So, I was going to post this on the critical care sites, but I think its pretty relevant to nursing as a whole.
I sincerely hope that no one gets the wrong impression here. I am a very empathetic and compassionate person. I love people and I love helping people - that's why I'm nurse! I also feel like I am a pretty moral person. I guess you could call it a little bit of depression that I have been dealing with lately when it comes to a specific group of patients, and I am falling out of mainstream here.
I work in a busy CCU/MICU. Love my job as a whole. Went into critical care because I wanted to deal with the sickest of the sick. Found the prospect exciting. Came into nursing feeling like every life was important (and still do!) and quality was in the eye of the individual. Who am I to say what quality is for each individual? However lately I have found going to work depressing. Not because my patients are sick... I can handle that no problem. It is the people who have "poor" quality of life that we are endlessly keeping alive. This is the end-stage, chronic illness type, usually elderly person who would have probably have loved to "meet Jesus" before the family made the decision to have them intubated, or have other life pro-longing care. I hope this is coming out right.... It just makes me sad taking care of these miserable, elderly people with no quality of life who are being sustained on and on because the family will just not let go! Not because I don't want to take care of them, but because I care about them! I mean, how many of them, if they could see their future would say, sign me up for that! Families have such a hard time letting go sometimes. I guess sometimes it is guilt, sometimes it is desperation and a lot of times it is just lack of education and understanding. Like when when an 80 year old man is resuscitated post cardiac arrest and brought in to us. All of the hypothermia in the world is usually not going to bring 80-yearold grandpa back to where he was (and if he had delayed cpr) or even conscious. If he does go home, he is usually not the husband/father/grandfather he was before and everyone is upset. (Don't get me wrong, hypothermia IS amazing and works out beautifully in alot of cases).
Do you get what I am saying? Sometimes I just feel like I am a villain, working in a torture chamber. Does anyone else feel this way? People just don't get what they are signing their family members up for sometimes. Then again, there are those cases, where everyone said it was pointless, and here the person is, walking out of the hospital as good as new....(exception, rather than the rule, for sure).
Sorry for the super long vent. Tell me what you think. Thanks.
I have always felt the way you do. I also think that when nurses in families with issue it does work bettter. My dad had a stroke a couple of years ago He seemed like he was going to get better after a couple of days. On the 3rd day I went in he was nonresponsive Mom said he was asleep. I checked his pupils and they were blown. I told her what to expect. He had a very negative response to touch. I knew he was gone. And so did Mom. He was on the med/surg floor. The nurses all charted he was asleep. When the doc came in and before he even checked him she told him she wanted him discharged and take him home. The doc threw a fit and started screaming at me. Mom let him do a ct scan Doc wanted him in ICu AND SHE SAID no!! We took him home and sat with him for 30 hours . He died in his bed with all his grandkids and kids with him. And Mom was in bed with him.
I just wish everyone who is at the end of their life could do this. What a peaceful way to go.
I totally feel ya. I'm a tech on a med-surg floor and, goodness, I feel so bad for some of the pts that I see come through here. They have aboslutely no quality of life, some of them. Some are totally unconscious, some can't move at all and are not at all aware of anything, some can't eat po, some have pressure sores the size of grapefruits. The worst are the ones that come thru here in this condition, are here for days upon days like this, and have no one even come to visit them. What a terrible way to..."live"
I like the phrase "Allow natural death" MUCH more than DNR.
I feel for you. There are times when I just want to grab families, march them into the hallway, and tell them "Let him go, he's in horrible pain, you're just torturing him by not letting nature take its course".
We had a daughter of a patient one time volunteer to me, "No one understands why I want mom to be a full code, but I hope she'd do the same for me." I had to leave the room before snapping back "What, you hope she'd keep you in constant pain, bedridden, with a stage four decube so large I can't even measure it, blind, deaf, confused, with no arms or legs, on tube feeds, and not understanding why? Do you hate yourself that much?"
OK, I don't work in these areas, but I have had personal experience and have read many of these type of posts. Do you think that this needs to be a change that comes from the medical establishment (physicians)? It almost seems like a paradigm shift is needed and the docs need to lead the charge. I wonder why docs have let go of educating people about these things. We can educate all we want, but the decisions are really between the doc and pt/family.
I think that I like the Allow Natural Death thing. Thanks guys. Alot of it is in the way you present. I think that is part of the problem, however as a nurse I always wonder when I am crossing the line when talking to the families about letting go. We have some physicians that are outstanding patient advocates when it comes to talking families in to letting patients go, and others that you just want to say, "what are you thinking?!?!" I think it really depends on how comfortable the doc feels in their own skin too. Some view it as admitting defeat.. they don't like saying, "sorry, you can't save em' all..." I think part of being able to recommend letting a patient go comes with time for them.
Interestingly though, it seems like our biggest patient advocates when it comes to recommending DNR are some of our female intensivists.
I really like how "allow natural death" reframes the question from being 'do you want us to stand by and let your family member die when we could save them.' I'm going to start using that from now on.
Dalzac, LPN, LVN, RN
697 Posts
I have always felt the way you do. I also think that when nurses in families with issue it does work bettter. My dad had a stroke a couple of years ago He seemed like he was going to get better after a couple of days. On the 3rd day I went in he was nonresponsive Mom said he was asleep. I checked his pupils and they were blown. I told her what to expect. He had a very negative response to touch. I knew he was gone. And so did Mom. He was on the med/surg floor. The nurses all charted he was asleep. When the doc came in and before he even checked him she told him she wanted him discharged and take him home. The doc threw a fit and started screaming at me. Mom let him do a ct scan Doc wanted him in ICu AND SHE SAID no!! We took him home and sat with him for 30 hours . He died in his bed with all his grandkids and kids with him. And Mom was in bed with him.
I just wish everyone who is at the end of their life could do this. What a peaceful way to go.