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.
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.
Admittedly I have been thinking quite a bit about this patients death. It was my first patient death under my care as primary nurse in the ICU. I never had a patient die under my care before. My background was postoperative, so death was far from the agenda as most patient always progressed.
This is another part of transitioning and growing. I would be more worried if I didn't have philosophical questions or thoughts surrounding this event as a new ICU nurse.
I've also taken note of my coping abilities, such as being able to joke about death. Something I knew happened but never partook in as I never had patients death. It is interesting how joking about death with other nurses in the break room, while a dark humor - is a form of coping.
When I was in the room with the patient and the wife, (still continuing care at this point) - the wife asked if he was still cold. When she said that I thought in my mind, "oh he's getting pretty cold alright". 🙄🙄🙄
She is also a champion for Slow Medicine, which is something that I am a big advocate of as well.
My unit manager stated it so well the other day that unfortunately in many cases, we are treating our patients to death. Somehow, somewhere, society has grown to believe that this is okay, to be treated to death. Somehow, somewhere, the medical field has made it okay to treat people to death. It makes perfect sense that the OP would have these feelings of conflict because ultimately, we are not meant to be treated to death.
Specializes in Float Pool - A Little Bit of Everything.
Hi,
I think how you are feeling is the natural part of the ICU nursing experience. I wish I had any advice, but these are questions I think we all work out in our heads in one way or another. There will always be patients and experiences that stick with you and make you question everything. Just as long as we always advocate for our patients and not let any of our bias influence patient care, we are doing the right thing. Remember how important self care is, in this setting. If you don't self care you burn out!
As a ICU nurse I feel your pain and have done this all too often. I watched family keep essentially a body alive in a bed to the point that it begins to breakdown. No matter how we turn them, feed them nutrition and provide hydration its a lifeless vessel. I understand wanting to try to live but there is a point of diminishing returns and its just inhumane. I have long felt the general public is so far removed from the life and death process thanks to hospitals and modern medicine they now have no realistic understanding and expectation of quality of life and the eventual end. The general public has a mentality that hospitals should and do have fixes for everything. And everyone is special. The fact is we are going to die and the only unknown is when. I have had to explain this to adults far older than myself way more times than I care to imagine.
It has gotten common to see post open hearts in 80-90s now. Do they survive? sure, (as long as they make it post op 30 days at least for surgeon and billing purposes) but they are already at the end of their bodily life expectancy so why put through that when they may only live 2-4 more years at most? Not to mention their quality life is diminished greatly. I have seen family reverse patient DNR wishes once they are intubated only to turn what would be a peaceful quick death into a long and slow decay.
My worst situation was a man in late 60s who had mets cancer all over especially in the abdomen with massive painful tumors. He kept demanding we do everything but everything had been done. Family stayed in denial and when he lost consciousness of course he got intubated and followed by pressers and more worthless chemo. He died a slow ugly death on pressers maxed out to point he begin to loose fingers. Ethics committees and everything (ethics committees are useless FYI, bunch people meet and family says I'll sue and they back down). It was emotionally exhausting for family, staff and doctors.
Another patient I had was a 96 years old on bipap...she was literally just dying from old age..liver failing, respiratory failure, CHF...all fantasy medical terms but the fact is the car had gotten old and worn out...her body could carry her no further. The family wanted to put her on vent so she could make to be 97 in 3 weeks. I felt like I was living in some altered reality when her kids were visiting her in walkers, a wheelchair, wearing portable O2 and telling us to do everything. THANK GOODNESS one was an old military medic who talked some sense into them at a family meeting. They let her die peacefully.
What burns me up inside is the patient on hospice who are actively dying at home and family members panic when they start breathing shallow or go apneic and call 911, revoke their hospice status and send them to the ICU. This should be illegal and punishable by jail IMO.
Back to the point. I feel our society has no clue about death, quality of life and nor do they ever even remotely discuss it with family. So when when it occurs they are totally unprepared unlike older times when people died at home and family had to help care for their loved ones. Patients and their families have lost their intimate understanding of the death and life process in large part due to our culture of "we can fix anything". MDs have also gotten terrible at addressing these issues.
Some countries have mandatory military service but ours should have a mandatory law that every citizen work in a nursing home for at least a year. And no, not the rich nice assisted living ones....
Focus on the successes and good outcomes..there are reasonable families and patients. I try to use them on going source inspiration.
Hang in there...its exhausting but its also rewarding.
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.
All too often treatment like you describe ends up prolonging a person's death; not their life.
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.
Not trying to be a soul crusher here but here is a great link to an episode of Radiolab (NPR) called cellmates- as in living cells. The part about how much power/energy is created by mitochondria is amazing. I mean it's a ridiculous amount of energy. All of Radiolab's episode are worth listening to.
This is a society that does not want to talk about death and dying. People do not even want to discuss natural aging and all that comes with it. The progress in medicine and nutrition created the illusion that everything is possible - and if not right now perhaps in 1 day or one week ....perhaps next month we will be able to cure cancer, or be in good health at age 95 or live forever....
Aging is rarely ever seen as something that occurs naturally and comes with a decline in functioning and health problems. Instead, the mantra is "treat treat treat" no matter how futile.
I can not even write about the things I hear on a daily basis. From the family who wants full resuscitation for their almost 100 y old matriarch despite the fact that the pat is bed bound, advanced dementia and pneumonia...not eating anymore either.
Or the family that wants their 90+ family member to start dialysis.
Or the patient who has cancer from head to toe age 90+ and who says "what do you mean palliative care - I am young - never mind that I can't move, incontinent, bedsores" and so on.
Top 10 this week is the almost 100 patient who is a full code and will most likely stay a full code despite the list of illnesses. "Of course I want everything done". When told that resuscitation - no matter what the reason would be - would not be successful and result in getting up and leaving the hospital - the patient states that at least it should be tried.
What happened to aging and illness as normal part of life? What happened to common sense and acceptance that we all have to die at some point.
You hit it on the head. Working in critical care has turned me into an existentialist. What's the meaning of all this? What is death really? Theologies, dogma, religious beliefs, etc. are good and all until you actually watch person after person die in front of you. I've stepped away from ICU because it has shaken my soul. I'll return one day when I've made my own perspective on what life is. And by the way....please don't beat yourself up with the "if only I would have done this".....most of these people can't be saved. I've been there too. Had patients with balloon pumps, crrt, VADs, and a dozen drips that die (then I wonder what I did wrong). Looking back, I was just perfusing someone who had already died days ago. ICU is a life-changer for all involved. Nothing can prepare you or predict what will happen inside of you after entering that environment over and over again. Be well. TAKE CARE OF YOURSELF.
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.
Paralytic do not alter pupil size or the pupillary light reflex.
I believe the soul is just a function of the brain. Its your personality. Sure, its awful when people are brain dead and kept alive artificially but I think its 100000x worse when you know they are still there inside but just cant communicate in any way. I have known a few residents in the nursing home who I could look at in the eye and know with certainty that they have awareness. They stare back in desperation trying to speak but all they can to is growl and drool. Its so sad.
The book Ghost Boy by Martin Pistorius is about the above scenario. I highly recommend.
Though this will be controversial, I have to say it; it is merely answering the end of the OP's post.
According to the Bible, every man has a soul. Also there is an afterlife - either heaven or hell. The deciding factor is whether or not each person has repented of their sins and placed their trust in Jesus Christ as their LORD and Saviour. Life's question from Mark 8:36, "For what shall it profit a man, if he shall gain the whole world, and lose his own soul? We have all broken God's Law, just look at the 10 Commandments for an example. Even though a holy God said the penalty for sin his death, He has offered us life after death through His Son, Jesus Christ, if we turn to Him for salvation.
- this would be in answer to the OP's question about the afterlife and if a person has a soul - it is still on topic.
As for a person on life support, I cannot say. It seems like a very difficult topic. I would be very careful, however, to make a person's life and death subjective to whomever is caring for them. In other words, one person may determine that even though a person may be mentally alert, that their quality of life is low and they are unable to voice their wishes; that they should be "let go". Another person, such as myself would think that borders on murder.
Where do you draw the line? Hitler decided that elderly, handicapped, and disabled people were not supportive to society and therefore they could be killed. It may be a shocking comparison, but euthanasia is still practised in some parts of the world. - just a thought-provoker - still on topic.
I know that a number of people may not agree with what I wrote. That is understandable, however, just because someone does not believe or agree with something does not mean that it does not exist. For example, I could say that because I never saw the moon landing in person, than it was a hoax. That would be my opinion, as we definitely have evidence that it happened and more than once. Whatever your thoughts are about God, heaven and hell, and people's souls, just remember, that when each one of us dies, we will stand before God to give an account of our lives. Each person does have a soul and there is life after death.
Thank you, OP, for your thought-provoking post. It raised some reflections of my own. Healthcare certainly brings up interesting topics. Have a wonderful weekend! I may not post for a while if anybody wonders, as I have finals for the next 3 wks.
I enjoyed reading everyones input on this subject. I started on an Oncology Floor with some pretty sick patients getting Chemo. Its not easy seeing people go through this because Cancer has no limit to age, some are so young. Its a daily struggle to make a differance in my patients lives.
CardiacDork, MSN, RN
577 Posts
Admittedly I have been thinking quite a bit about this patients death. It was my first patient death under my care as primary nurse in the ICU. I never had a patient die under my care before. My background was postoperative, so death was far from the agenda as most patient always progressed.
This is another part of transitioning and growing. I would be more worried if I didn't have philosophical questions or thoughts surrounding this event as a new ICU nurse.
I've also taken note of my coping abilities, such as being able to joke about death. Something I knew happened but never partook in as I never had patients death. It is interesting how joking about death with other nurses in the break room, while a dark humor - is a form of coping.
When I was in the room with the patient and the wife, (still continuing care at this point) - the wife asked if he was still cold. When she said that I thought in my mind, "oh he's getting pretty cold alright". 🙄🙄🙄