Published Oct 13, 2008
EscapeTheDungeon
6 Posts
We have a patient who is a vegetable. He has no quality of life whatsoever. He can't eat, can't breathe, can't speak, his whole body is paralyzed. The only thing he can do is open his eyes and blink. It seems cruel to perform all these medical procedures on him to keep him alive. I know I'm legally obligated to perform these procedures, and to try to keep him alive as long as possible, and I am certainly willing and able to do that. But it does makes me feel a little bit like an instrument of torture.
SuesquatchRN, BSN, RN
10,263 Posts
Yup. Write your DNR now.
driving85
19 Posts
That's exactly how my grandmother would have been if we had not made the decision to not intubate her when she had pneumonia. She died of Lou Gehrig's Disease (ALS).
I agree with Suesquatch. Write that DNR/DNI.
CuriousMe
2,642 Posts
Since "vegetable" can mean a lot of different things....You say he can blink, is he responsive? Can he answer yes/no questions? If yes, I'm assuming he's been asked what he wants?
If no, does he have any family?
Lovely_RN, MSN
1,122 Posts
Skilled nursing facilities have entire wings full of "vegetables" like the one you described. It's very sad for the resident when the family refuses to let go and they are left to linger for months and years. IMHO, I don't think a DNR/DNI order is enough. I wouldn't mind being resuscitated or intubated if there was a chance that I could recover because I am still relatively young What I don't want is to end up in some SNF as a "vegetable" on GT feeding with MRSA/C-Diff, bedsores etc etc...
I think an advance directive is a better choice.
Daytonite, BSN, RN
1 Article; 14,604 Posts
i worked on a stepdown unit for many years and can't tell you how often i saw this. i went home so much wondering "why is this happening?" well, it is the law, of course. doctors were, and still are, afraid to pull the plug. we had one gentleman who was vegetative (comatose) and on a ventilator for a year. we all knew him very well since we all took care of him. we saw him through trach infections, utis, tube feeing problems and originally a decubitus that he came from the icu with. get this, after a year his insurance reached the limit that it was going to cover his care so his family decided it was time to let him go. he was removed from the ventilator and he did start to breathe some on his own, but died 2 days later. most of the staff was just upset. what worth was all that work we did for a year? we loved this man (maybe love isn't the right word here, but it's close enough) and had to stand by helplessly while economics was determining his fate.
i also lived in missouri at the time when the controversy over discontinuing a tube feeding was a big issue.
the minute i was diagnosed with parotid cancer i went to a lawyer and had a durable power of attorney drawn up. when i moved to california i did the same (each state has different rules). i always have extra copies of it and every doctor i go to gets one and i have very openly discussed exactly what i expect my doctors and my two appointed powers of attorney to do for me. it gives them authority to pull the plug and not be afraid of a lawsuit. i think the newer docs are better educated in these laws. unfortunately, it is extremely expensive to keep someone alive in a vegetative state. economics will probably be the major factor leading the change of thinking on the treatment of these cases.
justme1972
2,441 Posts
Advanced directives can also be written as specific as you want them to be. I have read too many stories about people coming back from alledged "brain death"...whether true (by a miracle) or misdiagnosed...that is why I get nervous whenever I hear stories about someone getting the plug pulled almost immediately upon being declared "brain dead".
Mine is written to where if a neurologist certifies me as brain dead it must be confirmed by another one, and my condition must continue for 30 days before I can be allowed to expire.
I am also to be put on a DNR if I am paralyzed from the neck down or if it's known that I will have any major mental impairment due to disease/stroke/accident, the loss of two limbs or horribly disfigured from a burn or accident as determined by my spouse.
Yup, sounds nutty...but just how I feel I would not want to live.
DDRN4me
761 Posts
There are some good points here. first and foremost, is this patient able to make decisions and communicate by eye blinking? If so, he needs to be involved in this decision. if not, then your facilities ethics committee should. There are some people who are so afraid to die that they do not want a dnr; and others think that its "playing God"
would I want to live that way if it isnt reversible? no, but that is ME
My mother would not want me to pull the plug on her. She refused to sign a dnr on my dad when he was ill. so it is a very personal decision, which at times we do need to make for the family
robynnelpnstudent
32 Posts
I know everyone thinks this is so cruel, but when you can't tell what someone is thinking beyond that communication barrier, how can you determine that he is not fighting to live underneath everything else that is going on? I suffered from a TBI over a year ago and I spent time in a coma, but I could hear everything that was going on and kept trying to talk back and let someone know I was alive. I even heard my now-exboyfriend preparing to "pull the plug", but thank god they didn't let him since he was the cause of my injury in the first place. I guess we just need to keep in mind that some people below the mask of non-communication abledness (sorry, made up a word, taking after my medsurg teacher) there is a person possibly trying to come out of it. I didn't mean to offend anyone by this response...Just offering my point of view, from my own experience.
kcochrane
1,465 Posts
Skilled nursing facilities have entire wings full of "vegetables" like the one you described. It's very sad for the resident when the family refuses to let go and they are left to linger for months and years. IMHO, I don't think a DNR/DNI order is enough. I wouldn't mind being resuscitated or intubated if there was a chance that I could recover because I am still relatively young What I don't want is to end up in some SNF as a "vegetable" on GT feeding with MRSA/C-Diff, bedsores etc etc...I think an advance directive is a better choice.
I work in one of those wings. It is a respiratory unit, so we have lots of trachs. It is hard to watch people linger for years and years without any improvement. I can understand the younger person with parents not really ready to let go and give up. Yes, the stories about those that all of a sudden wake up, make it much more difficult to let go. On the other hand, the 60-80 year old lady/man who really is not going to recover is just beyong my comprehension. We have a 70 year old demented women that they put a g-tube in since she was not eating enough. In the old days that was nature's way of determining end of life.
I take care of them as if they were my family, because at some point most of the family members that decided to keep them alive stop coming or come once a year. I talk to them and hope at least I make what life they still have more comfortable. My biggest wish is that they have no comprehesion of what is going on and that their soul already resides in the next life.
Elvish, BSN, DNP, RN, NP
4 Articles; 5,259 Posts
This is so difficult a decision to make, and equally difficult as a nurse to be party to when we know with all our being that what we are doing is prolonging suffering and nothing more.
I have had this conversation with all my parents (stepparents included, even though I'm not legally their NOK) and my husband. He knows what I want and vice versa. I just cannot stand the thought of anyone I love being kept alive in some sort of limbo when it's obvious they're not coming out of it.
We know where you're coming from, Escape.
Bortaz, MSN, RN
2,628 Posts
If only your family couldn't disregard it.