I have had limited occational contact with a 50 yo patient who has been brought to the facility with ALS or Lou Gerhigs disease. She is ventilaor dependent. She communicates by writing on a board, very slowly and hard to read. My heart goes out to this woman. Her mind is perfect, but she is trapped in this body and is 5 years with this disease. She was brought to this facility because no one else in her area would take a ventilator patient. So she is an hour away from her family, who comes on the weekend. She says she was put on the ventilator without her permission, the family insisted. She has decided to end her life. She told me she'd be gone in two weeks.
I've questioned the two Respiratory Therapists who work with her. One explained that the wheels to begin this process have begun. she and her family will need visits from social workers and hospice. Then she'll be transfered to an ICU closer to her family and sedated with MS and taken off of the ventilator. One says she will be snowed and completely comfortable and have an easy death. The other said it doesn't always come easily, the MS helps some but not entirely.
The patient and I had a limited conversation about this and it left me rattled. I found I had trouble talking with her about her death. She obviously is having trouble with her decision. She said her family says she owes her grandchildren to stay here. I responded that I was so sorry she has this terrible disease and was so rattled I don't know what else I said. She cried and I hugged her. I had to leave, I'd already spent so much time, communication from her is very slow.
I don't know that religious counsel has been in, or if she even wants it. I worry that this lady isn't recieving the emotional attention she needs (from myself or anyone else). I would think that hospice would be coming every day to start this process but I've not seen anyone visit her yet.
I feel guilty that I've had her as my patient 4-5 times but spent my time with her concentrating on tubefeeds, meds, ventilator, treatments, and haven't taken the time to be there for her emotionally.
I'll see her again later this week, dont' know if I'll be assigned to her, but wondered if you could help me with a few thoughts on how to do a better job this time? It might be my last time to see her. How do I say goodbye?
Speaking of God, He needs to help ME right this second....
So, you believe that God is vengeful and unforgiving? And that because we knew my father did NOT want heroic measures, including all forms of life support, THAT WE'RE GUILTY OF MURDER because we took him off the vent???
Oh, man, say it ain't SO...
My father WAS meant to die - because when we took him off the vent, he died - therefore, he wasn't meant to live in the first place and the vent was an interference...he always said "if you take me off, and I die, I was meant to die; if you take me off and I live, I was meant to live". I couldn't agree more, really....
Most of the time, when I've seen families in the stages of disagreement over what measures to take, it's because they, individually and as a group, have not yet come to realize that the patient is dying. It's coming. The train has left the station, it's on its way, the end of that person's life is around the corner.
If you can gently point out to the family (and sometimes it has to be done over and over) that the patient is going to die and that there's no stopping it, but there's torturous things that can be done in the meantime to make the suffering last longer, they'll begin to come around to a different way of thinking. Sometimes we are not at all successful with this, and that's due to people's inability to grieve mostly.
she was put on the ventilator against her will.. can anyone tell me why this happened..? if she was meant to die, then she would have died.. i'm just saying that if it's not your time to die and you decide to end it before your time, it's the same as killing yourself.. if you kill yourself, then you will not go to a better place..
i am going to try to understand what you really might be asking. i noticed you are a nursing student, and may be trying to figure out the way things work.
your first question: why was she put on a ventilator against her will.
the original poster could clarify the actual circumstances, but every patient has the right to a living will, personal directives, and a dnr. this gives the patient the opportunity to state ahead of any event (where he cannot communicate) what measures they allow to prolong life. if a patient is terminal, lets say, with incurable advanced breast cancer, she has the right to state ahead of time that she wants no lifesaving measures. therefore, if she would go into cardiac arrest, we would not perform cpr. this is not suicide, this is letting the person go when god is graciously taking them.
there is a clear difference between not providing measures to prolong life and taking a step to actually end a life. this patients life has been extended beyond its natural course because of all the extraordinary measures that have been taken. i think she is saying, enough is enough.
Specializes in ER/ MEDICAL ICU / CCU/OB-GYN /CORRECTION.
Had an interesting case several years ago.
We had a 43yr old RN who admited to the hospital for elective inguinal surgery. He had no past medical or surgical history of significance except for depression which was controlled.(I think w/ celexia). No hx of psychosis or history of suicide attempts. He had been sober and active in AA for 22years with no remissions and stated his life was given back to him once.
He insisted on signing a DNR and was very clear if anything happened that he wished no rescue efforts -- NOT even medical interventions. The surgeon had a psych consult and he was found to be totally lucid and with controlled depression.
When asked why -- he had worked in ER for years and had seen and been involved in many codes. He felt that if there was a serious complication that he was totally ok with he passing. His family had no knowledge of his adamnt wishes. He also denied that he had any premonitions or feeling of impending death.
His primary care MD said that his wishes and right to make a descion, if an event occured, should totally respected. He said that since there was a psych clearance and he had non unreasonable explaination demonstrated t-- it ultimately was his right and privledge.
His surgeon refused to operate and he was discharged to seek care from another surgeon.
This caused a bit of controversy with the nurses on the surgical unit.
Have any of you had a similar case or even feel similar ?
As always I am interested in your thoughts and opinions.
We had a 43yr old RN who admited to the hospital for elective inguinal surgery. He had no past medical or surgical history of significance except for depression which was controlled.(I think w/ celexia). No hx of psychosis or history of suicide attempts. He had been sober and active in AA for 22years with no remissions and stated his life was given back to him once.
He insisted on signing a DNR and was very clear if anything happened that he wished no rescue efforts -- NOT even medical interventions. The surgeon had a psych consult and he was found to be totally lucid and with controlled depression.
When asked why -- he had worked in ER for years and had seen and been involved in many codes. He felt that if there was a serious complication that he was totally ok with he passing. His family had no knowledge of his adamnt wishes. He also denied that he had any premonitions or feeling of impending death.
His primary care MD said that his wishes and right to make a descion, if an event occured, should totally respected. He said that since there was a psych clearance and he had non unreasonable explaination demonstrated t-- it ultimately was his right and privledge.
His surgeon refused to operate and he was discharged to seek care from another surgeon.
This caused a bit of controversy with the nurses on the surgical unit.
Have any of you had a similar case or even feel similar ?
As always I am interested in your thoughts and opinions.
Some surgeons really don't like DNR's. I have known several who would not operate on someone who had a do not resuscitate order in place unless they rescinded it prior to surgery. I know in some states it is a coroner's case if a patient dies in the OR and so both the surgeons and the hospital will insist on resuscitating a person if they code while in the OR and move them to ICU to die there. I have worked in two hospitals that did this. Does anyone else know why this might be?
Most of the time, when I've seen families in the stages of disagreement over what measures to take, it's because they, individually and as a group, have not yet come to realize that the patient is dying. It's coming. The train has left the station, it's on its way, the end of that person's life is around the corner.
If you can gently point out to the family (and sometimes it has to be done over and over) that the patient is going to die and that there's no stopping it, but there's torturous things that can be done in the meantime to make the suffering last longer, they'll begin to come around to a different way of thinking. Sometimes we are not at all successful with this, and that's due to people's inability to grieve mostly.
I like this reply. It makes so much sense. I will probably use this. Thank you.
Very simply, DNR/DNI orders are incompatible in many ways with general anesthisia. As a general rule, the very act of intubating, and possibly having to bag O2 a patient during induction/reversal of anesthesia would not be DNR/DNI. In addition, many of the meds utilized are to a certain extent, "code" drugs.
The surgeon and/or anesthesiologist/CRNA is going to be interfering w/ normal body stasis, inducing situations that require intubation and must have the freedom to return the body to stasis postop. DNR/DNI would be at odds with this.
As such, DNR/DNI orders are rescinded preop and must be rewritten postop in most places. For periop, the patient is generally a full code.
I had a friend who took care a lady w/ ALS - she too was ventilator dependent and could only communicate w/ her eyes. Her goal was to live to see her son's 2nd bday, and after she did that, the patient directed that her vent be slowly weaned off so that she be allowed to die peacefully. It was a peaceful and graceful death - she was not in pain, as they had given her meds beforehand.
In hospice, we DON'T assist people in dying, but the goal is to make the death as painless and peaceful as possible - everyone has a right to make a decision about their own healthcare, and as long as this lady can be deemed competent to do so, then her wishes should be followed. If she is not competent, then hopefully someone had the foresight to fill out an advanced directive; otherwise, the decision will be left to the next of kin, which can get very sticky, AEB the Terri Schivo case.
In any case, ultimately, the patient should be in control of her healthcare - I too am wondering why she was put on the vent if she didn't want it, unless she had no DNR papers previously.
Very simply, DNR/DNI orders are incompatible in many ways with general anesthisia. As a general rule, the very act of intubating, and possibly having to bag O2 a patient during induction/reversal of anesthesia would not be DNR/DNI. In addition, many of the meds utilized are to a certain extent, "code" drugs.
The surgeon and/or anesthesiologist/CRNA is going to be interfering w/ normal body stasis, inducing situations that require intubation and must have the freedom to return the body to stasis postop. DNR/DNI would be at odds with this.
As such, DNR/DNI orders are rescinded preop and must be rewritten postop in most places. For periop, the patient is generally a full code.
2007RNHopeful
14 Posts
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