Great article re: death and dying

[brownbook]

The New Yorker magazine Aug. 2nd 2010. Great article by Atul Gawande about dealing with terminal illness.

[realnursealso/LPN, LPN]

Link to article: http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande

[sparklie.lady]

Excellent, thought-provoking article. Thank you for posting this.

[cmonkey]

I love him so hard. He's our new Burton Rouche (and if you haven't read him, he's like the grandfather of medical detective writers. He used to be at the New Yorker, too).

[tencat]

Should be required reading for every physician EVERYWHERE! Thank you so much for sharing it.

[msjellybean]

I love love love him. Great article! Just picked up his latest book tonight and it's next on my list to read.

[Nurse SMS, MSN, RN]

Thank you for sharing this. We lived through the worst case scenario with my son. He had AML and was 13 years old. The doctors could not bring themselves to admit it was over, even when we said aloud we were ready to hear it if that were the case. He spent the last four weeks of his life in PICU on a vent and we were put in the position of having to decide to take him off the machines and let him go. No goodbyes. No closure. Four weeks of suffering, for all of us.

I am studying now to become an oncology and hospice nurse, entering my second semester. I am glad to find resources like this and read it voraciously. I appreciate a lot you sharing the article. Learning to guide people through these decisions can only lead to good things. There is such a thing as a good death.

[healthstar, BSN, RN]

Such a sad story. It reminds me of the book " the final gifts" I don't know if any of you have read it but it is all about terminal illnesses and how the patients cope and what the dying person experiences. It's just so sad.

[leslie :-D]

Thank you for sharing this. We lived through the worst case scenario with my son. He had AML and was 13 years old. The doctors could not bring themselves to admit it was over, even when we said aloud we were ready to hear it if that were the case. He spent the last four weeks of his life in PICU on a vent and we were put in the position of having to decide to take him off the machines and let him go. No goodbyes. No closure. Four weeks of suffering, for all of us.

I am studying now to become an oncology and hospice nurse, entering my second semester. I am glad to find resources like this and read it voraciously. I appreciate a lot you sharing the article. Learning to guide people through these decisions can only lead to good things. There is such a thing as a good death.

first, i am so very sorry about your son...

so, so sorry.

second, congrats on your schooling.

knowing what you have experienced, i believe you will be an outstanding advocate and nurse.

sadly, nurses don't have much input when it comes to eol (end of life) decisions.

and that is why i got so frustrated, reading this article.

it is often, the doctors who let the pts down.

they are either unwilling or incapable of allowing their pts to die peacefully.

it seems they would prefer a substandard life over a good death.

and everyone suffers throughout this process, esp the pt, who has been robbed of precious time to live out their remaining life.

i already posted in the hospice forum, but briefly, med students need to be thoroughly indoctrinated about terminal disease and choices these folks have.

afterall, it should be about the pt's life, versus a doctor's darned reluctance in discussing such delicate issues.

anyways, we have a long way to go, before hospice is fully and properly utilized.

and only then, will these terminally ill folks, be afforded the choices to live out their life, according to what they want, and no one else.

welcome to the boards.:balloons:

leslie

[Nurse SMS, MSN, RN]

I agree leslie, but do want to say...when push came to shove and the docs were finally willing to admit they could not cure/solve/whatever...it was the nurses that made it as good of an experience as it could be given the circumstances. They were the ones who educated us on our choices. They had the stories of children coming to "meet" other children who were dying, who held my hand and laughed and cried and met me where I was in any given moment and who presented me with the memory box, the locks of hair, the hand prints. And they definitely affected our EOL decisions on that day.

I would love to see, if doctors cannot do this, a referral service to a kind of nursing specialty that this is what they do...have these conversations...and that this specialty is respected in the medical community so that when they speak to the docs about the patient's choices, the docs listen and abide. Maybe that is what hospice is supposed to be in an ideal situation and what needs to happen is docs getting better at referring to hospice and hospice getting better at letting the world know what they are all about. In our case, it was the docs who were not ready to let go and it is sad. The night before he was placed on the vent was a horrible, awful, blessed night. He was in pain and could not breathe. But he was unafraid as long as I was there, as long as we got the pain meds and helped him not to soil himself and kept the oxygen mask near his face when he could not tolerate it on his skin for a while. We were two naked souls facing the unthinkable together and that is what I wish the end had been like all the way through. It was the ultimate in intimacy. If the doctors had only been willing to let us have that, if someone at that moment had been willing to tell us it was okay to let him be done..that we weren't bad parents or giving up too soon. I don't kick myself for the decisions we made - we did the best we could. But I wish it had been different.

Anyway, I am yammering. Please don't ever think what you do doesn't affect the decisions. It can and does, perhaps more subtly at some times than others, but it does. It affected us that day...and affects me now in my journey to healing...enough that I want to be one of you.

[EMSnut45, BSN, RN, EMT-P]

I would love to see, if doctors cannot do this, a referral service to a kind of nursing specialty that this is what they do...have these conversations...and that this specialty is respected in the medical community so that when they speak to the docs about the patient's choices, the docs listen and abide.

The last ICU that I worked in had a palliative care team that was lead by nurses and CRNP's. While the doctors could consult them, it was usually the bedside nurses that made the referral. I know personally, once I noticed that the doctors were talking about slim odds of beating the diagnosis, I was on the phone with the palliative care team. On many occassions, I was told that my referral saved the patient days/weeks of suffering. The palliative care team that I worked with had a great rapport with the physicians, and usually whatever they suggested turned into orders from the doctors. This was truely a great system to work with, and I saw enormous benefit to the patient, their family, and the bedside nurses who cared for them.

[leslie :-D]

The last ICU that I worked in had a palliative care team that was lead by nurses and CRNP's. While the doctors could consult them, it was usually the bedside nurses that made the referral. I know personally, once I noticed that the doctors were talking about slim odds of beating the diagnosis, I was on the phone with the palliative care team. On many occassions, I was told that my referral saved the patient days/weeks of suffering. The palliative care team that I worked with had a great rapport with the physicians, and usually whatever they suggested turned into orders from the doctors. This was truely a great system to work with, and I saw enormous benefit to the patient, their family, and the bedside nurses who cared for them.

i'm glad to hear this has worked well for you.

but keep in mind, there's a difference betw palliative and hospice care...

the most notable difference being, a pt can continue w/'curative' txs under palliative care.

granted, most do transition to hospice, and granted, most will not continue w/aggressive care.

but, it seems to make a difference (to the pts and families) that they would be able to do so, should that be their decision.

and, it is unusual (from my experience) that a bedside nurse can independently, make a referral to palliative care...

very unusual.

but am still encouraged to read this.

leslie