herbie is confused. He has a foley, colostomy bag, g-tube, and constant o2. He has a PSA because he frequently tries to get out of bed, and he uses his call light to request the bedpan (even though he clearly does not need one).

In report, one the leaving aides told me to take a look at him -- I've never seen so many hookups to one person, having only worked in LTC so far. Our rooms don't usually look like small hospital rooms! This poor man was just lying there, sweating -- the DON and I were actually worried about him. We stripped him of his gown, pulled the blanket down to his knees, pulled his privacy curtain and just had a fan right in front of him. It barely helped.

The DON and I were talking as she helped me repos. him, and I simply said, "I could never live like this, and when I get older, I'm going to make that known to my family." The DON told me that Herbie was a full-code and had all of this because of his daughter. And she told our DON that she was "happy to have him out of the hospital, and excited to have him home one day, on his feet and back to his old life!" I almost choked!

Herbie could barely speak. And when he did, you could barely make out anything he said. In fact, the only things I heard him say were "hi" in response to my introduction, and "no, no" when I replaced his cannula that he took out.

I cannot believe that some people are still full-codes and we're pulling out all these stops to save these 90 or 100 year-old people! When the body starts to break down, in my opinion, you can only go so far before someone just has to rest in peace. How can these little frail old ladies who are just bones still be full-codes? Do you really want us to perform CPR on someone when we know it will just break their bones in half?

All of this just hit me like a train with Herbie. Not to mention he has such terrible circulation problems in his legs, they may as well just not be on his body anymore, and for the better. I just don't understand, are you trying to make someone live forever, or just more comfortably? When it gets down to it, perhaps science could just make us live as long as we'd like, all these things Herbie had are just the start of it -- can't eat, void, defecate, or breathe properly? We have the fix! What's next -- mechanical organs or limbs, artificial fluids or tissues or whatnot for people turning 100something?

I went home and talked to my boyfriend's sister, who works in the same facility, about how disgusted I was with it all. She agreed 100% and told me Herbie had died last night. The worst part -- his daughter thinks it was somehow the facility's fault, as if we made some crucial error. He had labored breathing the only time I spoke to him. We all knew he was on his way, and as soon as he wasn't skilled, they wanted to talk to the daughter about hospice.

I think it's just a shame that he went on to live like this, that he couldn't have gone sooner, perhaps when he could still have memories in his mind, or feel a little more like a human being, and not just a body on auto-pilot.

[nightmare, RN]

I couldn't agree more! Let our elders die in peace and dignity,when it is your time to go because the body has gone past it's sell-by date then the families should be fully briefed by the doctors so that codes etc are not used and you can go in peace.

[Penny8611]

I'm not in nursing yet (I'm in school) but I feel very certain I am not cut out for LTC. I've had multiple family members in LTC; I have very vivid memories of visiting my maternal Grandmother and Great Aunt in nursing homes in the '60's. Sadly, my Mom is in one now. She never wanted to end up in one, I know. :-(

Her stroke left her NPO...way back before PEGs (and PICCs and PCN, oh my) there wouldn't have been any decision for us to make. As it was, though, she had the PEG inserted and then went through months of therapy to be able to swallow again. She's completely wheelchair-bound and incontinent. My Uncle, her only living brother, kept pestering me about why I wasn't "looking into" assisted living for her. I tried to be diplomatic about it for months, and then finally told him that if I wheeled her into an apartment and left her there, I would be arrested. I think that finally got through to him.

I am not in favor of euthanasia, but I'm relieved to see your post. I have the same thoughts and questions. How much is too much? Frankly (and I'm being brutally honest) I could argue that giving my Mom a PEG was probably too much intervention. I believe with all my heart that she will go to heaven and be infinitely happier than she is now. She's MISERABLE. She doesn't understand why I won't "let her" go back to her apartment and why I "stole" her cat from her. This, inbetween bouts of not knowing who I am and being convinced that her mother (who died in 1970) was just there for a visit.

I don't think euthanasia is the answer, but I'm also not convinced we're on the correct path with all the intervention that's available, nay, MANDATED now.

I have at least made damn sure that I'm not one of those daughters the nurses hate to have to call. I don't ever kill the messenger. And yes, Mom is DNR...that's what it states in her living will.

I don't have any answers to ANY of these questions, but...contrary to what you might be feeling, I am relieved to know that there are people like you caring for people like my Mom. I appreciate that you're not on auto-pilot.

Hang in there!!!!!

[traumaRUs, MSN, APRN]

This is such a timely subject for me as I'm soon to start a position as an APN in a brand new hospital palliative care unit. Did you know that fewer than 5% of the cardiac arrest situations even in hospitals result in a patient that walks out of the hospital? Unfortunately our society has ER and other TV shows as models of care and don't realize that some people should not be saved due to their poor quality of life.

Even now (I work in dialysis) I encourage my patients to have advanced directives.

[psalm, RN]

...this may sound horrible, but maybe *some* adult children who won't let go or insist on mom or dad being a full code are punishing them for abuses they endured as kids. I have seen some terrible name-calling and unbeliveable verbal abuse of an elderly pt. by her adult kids (which she prob. taught them, as she gave it right back). All I could do was try to get the "children" out of the way while I nursed their mom AND reported to the docs, etc, on the case.

Then there is denial. So as a health professional I do all nursing care I can to make my patient comfortable physically and mentally and spiritually. Hang in there, you sound like a compassionate person who is needed. Just beware of burnout. Hugs.

[Neveranurseagain, RN]

My husband, who was 47 years old, went into cardiac arrest following a "medical incident." I watched him for 5 days seize, decorticate posture, develop Doll's eyes and blow his pupils. I talked to him, cared for him, cried with him, and told him it was going to be ok, I would take care of the kids and it was ok to leave us. Then I did the kindest thing I could, and turned off the vent. There was absolutely no way was I going to send him to a SNF or LTC facilty to die a slow dead from sepsis, pneumonia and decubs. His death was inevitable, and I felt there was no way I could prolong it. Before I made the decision, I thought of all the LTC Home Health pts. that were in his condition that I had cared for, sometimes for years. Not one family had said they would do it again, that if they had known what it was like.

Sometimes you have to accept death as opposed to life, if you can call it life living in a vegetative state.

Let our elders go with dignity when it is their time...esp if they had made it clear of their wishes not to live this way. I hope someday my family is kind enough to do the same for me.

[nyapa, RN]

I agree with everyone here. I can't count the number of times our senior staff have begged the medical teams to organise DNR status only to have the family refuse. We have a large indigenous population (Australian aboriginal) and due to the huge distances between their communities and the hospital it is very hard to organise such an order. Also, decisions about health in their culture is not often made by them, but by elders, even if they are capable of making decisions. It is a whole other world. Often teleconferences are required between the community (it is a community decision) using their clinic staff at their end, and at our end, the boarder staying with the patient, interpreters, aboriginal health workers and educators, medical staff, senior nursing staff, and allied health professionals are involved.

Nevertheless, on the ground for nurses, the decision is the same. And I hate having to jump on someone you know isn't going to make it. Or in the minute chance that they do, they will be more discomfort than beforehand.

We had one very compassionate specialist here who made extremely sensible decisions and discussed options with family as soon as possible without prompting from the nursing staff. It was so refreshing. Mind you, this man also wrote in the notes "excellent care given by nursing staff". No, he wasn't being patronising.

[Penny8611]

awsmom8, I am so sorry for your loss. You are obviously a very compassionate, huge-hearted person. You did the right thing even though I can't imagine the pain. I'm sorry, honey.

[Neveranurseagain, RN]

Thank you Penny. I forgot to mention he became an organ donor and his receiptents are still alive and doing well, 3 yrs later.

[Penny8611]

Thank you Penny. I forgot to mention he became an organ donor and his receiptents are still alive and doing well, 3 yrs later.

That is SO awesome. I have made my wishes clear in this regard...I want them to use everything possible, but no one will want my corneas. ;-)

What a wonderful legacy for your husband!

[locolorenzo22, BSN, RN]

I think we see all of this first hand very often...I worked on a tele floor last night, and had a older gentleman, who was NPO for g-tube surgery, couldn't take a breath off of the bipap, turner, getting temps done rectally....was doing fine, had come in from home, but had a clear DNR bracelet on....

I went into a room to do vitals, I came out and literally the nurses were running back and forth between monitor and room...he had NO heartbeat, the daughter was hystarical...."but he's been fine all day"...."DO SOMETHING!"...they ended up coding him and sending him to ICU....not 1 hr later, code is called again...the family showed up on the floor, and I took them up, heard later that they let him go the 3rd time....

why do we let family overrule a patient's wishes? What else can we do? Just a bad situation all the way around.....

I hope that I can honor my family's wishes if I'm ever in that situation....or at least convince the rest of the family....

[underpaidrn]

Sometimes we have to love enough to let go. That's what I did with my dad when he died 17 years ago. I lived in another state and when I went to visit him, we both knew it was for the last time. He had cancer and was very weak. I told him it was okay for him to go. I would miss him, but I knew one day I would see him again. My sister and I are facing the same thing with our mom now. She's 83 with a failing heart. We have turned down all the testing the MD wanted. What's the point. She's in her right mind and doesn't want the tests. We have agreed and are strong patient advocates for her. Not something I look forward to, but when the time comes, we will let her die with dignity and peace.