I'm not proposing rationing or coercion. I don't want to make decisions for pts or families. What I DO want is someone objective, to honestly and compassionately provide hard truths about what death and dying looks like.
Doctors, for the most part, are not objective. Some I work with want to keep the pt alive as long as possible because it means a paying customer. End of life is when most of the health care dollars are spent, and that's where MDs and hospitals make the most money.
Death panel? Call it what you want, but our society is sorely lacking in honest accepting discourse about death.
Some people want to live forever and will submit themselves to any test, drug or procedure for that end. I respect that decision.
Some people want to live as long as possible, with quality of life determining how much intervention they want.
Shouldn't these people be given hard, basic information to guide them in these decisions?
I just think the government needs to say out........I look at many government run entities ......I am NOT impressed! If they really worked for me......I'd be having a massive firing!
I thimk the term death panels liken more to WWII and Hitler......hence the extreme unease.
Like I said, there's no hope of a rational discussion . . .
We have a points based worksheet for pneumonia cases, predicting the severity of illness, and we admit or start IV antibiotics based on points. Too bad we don't have one predicting one year survival, or survival to discharge. It must exist somewhere...if you've got more than 3 systems failing what's the likelihood of survival? Bet it's less than 10% for any age.
your aunt healed in many ways before she died, and you played a great part in that.
God bless you, and prayers for peace and faith.
leslei
I agree leslie, about some things being "good" despite the overall circumstances. Thank you for the prayers.
Obviously, we didn't want to lose her, and it almost makes it HARDER to have learned that it still really was HER, since alcohol has so dominated her life for many years, in increasing amounts.
I think the pain now is from the fact just in GENERAL that she is gone, less of HOW things happened, if that makes sense. During the course of it, it didn't seem as "sudden" as it really is.......only a couple of weeks in total. The last two weeks have felt very long, and it's been in the forefront of my mind (if I wasn't working, I was visiting there, or with my mom, etc). This is the first time, today, that I've just been able (or have no choice but) to sit and really THINK about it (and also sleep.......I've slept so little, that the flipside was, I could once I didn't have to worry any more, so I napped hard for a bit today).
I was so busy running interference with the family, helping to answer questions and decode the medical/technical details, that it helped me to be able to distance myself. I could focus on the "what" without focusing as much on the WHO they were happening to......defense mechanism. That "barrier" is gone now, and all I have left to do is feel. But, I am glad for having the time to be able to reconnect with her, and have closure on the last chapter.
Sorry to side track the direction of the thread. I remember one convo we (my family) was having by the ICU lounge, and some random guy just JUMPED in, talking to my cousin (the partial code one) about how doctors always "push" to have patients taken OFF the vent. I was just astonished listening to him . He said his grandma was one of the people that wants "everything" done, so that she could have ONE more day with her grandkids. But, my goodness.......AT WHAT COST, not only to her, but to her grandkids? NOT monetary cost, either....but is what is best for them to see grandma go though so much for ONE more day? Is it a "quality" day? I know it's up to the patient, and if that's what SHE wanted, fine, but.....and of course, there was one time she was in the hospital, and they were told she'd never make it off the vent, and then she DID, so.....*eyeroll*
At any rate, NOT what my cousin was needing to hear. They don't push people off the vent, I'm sorry. They didn't NOT do things because she didn't have insurance (he read, also on the internet, that uninsured patients are 21% more likely to die in the ICU than patients that had insurance). He RAN with that statistic (I hate statistics, they can be twisted to meet anybody's particular needs). Never mind that those patients might be more likely to die because they haven't had good, regular, preventative care for years prior to BEING in the ICU (as was the case with my aunt, and that's beside the drinking and malnutrition from not eating properly for years...that's just the hard truth). Do "miracles" happen where a person isn't expected to live, or get off the vent, or whatever, but in the end, they do? Of course. But what do they expect doctors to say? "Your mom/dad/sister/Uncle Henry has A, B, and C wrong with them, and they options are X, Y, and Z. The possible outcomes are 1, 2, and 3. BUT, even though there is a slim to none chance their body will overcome this and get better, a miracle COULD happen, so we'll keep doing what we're doing and put "pray" as priority one one the treatment plan." They have to deal with what the facts are.....I don't know why that is so hard to understand. So many people don't, though.
One other good thing that came from all of this is that it opened up the discussion (again) with my mom about what she does and doesn't want done someday. We've discussed it before, and she has an Advanced Directive and I'm her POA, but it's ALWAYS good to talk about (she knows what I would want done, too, I really SHOULD have my OWN documents done). She supported everything I thought and would have done in this case with my aunt (even though the decision came down to a NON decision, in the end). I was happy to know that if I were making the decisions had it been her (heaven forbid), she would have been agreeable.
Takeaway lesson: talk, talk, and talk some more with your family about what decisions you would want made in various situations (and ask them what they want), and draw up your Living Will and Advanced Directives!!!!
Nothing is wrong with discussing end of life care we do it all the time.....but this is none of the goverments business!
All that changed is that MD's can now be reimbursed for providing this service. The government also reimburses for medications, surgeries, doctor's visits, etc. Should medicare stop reimbursing for that as well because as we can all agree it's none of their business?
I totally agree. I wrote a paper on Medical futility last semester. Nurses should be sure that the patient and the patient's family are aware of available treatment options and information needed to decide on end-of-life decisions that allow them to die with minimal pain. Nurses should advocate for counseling for patients and/or patient's families when emotions get in the way of making the ethical decision.
I totally agree. I wrote a paper on Medical futility last semester.Nurses should be sure that the patient and the patient's family are aware of available treatment options and information needed to decide on end-of-life decisions that allow them to die with minimal pain. Nurses should advocate for counseling for patients and/or patient's families when emotions get in the way of making the ethical decision.
Actually, that part is primarily the job of the physician. If, as a nurse, we don't feel that the patient and family have all of the info TO make those decisions, all we can do is talk to the physician. We can't tell the patients what their options are, that's out of our scope. The advocating, THAT we can do.
But, I am glad for having the time to be able to reconnect with her, and have closure on the last chapter.
. He said his grandma was one of the people that wants "everything" done, so that she could have ONE more day with her grandkids. But, my goodness.......AT WHAT COST, not only to her, but to her grandkids? NOT monetary cost, either....but is what is best for them to see grandma go though so much for ONE more day? Is it a "quality" day? I know it's up to the patient, and if that's what SHE wanted, fine, but.....and of course, there was one time she was in the hospital, and they were told she'd never make it off the vent, and then she DID, so.....*eyeroll*
sunnycalifRN
902 Posts
Like I said, there's no hope of a rational discussion . . .