The family just revoked Bed 4's DNR, they want everything done (on someone who's endstage everything, agonal breathing, SBP of 78, and having increasingly prolonged periods of apnea...)
Yes we get patients in the ED that are end-stage something or other. The poor families are like: Why aren't you DOING anything?? and save my Mum/Dad/Grandma from dying....feel like saying, what do you expect us to do? Wave a magic wand? Sorry if this sounds heartless but the docs really need to step in more and tell them straight there is NOTHING ELSE we can do for your loved one. But when the docs are all foreign, it's hard to get this thru to them....
I was with you until that last sentence - where I work the locally-grown medicos have just as much trouble, with rare exceptions, accepting death themselves, let alone explaining it to patients and family
We've got one that will apparently doesn't believe his patients are capable of being dead, since he will stand there and tell a family the pt's getting better (!!!) when I'm watching their HR and they SBP both trying to hit the same number -- zero! I literally had a night where he was telling the family the pt was just "exhausted" and once they got a night's sleep and a good breakfast, they'd be up and walking.
Pt had been bedbound for 3 years, severe contractures x4 extremities, and had been on tube feeding for the last year. Uh...there was only one Person who could have made that patient rise, take up his bed and walk, and Doc, you ain't Him.
We've got one that will apparently doesn't believe his patients are capable of being dead, since he will stand there and tell a family the pt's getting better (!!!) when I'm watching their HR and they SBP both trying to hit the same number -- zero! I literally had a night where he was telling the family the pt was just "exhausted" and once they got a night's sleep and a good breakfast, they'd be up and walking.
Pt had been bedbound for 3 years, severe contractures x4 extremities, and had been on tube feeding for the last year. Uh...there was only one Person who could have made that patient rise, take up his bed and walk, and Doc, you ain't Him.
Hey, nerd- doc took that God-complex a bit extreme, eh? I LOVE it when the contracted folks get up and walk
Fairly early in the AIDS years (1987), we had a doc who was normally REALLY good about talking to the patient and family about code status, and was very realistic about AIDS- before the anti-retroviral cocktails. One night, about the only guy whose family had stuck around, stroked (bad)- like nuked his brainstem. The doc said, "oh, nooo.... he's just post-ictal". This was a neuro floor- we all saw strokes and seizures all the time....this wasn't a seizure. Next night... guy is still gorked. And vs are circling the drain- fast. Charge nurse called the doc- nope... still post-ictal (more than 24 hours after the "seizure") .
Later the same night, the guy is having agonal respirations, and has "the smell"....parents are still there telling us to let him go...super nice people, and it was heartbreaking to see them go through all of this. (the night before the mom had grabbed the doc by the shoulders and told him "let him go"). Doc says no, he'll be ok.... :eek: I had stopped the doc in the halls and asked him (in a sort of "uh, DUH...." tone of voice) "what are you doing?". He stuck with the "he'll be ok" line....very unlike this doc- wondered if he was getting fried on losing all of the guys (- and one entire family from a blood transfusion to the mom, transmitted to the newborn via breast milk, and her husband via monogamous heterosexual sex. - THAT was bad- all dead in
We got to the point of getting the oral airway in, backboard behind him, and parents shuffled off to the adjoining "suite" room before the charge nurse RAN (heard her coming- she would have blown through the concrete walls if she missed the door) into the room and said "we're done, we have the DNR". EVERYONE in the room sighed, including the parents, and THEN the guy died. I'm convinced he hung on. I still have a wicker basket from that family- they'd left it full of candy for us, and I got the basket. I'll always remember that night.
We've got one that will apparently doesn't believe his patients are capable of being dead, since he will stand there and tell a family the pt's getting better (!!!) when I'm watching their HR and they SBP both trying to hit the same number -- zero!
We had a stroke intern incapable of telling families about poor prognoses, so he'd say they had a good chance of full recovery and we'd have to go in and break the now-far-harder-to-hear truth. We ended up calling in the head of unit to have a chat with him about the cruelty of false hope and the importance of truth.
That was probably better than what I wanted to say: unless you're the reincarnation of Abraham or Jesus then some of them are beyond your powers of healing.
I LOVE it when the contracted folks get up and walk 
This was a neuro floor- we all saw strokes and seizures all the time....this wasn't a seizure. Next night... guy is still gorked. And vs are circling the drain- fast. Charge nurse called the doc- nope... still post-ictal (more than 24 hours after the "seizure") 
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carolmaccas66, BSN, RN
2,212 Posts
Yes we get patients in the ED that are end-stage something or other. The poor families are like: Why aren't you DOING anything?? and save my Mum/Dad/Grandma from dying....feel like saying, what do you expect us to do? Wave a magic wand? Sorry if this sounds heartless but the docs really need to step in more and tell them straight there is NOTHING ELSE we can do for your loved one. But when the docs are all foreign, it's hard to get this thru to them....