Problem with doc/ dying patient-kinda long

[lpn1313]

Well, here's the situation: Resident is mottled to groin on one leg, to the upper thigh an the other- for three days. Nonresponsive, bp down, apical high, resps in the 30's with O2 on, no po intake for four days. Doc has IV fluids infusing because the lab numbers are off... did I mention that res. was no void for almost 15 hours? Spoke with family, who were asking my favorite question "When will he die?" Explained to them that with IV fluids running there was no definite answer, but that the fluid was running out of places to go- bilateral hands grossly swollen, oral suctioning being done. Family saks if we turn off IV what will happen, will he suffer with no food or water. I explained to them what happens at end of life and system shut down. Family states "stop the IV" Sooo... I call the Doc and tell him that the POA wants IV stopped. Doc launches into this rant about how 'you want him dead! He needs that IV to live, and you want to kill him! If you do that then I'm negligent. You people always want to do this sort of thing. Leave the IV in and let God take him when he's ready' I'm sure there was more but I handed the phone to the supervisor. Doc finally says that we can stop IV only if Hospice is involved. Family agrees to this and we shut off IV. Resident died 13 hours later, peacefully and comfortably.

Has anyone else run into this with an Doc? I find it difficult to believe that someone would think that IV fluids in a patient obviously dying is letting 'God take him when he's ready.' Have Doc's become so afraid of lawsuits that they feel this sort of behavior is appropriate?

[CapeCodMermaid, RN]

Sure--we get docs like that all the time. I hate to clue them in, but IV fluids really are NOT life saving. What's worse, and we hear this too often at clinical meeting, is if someone has stopped eating or doesn't eat enough, some dimwit will pipe up with "How about some IV feeding"...helloooo...it's fluids not food and a bag of IV fluid has less calories that a chocolate chip cookie. We all need more education on death and dying.

[hollyster]

Has anyone else run into this with an Doc? I find it difficult to believe that someone would think that IV fluids in a patient obviously dying is letting 'God take him when he's ready.' Have Doc's become so afraid of lawsuits that they feel this sort of behavior is appropriate?

Unfortunately, the fear of lawsuits influences pt care quite frequently. I personally feel that the pt and family's wishes be honored.

[leslie :-D]

thank God the family/poa were so realistic and reasonable.

i don't know how many families that have wanted iv's started on their dying, loved ones.

too many md's have a cya attitude and just do not know how to deal w/end of life issues. their egos take it too personally.

i'm glad hospice was involved and your pt died peacefully.

wouldn't you just love to dope slap some of these docs?

leslie