Scheduling Death??

It is time that our society quit hiding from this issue. For years docs and hospitals have touted all the latest gadgets that are destined to save people. But they won't educate people that you can't save everyone no matter how much technology you have. Docs don't like to admit that they are not God.

I do what is best for my patient first, then the family. If those two collide - the patient gets preference and the family will just have to be mad at me.

How awful. That poor man. I hope he stays comfortable.

Please update this thread. I am going to have him on my mind now. I wish I hadn't even read this.

what a heart wrenching story--i too have exp similiar events, family wanting the loved one to stay on the vent till other family can arrive, or to keep raising the leveophed till other family can arrive etc etc etc. it puts us in an awful situation, and correct me if i am wrong, even though the patient alert and oriented gives wishes, as soon as patient is not alert/oreiented family can change thier wishes?? it makes no sence to me, and why even have living wills?>??

my favorite line you wrote was " and i told them that putting him on o2 instead on intubating him if he declines is not making a decision to kill him(the cancer is doing that), but just respecting his wishes and making him comfortable as the vent will not cure him, "

i plan on using that myself next time the occasion arrises.

good luck, it is frustrating i know, but your doing the best you can for everyone involved...get some rest..

it's usually at this point that i become very frank with the family often telling them that sometimes they have to LOVE the patient enough to let him go, free him of his suffering. placed in those terms their own selfish needs are brought to light and they are reminded what's really important......dear old dad's wants and needs. i hope his suffering ends quickly and quietly......for his sake.

How sad that his condition is such a burden that they can't schedule time in for him to die. I bet it is more inconvenient for him that he is passing than it is for them to have to take a couple days off of work.

I think that is a bunch of BS the doctor should have honored the pt's wishes not the families. Unfortunatly like stated before after his LOC decreases family is in charge. It's very sad that they are keeping him alive for their own benefit. Why would you want some one you love to suffer any more than they already have especially knowing that that is not what they want. :confused:It just makes me soooooo mad. I just can't even comprehend how selfish and disrespectful that family is being towards the pt. It sounds like you did a great job explaining to them what HE wanted but they did not want to hear it.

I realize that it's very hard for them and they are more than likely in denial but someone needs to give them a hardcore reality check perhaps the doctor should have spoke to the family. I guess by the sounds of it it probably wouldn't have detered them from prolonging his life as that would interfere w/ their plans and arrangements.

Please let us know what happens.

I see situations like this in pediatrics often enough to know it's not an easy path. We sometimes see young adults who have had cardiac conditions, CP or other life-long issues who keep being referred back to peds because the adult service is "uncomfortable". These young people often have parents just can't let them be adults and make their own health care choices. I feel that if they're mentally competent and cognitively normal, their wishes should matter!! We have a case like this right now where the poor patient's wishes have been ignored, and now he's not conscious or able to make his desires known. It's hard and creates so much moral distress for us.

That situation seems horrible and selfish to let someone suffer while the family gets their "affairs in order." Unfortunately, I have seen this same thing play out many many times in ICU. I once had a 50 something year old lady who arrested in the nursing home she was living in. They were able to get her back and she was intubated in the ICU for several days by the time I was assigned to her. No one knew how long she was down at the nursing home, but she was not breathing above the vent at all. Her only living relative was a cousin who lived out of state. She was consenting to everything we needed, but would not make her a DNR though until she came down to the hospital. However, she was not willing to take off work to do that, so she wanted everyone, including her poor cousin, to wait until a week later when she had some time off to come down and make a decision. A neurologist was actually going to pronounce her brain dead because her EEG was flat (I believe), but when doing an apnea test, she had one agonal breath after 2 minutes. The patient did eventually die when the cousin made time to come down and withdraw treatment; the good thing is that due to her age she was still a good organ donor candidate and her cousin was willing to donate.

How come the family can override the patient here?! The man seemed very clear in what he wanted and his doctor seemed okay with it as well. Keeping someone alive because it doesn't fit their schedule is absurd.

Can you call in a social worker or clergy?! I would ASAP because this man clearly doesn't want a vent and it's time for him to die in peace. Perhaps sitting down with them along with the doctor and a social worker and whoever else you need to bring in is in order here immediately. Is there an ethics committee at your hospital?! Perhaps they can help too.

This BOILS my blood.

Does your hospital have an ethics committee? They will often sit down with the patient, then the family

It's a sad world when a patient's wishes is overridden by family because the doc is afraid of lawsuits.

i'm soooo not understanding why this family was even given a choice re their preferences?

once the pt stated his wishes, i know i would have gently but firmly told the family the plan of care, PER PT WISHES.

his life, his death, his choice.

i pray he dies before he wakes...

leslie

Wow this situation sounds exactly like one I encountered a few weeks ago.

The patient had colon cancer with mets to brain, bone and liver. I came in to do dialysis and thought the family was acting strangly festive for having a family member who is so ill. While I was there a medical equipment company brought in a wheelchair that the family had ordered for him. They were like "yay, look Dad. Your wheelchair is here!" When I looked at the patient to my eye he is definitely circling the drain - thin with sagging skin, pale, not aware of his surroundings, calling out and talking incoherently. I've seen this over and over and it's always the way they look when death is imminent. There is no way this man is ever going to leave the hospital. He'll be lucky if he makes it another few weeks.

After quizzing them I realized they were in complete denial about his condition. It was a similar thing - he was just fine until around April when his back hurt, and when they did a colonoscopy they couldn't even get the scope past his tumor and they inserted a PEG tube right then and there. The family was saying "we should have never taken him to the hospital. He was just fine until the doctors got ahold of him."

This family needed hospice so badly, but they refused to stop treatment and so weren't elligible for hospice. When this guy goes it will hit them like a ton of bricks. I kept thinking how nice it would be if they would stop treatment and take him home to die. It would be so much better for them if they could say goodbye, say all the things they wanted to say one last time, share memories, kiss, hug, sing, pray or whatever they wanted to help ease the transition. They could hold him and comfort him and each other while he slips away peacefully. Instead when his heart stop they'll jam a trach tube down his throat and someone will jump on him to do chest compressions, breaking his ribs in the process, with the family standing around freaking out.

We have come a long way with dealing with death and dying, but some people just aren't ready. It's so very sad.