Support for life support?

KaroSnowQueen, RN · Jul 22, 2009

I have been a nurse for over 25 years. I was kind of wishy washy on the subject until I took a job as a private duty nurse at home to an 18 year old guy. Six years earlier, his mom had sent him to the store with a $20 bill. He dropped the money, turned back to get it and was hit by a hit and run driver. Quadriplegic at 13. He coded 9 times the first year. He couldn't move anything below his mouth. Seriously, couldn't even turn his head to see who was coming into the room. And had all, I mean every one of his mental faculties, and he was just a body on a vent from the neck down. His mom was eaten up with guilt.

I went home and told my kids and my husband that if anything like that happened to them I was pulling the plug. And told them they darned well better return the favor if it was me in that bed instead of them. (And yes, I have a living will - given to my sister, my oldest daughter, my primary care doc and my usual hospital. My husband doesn't have a copy only because he'd never remember where it was!)

My oldest daughter is now an RN, getting her doctorate, and she completely agrees with me. We have seen too many people kept alive on hope, and they are miserable, and the famililes are too guilty to admit they are miserable too(IMHO).

I am a Christian, and one of the things I actually said to a person was this: The family, who kept coding their mother and keeping her a full code, said, she'd go when God called her. I said God is calling, how many times are you going to hang up on him????? (It was someone I knew well.) And she finally went, despite the last code being prolonged by the husband outside the door telling them not to stop.

Everything here is totally my own opinion. Yours may be different. Just know what I've seen and how it has shaped my own beliefs.

ToxicShock · Jul 22, 2009

Thank you for the response. I couldn't agree more! That's one of the biggest reasons why I don't want to be kept on life support. What kind of "life" is it?

I view a family who keeps their loved ones alive - even though there is no hope for recovery - as selfish. I feel that holding on to the false hope of some "miracle" is cruel and unnecessary. Sometimes it happens, sometimes it doesn't. There's no way to know for sure. I'd rather be dead than a vegetable.

I like what you said about "hanging up on God". It made me laugh, but it's a really good point. I'll have to remember that phrase for the future.

SummerTimeCCRN · Jul 22, 2009

The best advice I have ever been given about taking a loved one off the vent is bluntly stated: "God does not need a ventilator"

Also, reminding the family that the decision (if the patient will live or die after withdrawl) has already been made seems to take some of the weight off of their backs.

If said with compassion and understanding, this can be just what a family needs to hear to make that world-changing decision.

Ruby Vee, BSN · Jul 22, 2009

if your mother doesn't agree with your views and is up front that she won't comply with your wishes, appoint someone else to be your power of attorney for health care. a sibling, and aunt, uncle or grandparent -- even a close friend. be sure they know in advance what your wishes would be. you can bypass your immediate famiy! i've done it.

traumamike · Jul 22, 2009

The conversation you had with your mother is why i put my best friend, who is also in the medical field as my medical proxy! My mother couldn't pull the plug, as i expect most mothers couldn't. Especially the ones who are not in the field. I went to my attorney and had the proxy and living will and other documents put together and my best friend and his wife have a copy, i have a copy, and my family has a copy... If you feel this strongly about not being left on life support, may i suggest you do something similar..Just my opinion and my way, it may not be right for everyone. How many times have we coded a pt. to see them yanked from the afterlife just so the family can "have them a little longer". We see this time and time again, until after the 8th or 9th code... the drugs can't sustain them any longer and they finally go tortured the whole way.. I am a fan of letting the family in while we code the pt. just so they can see how horrific it really is. They are starting to do this more and more at my hospital in the units and the result is overwhelming, the families are more apt to say enough is enough and they let them go alot sooner than later...I also think if we as caregivers weren't so afraid to actually let the families know what is going on with the pt. instead of sugarcoating it, the expected outcome the family has would often be of reality instead of fantasy.... Medical doctors are the worse when it comes to this. IMHO of course....

WalkieTalkie, RN · Jul 22, 2009

The family, who kept coding their mother and keeping her a full code, said, she'd go when God called her. I said God is calling, how many times are you going to hang up on him?????

I sooooo wish I could have said this to a few families!

cardiacmadeline, RN · Jul 22, 2009

My family and husband know very well that they are to withdraw life support if I have little or no hope for recovery and will not be able to live a quality life. And I would do the same for them. I would rather be in heaven watching down on them than a vegetable in a nursing home. I told them if they let me live like a vegetable that I will come down and haunt them when I finally do die! I have seen too many patients suffer beacause their families can't let go and I don't ever want to be in that position. Death is a part of life, everybody has to do it at some time, just some of us sooner than others. Regarding the POA--We once had a patient on our floor with little brain activity. The POA wanted to go with the patient's wishes and do comfort cares, but the rest of the family wanted to keep mom alive. So the POA went with the rest of the family, because he didn't want to go against the families wishes. So we kept treating the patient, and eventually she left and went to rehab or something. Not sure what happened to her. So in this case, what is the point of a POA if they are not going to stand up for the patient's wishes?

JustEnuff2BDangerous, BSN, RN · Jul 23, 2009

Laws regarding life support: From what I've heard, if no advance directive has been established, immediate family (spouse or parents, if the individual is unmarried) are the ones who make the decision. If the patient has previously established an advance directive, the family is expected to follow this - I do not know, however, if they are bound legally by it, and this may vary by state. I know a DNR (Do Not Resuscitate) order is legally binding. Appointing a healthcare proxy (also known as a medical power of attorney) is also legally binding; whoever the pt designates as a HCP has the final say on what happens to the pt if the pt is incapacitated. If the spouse/parent says keep them on life support and the HCP says take them off, they get taken off.

I try not to make judgments on the families, or make decisions "for them" on what I think they should do. Situations like these are very emotional; often the family believes that the person will make a miraculous recovery and "come back" - which is not to say miracles do not happen, because they do, but we all know such drastic ones are rare. I believe this is the reason so many families hold on for so long - they are hoping that if they wait just one hour more, they will have prayed enough and God will answer their prayers, and they are afraid that if they don't wait that hour, and pull the plug now, the patient will have been thisclose to coming back, and they will have given up too soon.

I do sincerely believe in fulfilling the pt's wishes. If it is clearly known they would NOT have wanted this, I support taking them off. But I also know it is not my job to judge the family for holding on to their family member. Always remember that is somebody's WORLD lying in that bed. That is the love of somebody's life, the light of somebody's life, someone's daddy, someone's mama, someone's baby girl or firstborn son or only child. We see dozens of patients everyday that we know full well should be DNRs, or should be taken off life support. But you have to remember that this patient means so much to that family member that making that decision is the hardest and most painful struggle of their life, and that is why so many people try to "leave it up to God", even if you and I know He's already made up His mind. They don't want to be responsible for "killing" their loved one, and that's honestly how some people see it!

cardiacRN2006, ADN, RN · Jul 23, 2009

Load me up with morphine and pull the plug.

If I'm brain dead, then donate my organs. If I'm not brain dead, but just gonna be a brain dysfunctional veggie, then MS, pull the plug, and do DCD.

nerdtonurse?, BSN, RN · Jul 23, 2009

I feel a lot of compassion for the families, but it's the patient that I advocate for. I've had the horrible experience of being caught up in a situation where a woman had written a very detailed Living Will, and only 1 of the kids disagreed, and that was the child the doc listened to because he didn't want to be sued. The doc wouldn't even come in the room as we tortured this woman her last week on earth. I hope that woman haunts his dreams.

I have a DPA for healthcare, and my sister's the executor; she's a doc and while we may disagree on almost everything, we both think quality over quantity of life is the way to go. I told her if something happens to me to look over the situation, and especially if I'm "locked in" she'd better pull the plug and let me go. I told her, "On that day, hear me say this in your mind. 'If you love me, let me go.'"

In terms of my religious beliefs, we are taught that life support is not a requirement -- if God thinks the fate of the world depends on me staying alive, I will, and He'll take care of it.

No vent. No PEG. Just hit me up with Versed/Ativan/Fentanyl and let me go.

Trishalishus, PhD, CNS · Jul 23, 2009

Bearing in mind that I come from a different culture and legal system, and that I am at a different stage in my life, here's what I think:

I have given a joint Enduring Power of Attorney to my two best friends - one of each gender - who don't particularly know each other. If I end up attached to hoses and wotnot they must jointly decide whether to turn machines off and make me DNR on the basis of degree of damage, prognosis for recovery and future quality of life. Bit of a horrible situation for them, in which they were tested recently - and each is honoured to be trusted with the task (lucky me). They know me-for-who-I've-become best - my parents know me-for-who-they-created-and-brought-up - arguably a different person, neh?

It's a shame you ended up having such a run-in with your mother. You probably scared her roots grey, and she reacted from fear - the hardest, saddest thing in life is for your child to die before you. Just the thought is probably enough for most mothers to get a nasty shot of adrenalin to the heart. Sounds like you and she need to have some mother-daughter chats and develop your friendship as adults - so she starts seeing you as an independent deicision-maker as well as the fruit of her womb and light of her life.

Best wishes