This time of year, we get them. Patients so gravely ill that they must be placed on life support. Ventilator, pressors, art lines, central lines, Swans, trans venous pacing, CVVH. And when all of these have failed, or are failing, the families want to keep their loved ones 'alive' until the holidays are over. I'm talking about patients for whom the term "futility of care" was created. And I just don't know which is worse...The families who want their loved ones to maintain a heartbeat until the holidays are over or the physicians who acquiesce to their demands.
Have we, as a society, become so reality averse that the thought of a family member passing during the holiday season is simply unbearable? Which would people have as a last memory of their loved ones? Passing peacefully at home on hospice...? Or tied to multiple life support systems as their systems shut down, they weep from every extremity and their skin sloughs off to the touch?
Too many families faced with this insist on 'everything' being done for their loved ones with no real comprehension of just how much and how far 'everything' can go. And the healthcare community won't stop and educate them as to just what 'everything' entails. It's a sad fact at this time of year, and it will continue so long as physicians fail to make the situation crystal clear to families with a loved one at the end of their days. Such cases not only use up valuable resources and critical care beds, they deny access to those who would benefit most from them. Never mind the emotional toll such patients take on the staff assigned to care for them, as they watch their efforts go for naught. And all because people fear their own, and their loved ones, mortality. Fear begins when you suspect your mortality and ends when you accept it.
my mom died 3 yrs ago today .dec 29,2007.that same year my bil died 3 days before thanksgiving.my moms was totally sudden died of sepsis .as a critical care/ed nurse i had the difficult decision to make my mom dnr/dni days after xmas.my moms death brought back memories of my dads death 10 yrs earlier .both loved xmas.these holidays have become very difficult for me since.i now have very little xmas spirit all it brings is a flood of memories.but the grief is getting better.i would never prolong a loved ones passing but i too understand it.
I have a family member that can't face a certain family function that is held every year. It was the last place she saw her son alive. He was killed shortly thereafter in an accident. It is five years now and she still can't manage to attended, perhaps she never will. It is OK, it is what it is, we all understand.
It is 4 years ago today that my mom passed away from Leukemia after a 9 month battle with it. I can relate to the family's feelings. Christmas was her favorite time of year so it has become a difficult season for me to get through. She spent her last Christmas at home only to be admitted back into the hospital the next day. Only after her passing did I learn from her close friend that she knew she wasn't going to make it and only wanted to hold on until Christmas to spend one more with us. She knew she was going to pass not long after, but couldn't bring herself to tell me. Although it was not our decision to make as in the situation in the OP, my mom, as the patient, knew and didn't want to let go until after the holiday. Still makes the season harder to face. Whether it is right before or right after, the season itself brings thoughts and memories. Of course, no matter when they pass, the anniversary will always bring up those feelings.
Choice makes all the difference in the world. But all too often the patient has no choice in the matter.
I just had a cousin that was killed right before Christmas, this decision was of the person who shot him, but I can understand family's not wanting to forever deal with something so sad at times that are supposed to be happy.
And I am one of those people who want to be kept "alive" at all costs, maybe my feelings will change as I age "I'm a 20 something", but as of know that is how I feel. And my husband as well as the rest of my family are well aware of my wishes. So sometimes it may really be what the patient wanted.
Also, remembering when my grandmother passed in ICU on a vent, my mom cried and said, "I just wanted her to make it home, to her bed, that's all." So, sometimes that may be the case, maybe they would have their family pass at home, and are just trying to get them there.
I blame TV & the media. How many times have u seen a tele-drama, movie whatever about someone on their deathbed & the granddaughter is just about to give birth to the newest baby, so grandma/grandpa MUST be kept alive, no matter what? Grandma has probably had enough of life and WANTS to go but doesn't seem to have much choice in the matter. And some Drs & nurses treat old people like they're idiots too. It also annoys me when on these TV dramas, they say something like such & such has an incurable disease, like a rare brain tumour (or whatever), and there just happens to be some new drug/surgery that's being tested, so they do it on the person and they live just that little while longer. That's the message society gets from all this media BS.
Too many people don't want to live in reality. TV, movies & dramas are a huge, influential part of people's lives today.
As children also we are not taught to accept death. When we're little, we see squished insects, or may get taken to a funeral but we don't really know what's going on. We are not taught that death is a natural part of life, even accidents leading to death are still part of the life cycle. We cannot accept it as a society. But my theory is once we start teaching children in an appropriate way, death will not become so scary. My sister would never tell her kids that their dog died or whatever, cos she didn't want them upset, she would just say some nice people took him to their farm. But I think when children do see things like that (in an appropriate setting of course), they can process the information better in their brain, and come to accept death as part of life.
We don't know what it's like at the edge of death, though we've all heard the stories about the tunnel and lights, and feeling of peace. I myself don't fear it, though I will be scared at the end no doubt. Depends on what u believe I suppose. My ex-boryfriend is a buddhist & he really believes he will go to a higher/different plane (don't know everything they believe), & told me he doesn't fear death at all.
I remember a nurse arguing with a Dr re a 90 or 92 year old lady in the hospice, they wanted to do a colonoscopy on her to have a look at what was cancerous polyps or something, to try & treat them to give her a bit more time. Well this lady knew her time had come. She didn't have dementia & didn't want to live anymore. She told us she'd had a wonderful life, had married the man she loved (who was now dead), had travelled, had her grandchildren by her side & just wanted to die at home. The Drs were really gung-ho about doing this procedure. Well my friend who was a very experienced hospice nurse just stood up to all of them, even the Director of Hospice, & said she would not allow them to do any procedures. I was so proud of her that day, advocating for her patient. And later this lady went home & the community hospice nurse told me she died not long after at home, & she looked very peaceful and content.
My father died over the Christmas holidays over 10 years ago. I still spent the better part of this Christmas weeping. Just when you think it's getting better and the grief is finally passing you realize that it never will. Having a death of someone close to you at such a time really does make it more difficult I think. Although I would never prolong a life for my own convenience, and would not have even with my father if that had been possible, I can certainly understand the strong desire to not have a death forever mar what is supposed to be a joyous family occasion such as Christmas or a birthday - especially if there are children who will be affected by the death. It's a tough call. I really see both sides. It's never easy, but I think there are "easier" times than others.
So sorry to hear this, hope u feel better today.
My ex-boyfriend (we're good friends) had a serious accident a few days ago, & we all thought he may take a turn for the worse but he's OK now. So it scared me a lot (though not the same as your experience). I was sitting wondering what would have happened if he HAD died? It would have been so awful.
you still have to wonder, if the pt would want to be kept alive...
via vents, art lines, pressors, and endless poking.
my mom died on 12/19.
2 dr's were really pressuring us, to keep her alive (if able)...if only for a few more weeks.
i demanded that all txs be stopped, KNOWING my mom would have been horrified to awaken, only to know she was going to die.
so while Christmas is bittersweet for all of her family, we also know that she died peacefully and painlessly...
as it should be.
leslie
Yes Leslie we 4get that don't we that the person doesn't want to awaken to be told there is no hope, maybe for a 2nd time if they didn't have a DNR order. What an awful time for you, I hope u r OK today :)
I certainly wouldn't want that for myself.
It's funny cos my Mum was here on holiday not long ago, & we were talking about this very thing. My Mum said she does not want ANY measures taken to keep her alive if she is in a bad accident, gets dementia, or whatever. I said I would honour her wishes no matter what.
Funny the things we discuss with family around Xmas and new year isn't it!
i agree...that it's understandable, and incredibly selfish.
it certainly does not make for a peaceful, painless dying process.
leslie
You know, it just seems to me, that if it is not Christmas, it's someones birthday, or anniversary, or christening or the all too real "I just can't face this right now".
As a society we have to face aging and death and deal with it in a more profound and realistic way.
If only for the fact that if we don't stop wastefullly spending health care dollars on futile measures, as well as hip replacements and CABG's for 90 year olds; none of us will ever see a dime of medicare coverage when WE turn 65.
I just had a cousin that was killed right before Christmas, this decision was of the person who shot him, but I can understand family's not wanting to forever deal with something so sad at times that are supposed to be happy.
And I am one of those people who want to be kept "alive" at all costs, maybe my feelings will change as I age "I'm a 20 something", but as of know that is how I feel. And my husband as well as the rest of my family are well aware of my wishes. So sometimes it may really be what the patient wanted.
Also, remembering when my grandmother passed in ICU on a vent, my mom cried and said, "I just wanted her to make it home, to her bed, that's all." So, sometimes that may be the case, maybe they would have their family pass at home, and are just trying to get them there.
But when your Gran was in ICU on a vent, I am sure it was told to your Mom that going home was not going to be possible, probably time and time again. Hope springs eternal, but there are times when reality just HAS to be faced. This is the terrible dillemma, when sometimes all of our love and good intentions can actually be cruelty and selfishness when the bigger picture is considered. This is when a physician NEEDS to step up and present reality, instead of fostering false hopes.
I will FOREVER be grateful to the ER doctor who sat with my brother after my mom was admitted with a masssive subdural and so clearly laid out her prognosis to him. She was immediately extubated, and died unconscious 1 day later. No poking, prodding or futile tests. she went in peace.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
as a former family member having a loved one die on a holiday is rough. the holiday is forever an rememberance of the death. it just is easier for the family that it does not happen on said holiday. guess i can in some way understand it.
although dad didn't actually die on christmas eve, it's the day he had his stroke. and yes, i thought about it on christmas eve. but i thought more about dad's life than his death, and they were happy thoughts. as far as i'm concerned, the anniversary of a death is just one more time to think about the person's life and what they meant to you. everyone dies. that's the only thing that's certain. it's part of life.
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nuangel1, BSN, RN
707 Posts
my mom died 3 yrs ago today .dec 29,2007.that same year my bil died 3 days before thanksgiving.my moms was totally sudden died of sepsis .as a critical care/ed nurse i had the difficult decision to make my mom dnr/dni days after xmas.my moms death brought back memories of my dads death 10 yrs earlier .both loved xmas.these holidays have become very difficult for me since.i now have very little xmas spirit all it brings is a flood of memories.but the grief is getting better.i would never prolong a loved ones passing but i too understand it.