Life, death, and dying.

Published

Specializes in Critical Care.

I've a been a nurse for two years, however it is not until recently that my mind has bee thrusted into a world of philosophical and moral questions.

Yesterday I realized to the extents that chemicals and machines keep people alive. Are they really keep people alive though? Are they keeping bodies alive? Organisms alive? These are the questions that have come to my mind.

Yesterday I was instructed per the wishes of the family to turn off all vasoactive drips. I felt guilty for feeling relief that the family had chosen this path. I felt guilty because I saw a body being kept alive by chemicals and machines, as a nurse I knew there was nothing more to do. I knew this was it and that there was nothing more to do.

However after I came home I began to think, maybe if I had more finely titrated those drips down. Maybe if I had more quickly caught the acidosis. Maybe if we had treated this quicker or that quicker or more aggressively. After about maybe an hour I dismissed these thoughts and remembered that first of all, I know well no amount of treatment can reverse this extent of damage. Secondly, as a nurse I respect the wishes of the family.

I've been left however with questions such as:

Is there a soul? When does it pass on? If so, where does it go? What is death? Is there an afterlife? Is the soul still there when there are 15 drips, a ventilator, CRRT, and ECMO keeping the body "alive"?

I suppose more than anything this was a reflective post. There's one thing that is certain is that the transition to the ICU has made me more philosophical.

Up Vote Up Vote ×
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I've written about this issue twice. My view is that death is a natural end to the circle of life; however, the average American does not hold this outlook. Essentially, we live in a death-defying, death-denying society where people want 'everything' done.

Death is not the worst thing that can happen to a person. Being kept alive indefinitely to stare at a white hospital wall while receiving artificial nutrition and an array of tubes seems like a far worse fate, at least in my opinion.

https://allnurses.com/nursing-activism-healthcare/our-death-defying-773839.html

https://allnurses.com/nurse-colleague-patient/our-death-denying-897974.html

Up Vote Up Vote ×
Specializes in Critical Care.

Death is not the worst thing that can happen to a person. Being kept alive indefinitely to stare at a white hospital wall while receiving artificial nutrition and an array of tubes seems like a far worse fate, at least in my opinion.

I agree 100%

Up Vote Up Vote ×
Specializes in ICU.

Yep, what TheCommuter said.

I am personally of the opinion that even if everything related to the person ends at death, it's still better to go into that great nothingness than being slowly tortured as the pressors kill your fingers and toes, that giant pressure ulcer on your sacrum gets worse, you get tubes stuck in every orifice, you lose control of your bodily functions because even if you are aware, you have no way of telling anyone you have to use the bathroom, your arms are tied down to keep you from pulling things out so you can't even move your hands by yourself, and somebody manhandles you every two hours in the name of preventing further skin breakdown whether you want to be manhandled or not. You get holes cut in your throat and in your stomach without your consent because it's what your family wants.

And, of course, then you are forced to be awake through all of it because your "loving" family insists that they want you awake enough to interact with them, and so you just have to deal with how bad you're hurting because they bullied the physicians into D/Cing your pain medicines.

There are a lot worse things out there than dying.

Up Vote Up Vote ×

Yes, and this is why I never wanted to work ICU.

Up Vote Up Vote ×
Specializes in Critical Care.

Goodness gracious, that's awful. D/Cing pain and sedation or lowering it enough to where they are cognizant is quite selfish and disgusting! Unfortunately I've already seen this as well in the ICU. Family is so focused on them waking up and responding and not their comfort.

I agree that this is definitely an American culture phenomenon, where death is viewed as the worst thing possible.

What good is living if all your toes and fingers are falling off from drips? If you'll be dialysis now from the renal failure? If your bowels are so necrotic you'll need an ostomy? If your mind/brain is so far gone that memories and and thoughts are no more?

I couldn't agree more with everyone.

Up Vote Up Vote ×
Specializes in ICU, LTACH, Internal Medicine.

It is far from being "only American culture" phenomenon. I have many friends in medical field all over the world, and those who practice in Westernized medicine all complain on the same. People losing their perception of everything' limits, life including, and futile care is forced upon someone who may not even wish it. It is not even human only phenomenon. Our small city recently got second dialysis clinic... veterinarian one, that is. Poor kittens on chronic life support.

The real tragedy, IMH (umble)O, is that most health care workers understand quite precisely when things start to cross the line but have no means to communicate it with neither patient, nor family. To say "look, your mom's heart is giving up, we need to push more and more drugs into her just to keep it beating, it is close to 100% that she will not improve even for an hour" is perceived by too many as "refusing hope" instead of "stopping torture", leaving alone "customer service" obligations and junk.

Up Vote Up Vote ×
Specializes in retired LTC.
Yes, and this is why I never wanted to work ICU.

Not only ICU, but LTC is similarly affected. There came a moment after I had committed my career to LTC when the finalities of life and its circle began to set in. It coincided with family member illness so a double whammy!

Up Vote Up Vote ×

I always knew when the soul left the body... by looking into the patient's eyes.

After all, they are the windows. As far as where did the soul go... is any one's guess.

We do our best to keep them alive. We need to know when to let them go.

Up Vote Up Vote ×
Specializes in ICU, LTACH, Internal Medicine.

I like, if situation permits, to let families read a small and little known story by Mark Twain named "Captain Stromfield' visit to Heaven". In short, it is a brilliantly written piece about a happy place where everyone become what they wanted to be, for real and ever. One can walk all day and night singing psalms and weaving palm fronds if he so desires but, for one example, the Richard the Lion-Hearted of England became wrestling superstar and is swarmed by mad fans on every corner, just like he wanted it to be all his Earthly life... you got the idea. Few people know about this story, and, funny thing, reading it makes them feeling kinda better pretty often.

P.S. I'm pretty much sure that there is just such place.

Up Vote Up Vote ×
Specializes in Critical Care.
I always knew when the soul left the body... by looking into the patient's eyes.

After all, they are the windows. As far as where did the soul go... is any one's guess.

We do our best to keep them alive. We need to know when to let them go.

Well all I saw that day was size 4 pupils fixed (from the paralytic we gave) and opaque and bulging from edema. Guess that soul departed long ago haha, even if he was still sort of warm at that moment in time with a MAP of 70.

Up Vote Up Vote ×
Specializes in retired LTC.
I always knew when the soul left the body... by looking into the patient's eyes.

After all, they are the windows. As far as where did the soul go... is any one's guess.

Readers, bear with me. I am NOT a Fruit Loop in a world of Cheerios! (TY to another recent poster for the quote.)

My philosophic reflection is that I want to believe the soul is the body's energy source, its battery. It is taught that "energy can neither be created nor destroyed" as physics' Law of Conservation of Energy. At a death, where does the soul's energy go? I like to believe it just floats around being shared by the rest of mankind's cellular metabolism. Energy and ATP, ADP, AMP. All those things that go "bumping" around.

How do you explain what propels sodium and potassium to cross cell membranes or for nerve action across the synaptic junction? Energy. Static electricity from my clothes dryer stinging me? Energy.

It's just there. And it's finite. If enough 'floats' out of the soul without enough floating back in, then it's empty. The circle of life complete.

Sounds simple, right? There's more for another time.

BTW - 4/13 was 75th birthday of Cheerios. Introduced 1941.

Up Vote Up Vote ×
+ Join the Discussion