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Wishing I wasn't an RN when it comes to sick family member.

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Avery205 Avery205 (New) New

I love being a nurse. I went back to school at age 33 to become an RN. I've had my share of helping to save lives as well as being there in the final moments of life for patients who are on hospice. I've seen many patients who have or will have such a poor quality of life that it seems cruel to keep them going by any means necessary while families sit there like an audience for a performance and watch their family member wither away as I do my job to keep them dry, turned, bathed, fed (if possible), and comfortable. As a nurse, I see things from a different persective than family members, yet try to understand that this is their family member whom they don't want to live without. Often, I wish that hospice or at least a change is code status was more of a norm than a fear or taboo subject for patients and family members. I get tired of seeing so much suffering by patients while family members sit there with a blind eye turned to their family member's quality of life.

My dilemma right now is that I have a family member in this situation. I am wishing that I could be that family member to turn a blind eye to what he is going through and hope for the best like everyone else. The thing is that I can't. I am an RN and I know what his day is like and his quality of life and I pray for him like everyone else in the family, but my prayer is not that he gets better and comes home, it's that he dies peacefully. But that is not happening. He has been in the hospital since the end of July when he collapsed. The paramedics did CPR and defibrillated him twice and intubated him on the way to the hospital and it has been a series of ups and downs from there. On his best day since that time, he was able to eat some soup and walk 10 feet with a walker. He already had COPD and heart disease among other things, but now also has an AICD, CHF and renal failure in addition to his multiple infections over the last few months (VRE, cdiff, etc.) He was intubated earlier in the week and remains on a vent with the possibility of now also needing dialysis.

This family member is my step father in law. He has a large family and step family with a lot of family dynamics. He is the typical patient that no one wants to take care of because of the entire picture. When I found out yesterday that they may start him on dialysis I just cried and cried for him. I don't want to lose him either, but I don't want him to suffer like this. He is a very proud, strong man and I think he would would want to live like this. I have a difficult time talking with my husband about it. I just try to listen, because when I give my opinion or advice I just seem cold and insensitive because I can't turn off the RN in me.

Any advice as how to handle my feelings on this yet be sensitive to the family would be greatly appreciated. Thank you for letting me vent.

I got nuthin'. I went through something very similar with my dad and you can't help.

{{{Avery}}}

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

Just put a bug in a few ears, "Do you think he'd like to keep going like this? Maybe it's better to just let him rest." Sounds like you aren't in a decision making position but bringing up the subject may open some doors.

As a professional your job is to continue caring for your patient until he or she takes the last breath. It does not matter what your personal feelings are or whether you agree with the family or not. I wouldn't have very many residents if every decision was based on quality of life.

escapebigd

Has 5 years experience.

I think as a part of his family you should try to be sensitive to your husbands, and all of the familys needs, and gently voice your opinion on how he does have a terrible quality of life right now, and that it may be time to let him have some peace. Try to not think like a nurse about this, but more as a family member and what you see him going through and let that be how you voice your opinion. I know I'm not a nurse yet so it was a lot easier to do that when my grandfather was dying.

As an RN I can see your point, you understand what he is going through. Is he alert at all? If so, I am sure he has already thought of alternatives. As a family member, I would just support the rest as best I could and leave it up to him and close relatives to decide the outcome.

If not alert, possibly asking close family members what they think his choices would be if he was?

Any decision you make will be specific for your family as a family member more then an RN at this time... it is good to vent though, and sorry, I don't have any good advice for you, take care!

Thank you for your responses. It is true that I am not in a position to make decisions. I know my husband and a couple of his sisters have come to the realization that he will not get better and that he is at the end of his life. They have tried to discuss what his wishes would be. In fact, he signed health advocate papers stating that he didn't want to be kept alive by a machine and they are all aware of it. He is on a vent, has an AICD (that has fired more than a dozen times since implanted), and now they're talking dialysis. I'm not sure how many more machines they can put him on before adhering to his wishes! I believe they (when I say they, I mean my mother in law and my father in laws sons that are also health advocates) are justifying it by thinking that these machines are only temporary. I know that the doctor did talk to them about how poor his quality of life will be "if" he does come off the vent. My mother in law won't go up to the hospital by herself anymore because she is afraid to have to make any decisions by herself. I really think that she does not want to be the one to make the decision to stop treatment because then everyone would say it was her decision. I do beleive that if his sons brought up the idea that she would agree with it, because then it wouldn't be all on her shoulders. Maybe I will try talking to my husband about this.

My father in law is a great man. He is 73 and has led an accomplished life. His stories amaze me. I will miss him dearly, I just hate to see him go out like this. Again thank you for your responses and letting me vent.

Orca, ASN, RN

Specializes in Corrections, psychiatry, rehab, LTC. Has 25 years experience.

Sustaining life processes is not the same as living. This man doesn't have what most of us would call a life. His day consists of continuous monitoring, medications, medical procedures and machines. That is not the kind of existence that most people would want, especially when there is no hope of a return to a normal life. In a situation like this, the real question is whether the person is being kept alive for his own sake, or to delay the family having to deal with the pain of coping with the person's death.

Sometimes the best way to show that you love someone is to simply say "goodbye".

mamamerlee, LPN

Specializes in home health, dialysis, others. Has 35 years experience.

I had many talks with my family over the years about end-of-life care. It isn't easy, and when the time actually comes, it still takes your breath away.

What would your FIL want? He said no machines, yet he is already dependent on them. Very scary to your family.

When my dad was actively dying, I had to force an issue about getting a tube for feeding. He had already turned it down, then the docs tried to get me to talk him into it. I had to say out loud to the docs - his kidneys are already shutting down. He was still AAO at that time, refused the tube again, and stated that he wasn't hungry. He made it very clear to us that he wasn't go to have the tube. He clearly understood the ramifications. He just wanted relief from his foot pain -neuropathy. We arranged for a morphine gtt, which started on a Wednesday, he died on that Friday morning.

It is so hard to make those decisions, my heart aches for you.

((((hugs))))

Has there been an ethics consult to discuss his wishes with the family? Or, has a hospital chaplain been involved? Maybe the decsion-makers need to discuss options with a 3rd party. My prayers are with you and your family.

freefalr

Has 10 years experience.

avery, i hear you. i'm so sorry you and your family are going through this. it is really, really difficult being a nurse and knowing the situation from that vantage point, and also having to process all the emotions that go along with having a sick loved one. i am sorry for your father-in-law, and i hope those making the decisions for him will do their best to honor his wishes, even in the face of heartbreak and inevitable loss. i don't have anything helpful to offer, i just want you to know i am sending prayers your way. ((avery)):heartbeat

catshowlady

Specializes in ICU.

I don't have much either. The hospital's ethics committee may be able to help, since he did have advance directives in place. If theirs is like mine, if nothing else, they can help clarify the picture, answer questions, and open up discussions for his family. An ethics consult does not have to result in a specific decision.

Sorry for what you are going through. :icon_hug:

:paw:

sounds like a terrible situation.

However, don't forget that when people want to "go", they make it very clear. Have you considered that maybe he wants to hang on as long as he can (for what reason, we may not know)? If the patient isn't ready, it wouldn't be right for us to tell him it's the best thing because only the patient truly knows.

Yes, I understand the quality of life arguments (and sometimes they are valid), but we also have to remember that even if we think we would not want to live like that, we have to be open to the possibility that someone might want to take that over dying. Maybe they're scared to let go, maybe not -- who really knows.

I don't envy your situation -- I wish there were an easy solution, but we must let things happen on their own time and sometimes, it's not up to us to decide. All you can really do is be the source of information

I am truly sorry for your dilemma.

pbirdy

Specializes in Med Surg, Telemetry, hhc. Has 15 years experience.

I'm sorry to hear what you are going thru. I don't know what to say that can help you. I was a cardiac nurse working on a telemetry unit when I was called to say my dad had a heart attack. He lives in another state and when I went to see him, he really only had mild chest pain and was admitted. Of course he went thru all the tests but when I was looking thru all the charts, I could see that he would develop other problems along the way.

The entire family would not listen to me. To make it short........in a few months he eventually had heart problems resulting in a pace maker.

I have come to the conclusion that just because you are a nurse, your family members don't regard you with the respect that you deserve. I don't believe that they see you as a professional. My advice is to just be supportive and be very brief in what you feel needs to be done. Your going to be right because of your experiences but your family will never understand what you go thru in your everyday life as a nurse. I think that they need to hear it from someone eles. In their mind, it gives them more hope. Don't take it personally.

Ayvah, RN

Specializes in Med Surg, Specialty. Has 10 years experience.

I would suggest that you be direct and blunt with your husband, as this is his father in law. I do agree that if your step father in law made his wishes clear, and he has no quality of life, then starting on dialysis seems a questionable way to go. I know its not something I would want if I was in his state, and the majority of us nurses have seen some pretty rough family situations where the patient's wishes are not honored and the passing of a loved one is made more complicated, painful, and prolonged.

I wish you the best. You have to balance your step father in law's seeming readiness to pass, and the rest of your husband's family's acceptance of that. You don't want the family hurt by thinking they did not do all they could to help him, but you want the passing of your step father in law to be as respectful and comfortable as possible. Not an easy task and I wish you the best. Yet another reminder to all of us that these hard conversations need to take place, and documents need to be in order.

elizabeth8503RN, ADN, BSN, MSN, CNA, LPN, RN, EMT-B, NP

Specializes in Psychiatrics. Has 14 years experience.

((((hugs))))

It is very difficult to know whats going on with a family member. I am currently going through that with my grandmother. Numerous health issues (CHF, renal failure, pneumonia, blood problems, recovering from HIT, diabetes, history of strokes and one major MI), she was just released from the hospital today after being in the hospital for 8+weeks. She refused (thank God) dialysis, and is staying in a nursing home for now. I fear she won't make it for much longer, but you can't tell that to my gpa.

My only advice is to love them as long and as hard as you can, and if and when it is their time to pass, be there for the family. You can't fix them, no matter how hard you try (believe me I have tried). So all you can do is hang on for the ride and hope that when its all said and done, the healing process will begin.

Know that when he passes, he will be in a better place, and will not be hurting anymore.

Again...((((hugs))))

I want to thank all of you who posted responses to my emotional dilemma. Thanks for all your advice and all your words of support for me and my family. I just wanted to update all of you and let you know that my father in law did pass away early this morning. His blood pressure dropped and would not respond to any of the meds they tried to bring it back up. His heart finally gave out. He was still on the vent and the ICD did not fire, so it was truely his time to go. My mother in law and the rest of the family were spared the decision to stop treatment and he did pass peacefully with his wife and most of his 9 children and their spouses at his side. I believe everything happens for a reason. He fought for his life as long as he could. His family fought with him as best they knew how. He is now at peace and that's all that really matters.

Again, thank you all.

MedSurgeMess

Specializes in Med/Surg, ICU, educator.

So very sorry for your loss. As you stated, he is in a much better place, with no pain. God bless you and all of his family.....