Life, death, and dying.

[CardiacDork]

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.

[Libby1987]

The ironic part is how non death defying we can be when we aren't dying and actually have a chance to lengthen our lives.

[Been there,done that, ASN, RN]

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.

Never could get pupil size down, especially in an emergent situation. I mean who really gives a rat's pattoti about pupil size , unless they are unequal?

Were they opaque from edema.. or was the window closed?

I was called to my father's bedside after many days in ICU. I knew the minute I looked into his eyes... he was gone.. even though that damn ventilator kept his chest rising and falling.

[Kiki1970]

Never could get pupil size down, especially in an emergent situation. I mean who really gives a rat's pattoti about pupil size , unless they are unequal?

Were they opaque from edema.. or was the window closed?

I was called to my father's bedside after many days in ICU. I knew the minute I looked into his eyes... he was gone.. even though that damn ventilator kept his chest rising and falling.

LOL! I love that saying; "rat's pittoti". Reminds me of my grandmother.

[CardiacDork, MSN, RN]

I'm a Fruit Loop & proud at that!

[CardiacDork, MSN, RN]

Never could get pupil size down, especially in an emergent situation. I mean who really gives a rat's pattoti about pupil size , unless they are unequal?

Were they opaque from edema.. or was the window closed?

I was called to my father's bedside after many days in ICU. I knew the minute I looked into his eyes... he was gone.. even though that damn ventilator kept his chest rising and falling.

I think the window closed down. There was a lot of edema though. Them eye balls were poppin' !!!

[Been there,done that, ASN, RN]

I think the window closed down. There was a lot of edema though. Them eye balls were poppin' !!!

Well then, close those eyelids and move on.

[CardiacDork, MSN, RN]

Well then, close those eyelids and move on.

And that we did. On to the next admission it was. A young trauma patient. The circle of life keeps going!

[Been there,done that, ASN, RN]

Party on Dork! You are a skilled and thoughtful nurse. Wondering if "the mind has been thrusted into a world of philosophical and moral questions"... changes direction when the patient is young.

[djh123]

It's not surprising that you're thinking a lot about this death. It doesn't have to be in the ICU ... I've had a few in my LTC facility that I kept thinking about over and over again. It's one of the tougher things we deal with as nurses. Yet sometimes - and much as been written about death, dying, 'good' deaths or not - it's almost 'good' for the patient and their family, depending on many different pieces of the situation.

[anon456, BSN, RN]

I just moved to hospice nursing after 4.5 years in ICU and stepdown ICU. I had many of the same feelings as you. Each person has to answer some of those questions for themselves per their spiritual and personal beliefs. I can tell you that death does not have to be painful, it can be done in a controlled manner. Hospice doctors and nurses have it down to a science so that the majority of patients can be at peace, slip into a comatose state as the disease progresses, and die peacefully. Of course it's not a perfect science, but it's a whole lot better than what I saw in the hospital.

[Raviepoo]

The questions you're asking aren't easily answered and the answers are not the same for everyone. In my opinion, my father died 2 years before his organs failed. He suferred a TBI and never became conscious again. All of his life experiences; all of his memories; all that made him himself were lost forever. Although his body existed for 2 years after that, no one will ever convince me that he was still in it. A religious person would not agree with that assessment, but that doesn't matter to me or to my mother who made the decision to have his feeding tube removed. End of life decisions are personal and should not be dictated.

May I suggest some reading that might help you come up with your own answers? A good place to start is Being Mortal: Medicine and What Matters in the End by Atul Gawande.

[CardiacDork, MSN, RN]

Although his body existed for 2 years after that, no one will ever convince me that he was still in it. A religious person would not agree with that assessment, but that doesn't matter to me or to my mother who made the decision to have his feeding tube removed. End of life decisions are personal and should not be dictated.

I do agree with. I also do agree that a religious person may tend to disagree with our similar views.

I will look into those readings, thanks.