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.
When I was a tech in nursing school at the VA there was a patient that had a massive stroke, on tube feeding in a vegetative state, being cared for by the wife at home. He was admitted with pneumonia and was starting to deteriorate and was closed to being intubated and the nurse asked if she wanted that for him she said "yes, I need his check".
That aside most family members have good intentions for their loved ones and find it hard to not engage in futile care. They want to sleep at night be able to say to themselves and everyone "we did all we good and he/she put up a good fight" and not wonder if they did all they could.
Tweety, BSN, RN
36,332 Posts
When I was a tech in nursing school at the VA there was a patient that had a massive stroke, on tube feeding in a vegetative state, being cared for by the wife at home. He was admitted with pneumonia and was starting to deteriorate and was closed to being intubated and the nurse asked if she wanted that for him she said "yes, I need his check".
That aside most family members have good intentions for their loved ones and find it hard to not engage in futile care. They want to sleep at night be able to say to themselves and everyone "we did all we good and he/she put up a good fight" and not wonder if they did all they could.