When Is Enough Enough?

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Specializes in Gerontology, Med surg, Home Health.

We have a 101 year old lady in my building. She has outlived all her friends. She had made peace with going to the 'next phase'. She got ill. She was comfortable. We called the family. They came from 2 states away. The doctor said we are going to do what they would do if we sent her to the hospital. Now, the poor thing is getting IM and IV antibiotics and fluids. She is no longer comfortable. She is still going to die. What a shame that her family didn't see the fruitlessness of the torture of IV therapy and IM medications.

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I know that some meds can torture the patients by making the pain worse. I don't blame the family for not understanding how painful those IM meds and IV therapies are...they want her to be around longer you can't just say STOP she has lived enough ( 101 years). Some people think meds hurt one person for a short period of time but death hurts a lot of people that know that person.

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Specializes in adult ICU.

You're preaching to the choir girlfriend....

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Specializes in Correctional, QA, Geriatrics.

Of course no one wants to let a beloved person die but it is the natural end of things. This lady has certainly lived a full life..over a century which is more than most folks get. Death is not something to run after gleefully but it is something we all must face someday. I believe almost always it is the fear of the survivors contemplating their own death someday that causes folks to throw everything including the kitchen sink at a terminal condition. Fear is at the root of so many bad choices and issues.

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Specializes in LTC, Med-SURG,STICU.

Stinks when the family that was never there before all the sudden gets a guilty conscience and decides that they want to keep their family around longer. It is too bad that they did not come around sooner so that they would understand that their family member has made peace with death and is ready to go. I have had to deal just such a family not to long ago.

The resident has since passed. However, the process was a lot longer and more painful than it needed to be.

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Specializes in Gerontology, Med surg, Home Health.

I miss one of the medical directors I used to work with. He was so kind when it came for the end of life discussion. He'd take me in the room with him so we could both hear what the resident wanted. He would explain the disease process, the usual outcome and the chances of meaningful life. He would mostly say "It's time to eat your dessert first."

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Have you talked to the doctor about recommending hospice services?

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Specializes in ortho, hospice volunteer, psych,.

i don't know how any caring family member can wish prolonged suffering on anyone they profess to love or care about. my husband and i both have medical (in addition to financial) poas that direct the other

partner to make all necessary decisions necessary, in accordance with personal wishes. if the partner should be affected by the same act, a cousin of mine has been designated to act as the alternate.

my grandmother had advanced parkinson's disease when she was suddenly widowed. she came to live with us until, several years later, she required more care than my mom and home health could provide.

such an uproar within the extended family!! no one in our family had ever ever been put into a nursing home before! ever! oh well. you get the idea, i'm sure.

grandma adjusted rapidly and very well to nursing home life, but continued to deteriorate rapidly physically, while remaining as sharp as ever intellectually. she made her wishes very clear on her advance directive wishes. my lawyer father (son-in-law) had a partner draw up formal documents

(this was 40 years ago) which went on file. my mom, the eldest child, and the three younger siblings were shown the documents and all agreed. right then. the other three children lived in other parts of the country.

it. happened. grandma got pneumonia and, in accordance with the document and grandma's wishes, only comfort care was given and all abx were withheld. eventually, food and water were stopped and her mouth was moistened and oral care given. my parents, who visited several times a day, agreed. two more children and their spouses came immediately and were supportive. but my mom's twin?! no way!

we were all murdering her mother and no one. cared. at. all. none of the adults (i was in college

then) could make any headway with her. she said the document was done in collusion with the doctor who was simply tired of caring for her.:eek: finally she just went home.

the family had thought everything had been taken care of properly beforehand. legally, yes.

emotionally? no. i have a feeling nothing would have changed my aunt's mind at the end. she said she only agreed when the document was drawn up because she had thought her siblings were simply humoring grandma and certainly not follow through when the time came.

grandma died as comfortably as was possible.

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Some of it is families that can't say goodby, sometimes I've seen Doc's withhold the "whole" truth.

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I hesitate to share much for fear of being identificable, but's let's just say that yesterday when a 95 yo lady had a mild MI and didn't want to go to the ED I didn't argue. Documented, informed the on-call, and let her alone. She's mildly forgetful, but A&Ox3.

I'm going through this with several residents right now, with families who can't let go and are in such denial that they have convinced themselves that it's what the resident would want. Um, no. It's not what any sane person would want.

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for the family it would hurt worse to have her die and not feel like they did everything they could than to have her suffer the therapy. when it comes to familys enough is never enough no matter if they have lived 200 years.

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I know that some meds can torture the patients by making the pain worse. I don't blame the family for not understanding how painful those IM meds and IV therapies are...they want her to be around longer you can't just say STOP she has lived enough ( 101 years). Some people think meds hurt one person for a short period of time but death hurts a lot of people that know that person.

It's not about the family and what THEY need or how much they will 'hurt' ; it's about the patient. And 101 is a long, long life. We don't live forever. We need to be allowed to die gracefully and peacefully, regardless of how much denial the family is in. I don't expect the family to totally understand how medications work, but they need to be educated on how their decisions are making things worse for their loved one.

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