Neuro ICU - Do you talk to brain-dead patients?

Specialties Neuro

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I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients (oh the joys of ethics approval committees!). My interest in this started when I read 'Rethinking life and death' by ethicist Peter Singer - he described observing nurses in ICU talking to brain dead patients as though they were alive, and from that decided they did it because they didn't understand that the patients were clinically dead.

I think that nurses who talk to their brain dead patients do it for a variety of reasons, which may included (but are not limited) to issues about reconciling the apparently living body (sensory knowledge) with knowledge about brain death (intellectual knowledge). I don't work in ICU, though I do work on a nero unit; I always talk to the unconscious, and sometimes talk to patients who have died.

I was at a conference in the UK last year, and an ICU nurse educator said that she not only never talks to brain dead patients, she corrects any students who do. However, one of the anaesthetists there always speaks to his brian dead patients. They're ruining my research!

What do you all think? This isn't something that will make it into my thesis, BTW, but I'm interested in what you think about the project idea, and about your own practice.

I am a student nurse, I have been taking care of a "brain dead" patient who only maintains brain stem function. We always talk to her like she can hear us. Although, I will agree that it is mostly because her family refuses to let go and believes that she is going to recover. On a side note, she groans at times and sometimes it sounds as if she's trying to clear her throat. Is this also part of brain stem function, or could this be a sign of actual recovery? However, while her eyes open at random, she does not track at all, they simply move from one side to the other.

Any thoughts?

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Specializes in CTICU.

If she has brain stem function, she's not brain dead.

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Specializes in PICU, surgical post-op.

Almost 11 years ago now, my cousin (17 at the time, and he might as well have been my brother) was admitted to the CCU at Sick Kids in Toronto after a near drowning. It was one of those freak accidents; he was under no more than 5 minutes, but he was completely brain dead as a result. My aunt and uncle were in France at the time, and the rest of our family is spread around the States and Canada, so it took a day or so for everyone to get there - my family was one of the first to arrive.

The way his nurses treated him is a huge part of the reason that I became a PICU nurse after graduating. I ended up unofficially being the "death and dying" nurse in our PICU, and I dealt with many brain dead children in just 2 years. I know exactly how much work and technology goes into sustaining those kiddos until support is withdrawn, especially if they're going to donate. Sometimes it feels like there's nowhere to turn around in their rooms.

But I remember Johnny's room so clearly. The nurse had all the pumps and wires tucked away behind his bed. The curtains were open to let in the sunshine, and she moved quietly around his bed, putting lotion on his hands and vaseline on his lips, chatting to him. "It's a beautiful day, Johnny. Your cousin is here to see you. She wants to say goodbye. Everyone's here to say goodbye."

I knew that he was dead. We all did, and his nurse, even though she talked to him, reinforced that by "telling" him that we were there to say goodbye. Every single time I take care of a brain dead or otherwise dying patient, I think of her. And I always talk, as long as it's a family that understands what's going on, that brain dead is dead. As others have said before, if it's a family who isn't getting it or can't let go of their hope, I'll tailor my interactions to whatever is going to make the experience easiest for them. I think that only happened once; every other time, I've been part of withdrawls on brain dead kids who I've spent the day talking to, singing lullabyes to, and praying over if the family wants me to.

I've spent the last 11 years wishing I knew who that nurse was that took care of my cousin and wishing I could thank her for what she did for me and for my family by talking to my cousin. "It's a beautiful day, Johnny."

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Thanks for sharing your personal family experience. Sounds like it has given you a gift that you have given to other families going through this heart-wrenching experience. Would you share how "you tailor my interactions" for those who don't quite get the "brain dead is dead" patient? Wish I could sing better...

So glad to have you as a fellow nurse!!!

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Specializes in PICU, surgical post-op.
Would you share how "you tailor my interactions" for those who don't quite get the "brain dead is dead" patient? Wish I could sing better...

It was mostly refraining from talking to the kids in front of their parents. If the parents were holding out hope in the face of properly-done brain death criteria and a signed death certificate, my talking to their kid was only going to confuse them. Those parents tended to get more agitated if I spent much time out of the room, in case I "missed" something or failed to do something for their kid that would help them get better. I would spend extra time IN the rooms, but would try to make a point of sitting down to talk to the parents, giving at least the unconscious impression that my work was finished (if that makes sense).

But like I said, for a family like mine, who had a grasp on the finality of the situation, I always talk. And I'll do pretty much anything that makes the family feel better. I've held hands with the priest and said prayers, I've shaved a baby's head, I've made pink and purple hand prints of a 16 year-old girl because her mama wanted them.

The biggest thing is education. I find that most people have no idea what death is going to look like, especially death after withdrawl on a brain dead kid. They often expect gasping and moaning, and the eerie stillness after that tube is pulled can be really scary for them. I always make sure I explain that they won't breathe, but that it could take some time for the heart to stop. And then we decide together how long they want to stay. I had one daddy decide that he wanted to be the one to know first, and he didn't want me telling him. So when we pulled the tube, he curled up next to his daughter, his head on her chest, not moving a muscle. Ten minutes later, he finally lifted his head to tell me that she was gone, that he couldn't hear anything anymore. I saw him later that year at our memorial service, and he told me that being able to do that let him feel like he had some tiny measure of control when his life was spinning out of his grasp.

I've been out of the PICU world for almost 2 years now, working on a hospital ship in West Africa, and I really do miss it sometimes.

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Specializes in CTICU.

You sound like a fantastic nurse.

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Specializes in ICU.

Thank you for sharing that, AliRae. It was very touching.

As for me talking to brain dead patients? Sure do. I also like to give them a good bath and shave if needed before we withdraw.

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Specializes in Med-Surg with tele.

I still talk to my brain dead patients, but I think you have to be careful if family is present if they are unrealistic about condition / prognosis.

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Specializes in Trauma/Critical Care.
I still talk to my brain dead patients, but I think you have to be careful if family is present if they are unrealistic about condition / prognosis.

Hi Guys,

Interesting Discussion!!

For some reason reading some of the post I get the impression that some nurses believe that the patient is "still there", please remenber that once someone had been declared "brain death"...that is, they are DEATH.

Personally I still talk to my brain death patients...but out respect for them. As Kristyn mentioned, I have to be careful of doing that in front of the family.

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Specializes in Medical.

It's possible that some people think that the brain dead patient is in some way still present, without beleiving they're still alive. I found in my research that all the interviewed ICU nurses who spoke to their brain dead aptients also spoke to their somatically (on non-heart-beating) dead patients, too. That's why I'm now conducting research into why health care practitioners who talk to their dead patients do so. If you talk to your patients while performing death work (eg preparing the body for the morgue, assessing the body for signs of life, during autopsy or in the morgue) and would be interested in writing a little about it, please let me know :)

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Specializes in critical care, PACU.

I still talk to brain dead patients and a family member summed it up real well before saying "it keeps the human aspect involved". Thats why I do it.

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Specializes in NICU.
It's possible that some people think that the brain dead patient is in some way still present, without beleiving they're still alive. I found in my research that all the interviewed ICU nurses who spoke to their brain dead aptients also spoke to their somatically (on non-heart-beating) dead patients, too. That's why I'm now conducting research into why health care practitioners who talk to their dead patients do so. If you talk to your patients while performing death work (eg preparing the body for the morgue, assessing the body for signs of life, during autopsy or in the morgue) and would be interested in writing a little about it, please let me know :)

Interesting thread.

I'm guilty I guess. I do talk to my dead patients during post mortem care. I feel as if it is disrespectful to just flop them all around and treat the body like it isn't a person. I know the patient is dead.... I guess maybe it is out of habit also.

I also talk to my intubated, sedated, non-responsive patients.

I also talk to my patients who have anoxic brain injuries.

Maybe it is out of habit.. Maybe it is out of respect. IDK

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