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So sorry you are facing this. There are no words that can convey the agonies loved ones experience. My most recent related experience with a COVID patient was in a support role for a family as mechanical assistance was stopped for the patient after months of ups and downs. The patient never left acute care. I can only say the family members deeply regretted not, "calling it quits", earlier. I prefer to look at such decisions as a change of focus. It was the patient who finally, repeatedly insisted that the family allow them to die.

Late to this thread, but a couple of points: Squeeze a bag full of liquid. If there is an exit point, forceful expulsion will occur. The definition of projectile vomiting does not depend on cause. It is a simple label for a physiological event. One cause can be related to CNS pathology. I have seen projectile vomiting at the time of death several times. In all but one, the dying patient's stomach was full of fluid due to obstruction/ileus, and was not being effectively emptied--NGT occluded, suction turned off, gastric filling not identified. Muscle contraction is not an uncommon event in the dying process. If it is the abdominal and chest muscles squeezing down hard, anything in the stomach that can come out will come out through the mouth and nose. Position those participating in the vigil at the patient's side, never at the feet. Second, I don't find the notions of toxins particularly useful in discussions that aren't informed by the medical definitions/examples. Specifically, what toxins? How did they get there? What is the physiologic function that causes "toxins" to be deposited in the stomach? When those organs involved in filtering and waste disposal are shutting down, normally occurring compounds build up to abnormally high concentration and become "toxic", but are not in and of themselves toxins. I'm with Leslie. The simpler the better when you are working with friends and family at the end of life. Stuff can come out of the body at the end: stool, urine, stomach contents, tears, vocalizations, flatus, belches, blood. Prepare them gently and pray for a peaceful transition.

It is one of the best things in our relationship/friendship.

Welcome, Prodigal. It sounds like you're taking a healthy chunk of responsibility. There's a lot of story in the little bit you posted; lots of "wreckage" along with its pain and grieving. Hang in there. I'm not particularly religious, but in my case anyway, I must credit the Higher Power. That "inside job" stuff is critical in my case. I worked at some pretty low paying, menial non-nursing jobs before I re-entered nursing in a non-clinical documents review position for an insurance company. I didn't have a felony conviction, however, which means I didn't get processed through law enforcement for the felonies I committed. I don't have advice that way. Hang in there! You know the drill, one day...one step...one prayer at a time.

Hi tanthalas and all, I dropped out of pre-med (biology major) half way through my senior year. I was already a RN, making top grades, and pretty much been invited to apply to a couple medical schools. Why did I drop out? I realized I was doing it because my culture held MDs in the highest esteem. It was expected that anyone who could, should. Men in nursing who are good at it will receive a kind of respect from the other nurses that physicians rarely do. I did not like the attitudes of my peers; tissue technicians. I really liked hanging with the nurses more than the doctors. Even the women in medicine can be intolerably macho. I realized my heart was not in it--too type B. I like operating below radar, which is what my RN allows me to do. I realized I really didn't care about the prestige. I don't care if people think I'm gay. I don't care that people think I would have been a good doctor. I really don't even care about the money. At the University teaching hospital I work at, the veteran nurses are highly respected, and their input is translated to plan of care and Attending MD orders often above even resident level MDs. Nursing has its up and down sides, like anything, but it has given me the freedom AND finances to pursue the other loves of my heart: family (insert major cardiac emoticon here), surfing, art, and without the pre-load of expectations that always goes with the MD. How many doctors report liking their jobs? I rest my case.

Thanks for sharing your story. ...cunning, baffling, and powerful. You've had some major losses that have to hurt. Glad you're here. Keep coming back to your Higher Power, whatever that means to you.

I resent daily moral dilemmas presented by management structures (ultimately shareholders) that require the pretense of patient centered priorities in order to reduce legal liability, but care only about money concerns. They might as well demand that we falsify our documentation. I love patient care. I would like to actually be able to do it more often instead of service the patient care assembly line. I try to nurture the spiritual/inner peace chunk of my being, although I'm not very religious. I play with my kids, go shopping with my wife, make art, surf, and grow bamboo.

Hi Ryan, I don't remember what it was like to be 34. I'm closing on 53 and would do it again right now. Go for it. I agree with other posters that you will probably have more options and better compensation if you go for the RN first. I worked my way through school as an "orderly", which is what they called the male nurses assistants where I started. I got the core of my real nursing education in the nursing assistant role. Good luck!

First profession for me. 32 years ago it was pretty rare. I was working nights as a janitor. I had dropped out of high school because I was living on my own and needed to support myself. Nurses on the surgical floor befriended me, convinced me I would be a good nurse, and went on to procure some funding to get me started. It wouldn't have been my first choice except for those fortuitous events. Although it has been difficult at times to stay with, I wouldn't do it any other way. There were those nurses in the early years that requested that no male nurse ever be assigned to work under them, or anywhere on their floor. I didn't let it bother me too much. For men, nursing offers a very unique perspective on life, and allows for a different set of relationships with women than most careers--women have been my bosses, friends, colleagues, mentors, and counselors for most of my working life. It has been helpful that I've really never cared much about what people think about me. I'm married to a RN also. I also have a BS in Information Technology, but haven't found an offer yet that is attractive enough to pull me away from nursing. Stringer

Personally, I never needed to be abused in order to need a fix. I know that the stresses of our profession contribute to and trigger a lot of dysfunction. A lot of what you point out above seems to go along with a higher rate of addiction problems, to be sure. Speaking for myself, however, I don't care if I was getting a piggyback ride from Jesus on the streets of gold. Before recovery I'd probably be thinking, "This would be cool with __________." (fill in your fix of choice) Oh gosh. The sun came up again. I need a fix. But that's just me. Stringer

Hi and thanks for your post. Ultimately, even if others here think you do or do not have a problem, only your decision will end up having any weight. I'm not sure if anything I say applies to you, but for me, I maintained the notion of "controllable" under conditions that appear ridiculous now. For life in general, I really think control is an illusion. But that's just me. Take Care

thanks for sharing. wow, it really must be difficult when you start so young. that carries a whole other level of psychology with it. i didn't start until i married a smoker. i quit smoking so many times... although i did not bring it up in na/aa meetings, i started to incorporate smoking into my 12 step routines. still could not quit. i'm not sure what finally took--probably the kids, one way or another. gum helped me, but i know it doesn't help everyone. like mr. tweetie said in another post, you only fail when you stop trying. :smiley_ab peace to you, quit or not. stringer

I don't think they are accomplishing what they hope or think they are. I don't think they are pure evil either. Also, an incidental problem is that health care entities themselves resort to paperwork and other nonsense to fix problems. "Contempt," I think best characterizes the attitude of the front line nurses toward TJC these days. That physicians formed the original organization to address physician concerns, unfortunately, engineered genuine nurse input out of the system, in my opinion. I do not believe the more global perspective of actual patient care issues nursing can offer is adequately represented. Another area of concern has to do with TJC methodology. When they shifted to measuring outcomes based on "Indicators", they initiated a symptom based response by health care systems in order to show well with respect to indicators, often not addressing the problems that cause the symptoms. I guess one could argue that if a hospital can't even come up with the dog and pony show required to squeak through survey, there probably really is something wrong. I believe this has been recognized and TJC is trying to correct this internal deficiency through "tracers" and surprise visits. Of course, they never really are a surprise, we just have less lead time now days; hospitals need to be a little more ready now. Our last survey still seemed like the good old last minute rush, with early warning systems in place to get the staff in who show well, and get the teams running ahead to put on a good face. Most troubling is the concern that the data that drives TJC is fundamentally flawed in that it does not reflect what is. Again, the people in the front line who have the most at stake, and the most accurate information are usually not even aware of the data collection tools like ORYX, let alone given a voice. It would be interesting to see direct care givers given more power on the boards and committees that make the decisions for TJC.

You Rock. Seeing an Admin be forthright here has a lot to do with my joining this Web site, and this forum in general. I have been watching allnurses for some time. Your post brought me through the door. Thank you!

Hi all, I'm Stringer, and my primary qualification is narcotics addict, but as most of you probably know, the addictive mind won't turn down many opportunities to include just about any repeatable behavior into the web. My experience includes alcohol and nicotine. My sobriety dates from August of 2000, but I turned myself in originally in 1995. Subsequently I failed Diversion for financial reasons and successfully finished the probation track for clearing my license about a year ago. You can tell from the brief time line sketched above that it has been a long hard journey. To add a complicating factor, my wife is also a recovering RN who is almost done with her probation track. There was a period of time where it appeared that we might lose everything, and we had 4 children at the time. We lost our 12 year old son to brain cancer at a time we were both in relapse. We lost just about everything, but I'm not able to tell the whole story here. For me, the keys to success have been and continue to be: 1) Keep coming back, especially to your Higher Power, no matter how much you love your "sins" and loathe to give them up, no matter how entrenched you are in compulsions and their attendant lies. He/She/It/They will no more reject you than you would reject your son or daughter who finds themselves in a long siege. 2) Keep coming back to your associations with people who will support you and who can pull your covers. 3) 12 Steps over and over with an experienced sponsor. The onion peeling metaphor has value here. For me, it's a continuous process of growth. Give yourself a break. I'm thrilled to be on the recovering side of the abyss. I can't tell you! It's a little scary to come out with this on such a public forum, but if I can offer some support and in doing, strengthen my own recovery, I'm in. Thanks, Stringer (chanting) Keep coming back!