Monday, March 7, 2011

Letting Go


I am very much for end of life care. I feel that someone at the end of their life should be let go peacefully instead of being put through painful tests and procedures, generally prolonging things for a long time.

Recently we had a very sick cancer patient whos wife would not let him go. He would be admitted, discharged, re admitted, re discharged, over and over. Despite all the counceling the wife received, she refused to put him on hospice. It got so bad that the hospitalists got the ethics board involved b/c the care was so futile. Finally, after a lonnnng and painful course, the patient died.

Yesterday I had a very different experience. I had an 85 year old female come in from home with her daughter. Her daughter had been caring for her since her stroke 3 years prior. She was unable to talk and could not eat on her own. Her quality of life looked very poor. She came in for decreasing mental status. She looked very ill. It was obvious she didn't have long left if we did not get aggressive in treatment (including a ventilator).

Of course, she was a full code. I had the normal talk with the daughter. Most families that I deal with refuse to make the patient DNR. They usually want everything done. I think there is guilt involved....maybe they think if they make them DNR they are saying they don't love or care anymore. But this patients daughter was very rational. She said, "you are right, she has suffered enough. Just make her comfortable."

So I got them both a blanket, turned down the lights, put on some music, turned up the oxygen, made the room peaceful, and gave just a little bit of pain meds. I checked on her every 20 minutes.... more so the daughter felt like I was doing my best to keep her mom comfortable. Within 2 hours she died....peacefully. I hugged the daughter, called the chaplain, and it was done. No dragging things out.

Maybe I'm just a death panel liberal, but I think this is the right way to do things.

ER Doc

31 comments:

Tracey S said...

Amen, brother.

Carol said...

I think you are correct.

rnraquel said...

We need more doctors like you.

arzt4empfaenger said...

In cases like this it's the best way.

Anonymous said...

Thank you for your compassion. Bless you.

Liz said...

This Tea Party hospice nurse believes you and the daughter did the right thing.

Anonymous said...

Totally 100% the right thing to do. Wish more doctors were like you.

Lisa said...

I think that sometimes difficult for a patient's distressed family to read between the lines of what a doctor, especially one they don't know, is saying.

Fen said...

Having worked in Palliative Care I couldn't agree more. There's nothing more heartbreaking than seeing families who just won't let go :(

Anonymous said...

I completly agree with the daughter. When my grandmother was diagnosed at 87 with stage IV ovarian cancer she decided to not have treatment and live her life the way she wanted since she felt fine. The day before she passed away she was doing water aerobics and she went quickly the next day. There is no better way to go.

Louisiana Belle said...

We've all talked hypothetically about a situation like this in my family and this is the way we want to go out. Very dignified and humane. Bravo.

tracy said...

My father is dying of cancer. i hope when the "time" comes, there will be a compassionate Doctor like you...to help my mom know it's time to let go.....

SuFu said...

Good work. Thanks for being caring about the patient, but also about the family. It's tough to let go, but we had to do this with my g-pa. It was the best decision at a horrible time.

newnurseinthehood said...

Strong work. I feel a little more for some of the families that struggle with that decision after going through it with my grandpa. I always wish I could express to the family members who do make the right choice just how great a thing they really are doing for their loved one. It's a hard choice to make, but I don't anyone who would want to be kept alive that way.

Canuck said...

http://www.lhsc.on.ca/About_Us/Baby_Joseph/index.htm

I work here (at the hospital, but not in the PCCU specifically) and this debate has been going on for some time. It is depressing and maddening. The parents believe they are doing the best for their child and the doctors believe what they want is best for the child. They are at an impasse.

And the baby is suffering.

jennabul said...

Amen and thank you for having an honest talk with the daughter, I hate when I hear doctors skirt the issue and not really explain...example chest compressions on a 90 year old woman who weighs 90 lbs will break her ribs and perhaps perf a lung, do you really want us to do that for your loved one when the time comes?

Lorelei Armstrong said...

My great-great aunt is "there on the sad height" after a major stroke last week. She's failing, and probably won't last the night. And her wishes to be kept comfortable and no more are being respected. The entire family are grateful. She is ninety-five, a former head of nursing, and has had a wonderful life. We are so glad it will not end in a nightmare.

Anonymous said...

Too bad she's not an old lap-bander. You could give all her meds in IV or syrup form. Maybe an IV potassium drip to speed things along!

Go Kevorkian on the oldies!

landlockedtxn said...

Job well done! Wish everyone felt this way!

Sometimes, by loving them, we have to let them go...I didn't want my mom to go, but her suffering was terrible...and we had promised her we would not let her live her life this way....as her kids, loving her as we did and still do, we fulfilled her last request...love ya mom!

Mandy said...

After watching my mother-in-law slowly die of Lou Gehrig's Disease, I am a firm believer in compassionately allowing someone to die in peace. She was suffering immensely and decided on a DNR a few months before she died. The last two days of her life she was in a morphine-induced coma until her breathing just stopped on its own. She couldn't eat, couldn't talk, couldn't move, could barely breathe. Letting her go was the best thing we could have done for her. She died surrounded by the people that loved her.

hannah said...

I'm finishing up nursing practicum on a heme/onc unit which is known for having a very good pally/hospice team. I almost prefer the black/white (either wants hospice/pally or everything done) types. It's the families that waffle or don't totally understand what pally care means who are the worst. They get The Talk, sign the papers, and two days later it's -- "Why aren't you doing vitals? Why isn't she getting a food tray?" Or, dear god, "Why isn't she getting chemo?" for someone who hasn't regained consciousness in, like, a week.
On the flip side, my grandfather's death was botched by the medical professionals at the hospital. They didn't give him enough ativan or morphine when they removed the vent and he had to be reintubated.

Anonymous said...

Amen.

I am veterinarian.. i am so glad we have the ability to end pain and suffering in our patients.

As i was euthanizing a horse that was not going to get better, a client said, " This has got to be the worst part of your job."

My reply, "No, the worst part is leaving an animal in this condition because the owner cannot decide or will not euthanize the animal."

twisteduterus

lostonthefloor said...

Guilt. Too often it's why they drag it out. Thanks for being willing to let it go. See too many docs who would have gone full monty and done nothing but extend this woman's suffering.

Shash said...

I think it was an excellent call by you and by the daughter.

My father was a DNR on his own wishes and my guy's mother actually quit eating to speed herself along. It was sad, but she did not want to the life she would have been left with after both her body and brain were checking out on her.

Josh said...

I would like to thank you for this post. I work as a tech at a delightful academic hospital. There have been many times where I have been with the patient and their families at that final moment. They always thank me. I would like to extend my thanks to the Docs that write the orders that give the people and their loved one some peace.

Geno said...

Thank you, I hope I have a doctor like you when my time comes. You can make the transition to the whatever after much more pleasant. Keep up the good work.

Dragonfly said...

Hoooray for not medicalising the end of life. I would much rather die that way. I would wish the same for my family.

ERP said...

OK, so I guess you redeemed yourself in some readers' eyes after the lap band post.
I have had a few similar cases where I've extubated someone who came in on a vent after the family made the sensible decision.
I felt really good about it.

Anonymous said...

I hope my doctor - and my children - are that sensible and honest when my time comes. Mom was in hospice care when cancer took her - God bless those people!

Meanwhile, I'm dealing with my Dad, who's signed a DNR order but won't wear the state-mandated wristband/bracelet telling the EMTs he doesn't want resus. I can only hope he goes in his sleep....

Anonymous said...

More Doctors like you are needed!
~Cdn RN

Nurse Schneider said...

What a brave daughter. That's not an easy decision to make.

We had a 95 year old patient who came in from the nursing home for aspiration pneumonia. His daughter in law would change his code status on a daily basis. There would be days where she would said we had to call her before intubating him. She elected to put a PEG tube in him -- he mercifully died a few days later. Turns out she was collecting a check by keeping him alive. Sad.