tag:blogger.com,1999:blog-1408616337296439010.post1538659014754238971..comments2024-01-24T21:28:29.675-08:00Comments on TALES FROM THE SERENITY NOW HOSPITAL: Compassionate death?SerenityNowhttp://www.blogger.com/profile/11692300152273949586noreply@blogger.comBlogger40125tag:blogger.com,1999:blog-1408616337296439010.post-20611418929274698092013-02-16T14:04:06.261-08:002013-02-16T14:04:06.261-08:00I worked at a nursing home for 18 years as a CNA a...I worked at a nursing home for 18 years as a CNA and saw way too many people being kept alive in a vegetative state of either brain damage or dementia etc.. if they get sick they get shipped off to the ER for meds, fluids etc.. and then shipped back usually with a bed sore. Then again there was the one case of a lady who was in a wheelchair but had all her mental capacity. She needed a new battery in her pacemaker and her family said no. She died. That to me was wrong.Adirondackcountrygalhttps://www.blogger.com/profile/08647770774053345725noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-10100520487294037172010-05-19T21:14:50.970-07:002010-05-19T21:14:50.970-07:00you're all silly. I hope when you are too deme...you're all silly. I hope when you are too demented to know what's going on that you are forced to live through procedure after procedure and treatment after treatment, because of stupid sentimentalities like this. A high potassium induced arrhythmia is a peaceful death. I hope my doctor has enough compassion when I'm stuck in a nursing home because my dementia and chronic medical conditions have made it so that I am no longer able to perform my activities of daily living! (the definition of a nursing home resident) I wish the tube, the trach, the peg and the suprapubic caths upon you all. May our failing, bankrupt medical system then come crashing down on your childrens heads. a pox on you all!PRPAhttps://www.blogger.com/profile/08649931146255133252noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-46785921646537529322009-10-02T15:55:15.609-07:002009-10-02T15:55:15.609-07:00OH, we do the heroics in socialized medicine too. ...OH, we do the heroics in socialized medicine too. Sometimes the family demands it but I don't know how they can stand seeing their relative blown up like a baloon and weeping albumin all over the bed, a tube down their throat and us suctioning green mucous out, jaundiced from multisystem failure and tubes in every orifice. <br />Really, I see 70 yr old who don't think hteir 96 yr old Mother/father should ever die. Comes as a terrific surprise!heartnursehttps://www.blogger.com/profile/13904079539478483962noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-15744083889863213652009-10-01T08:31:14.957-07:002009-10-01T08:31:14.957-07:00I spent the last hour of my shift lady night tryin...I spent the last hour of my shift lady night trying to encourage a large family into making their 98 year old grandmother DNR and comfort care versus going to the OR and everything that comes with that. 98 years old!!! Come on people at some point we have to call it quits on people. Doctors have a pretty good idea at determining quality of life and/or futility of treatment. Way much $$ is spent on end of life care. We need to develope death as a concept and not a failure and focus on making those at the end of their lives comfortableAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-33593643884949695702009-09-29T20:26:52.701-07:002009-09-29T20:26:52.701-07:00Are you guys serious? anyone could figure out his...Are you guys serious? anyone could figure out his quality of life....he is very old, blind, demented, and living in a nursing home? let him go in peace whats the point?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-30892868413518025762009-09-29T17:45:31.692-07:002009-09-29T17:45:31.692-07:00Quite the debate going on here, Doc Sensitive. I ...Quite the debate going on here, Doc Sensitive. I read your post tonight after just writing one of my own -- on the flip side of the subject. It's beyond me how anyone could be against end of life counseling. No one will escape death. Make your wishes known, people.DreamingTreehttps://www.blogger.com/profile/09911536074688347584noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-25448992236910764032009-09-29T15:34:25.526-07:002009-09-29T15:34:25.526-07:00Yes, you are right, I don't get it. I have rep...Yes, you are right, I don't get it. I have repeated my point of view, I have not abused or denigrated or been superior to the third world. I only wrote that I thought that the medicine being practiced was third world as opposed to socialised but take from that what you wish. You do not know me, and you know nothing of my beliefs or values however you feel able to abuse me and swear at me - troll behaviour. I will repeat myself - I believe that there is a time for everyone to die, it is as natural as being born and it is part of life. I was taught to respect life and also taught that when the time came people should die with dignity and be pain free, I also believe that people should not die alone and as such I have held a few hands (and shed a few tears) when patients have died. So no, I do not understand what you are on about, but in this case I claim the moral high ground.GrumpyRNhttps://www.blogger.com/profile/06774717062401988853noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-71927217891467987202009-09-29T14:11:55.992-07:002009-09-29T14:11:55.992-07:00You change the words you used but you basically sa...You change the words you used but you basically said the same thing. You just don't get it.ThirdWorld my a**noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-56964774130368006182009-09-29T11:03:52.916-07:002009-09-29T11:03:52.916-07:00Why on earth do you make the connection between th...Why on earth do you make the connection between the medical system being socialized and decisions like that? That's a pretty big jump. <br /><br />I am in a socialized medicine country and we also would have treated that (and many worse-prognoses) aggressively. In some ways, even more so because it isn't leaving a family with a big bill - it feels like it's free because it comes out of a public coffer. <br /><br />Don't confuse the issue at hand with the issue of socializing medicine in the US meaning "We'll kill Grandpa."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-41244573533024876272009-09-29T11:02:41.915-07:002009-09-29T11:02:41.915-07:00Third world my a*,
I am neither ignorant, arrogan...Third world my a*,<br /><br />I am neither ignorant, arrogant nor a bastard, and my moral integrity is such that I do not abuse and swear at people I have never met and know nothing about. I made no comments about the third world merely pointing out that the story had changed and now resembled medicine I would expect to see in a developing nation. <br />Doc Sensitive wrote 2 things; first, "In this particular country, he would not have been operated on by our surgeons" and second, "He would have sat on the floor in terrible pain". These things led me to believe that there are not enough beds and that there are not enough local surgeons, problems usually associated with poorer nations.<br />As for paying for other people's care, I would like to point out that I, and every other employed person in UK, pays national insurance to ensure that the poorest and least able are cared for as and when needed - so high horse placed firmly back in it's stable. <br />The whole point of this story as I read it was about allowing people to die with dignity and in peace without pain when it has become obvious that it was their time. This is something which is absolutely accepted as normal in the UK and we as nurses and doctors do not understand and do not want to go down the road of trying to save everyone regardless. Unfortunately, Doc Sensitive had used an example which as I have already stated was poor, this patient had treatable problems and would in UK have been treated - 72 is not old.<br /><br />Doc Sensitive,<br /><br />I made no mention of a third world country, I merely thought that it sounded like third world medicine. I agree with your response of 9:20am, heroic intervention and trying to defeat death are doing our patients no favours, as I have stated, in UK doctors would make this decision but it would not be a unilateral decision. Family and the rest of the team would be involved and the decision would in fact be an easy one as it would be obvious that it was right by the patients condition. My only complaint was about associating this story with socialised medicine which is incidental.GrumpyRNhttps://www.blogger.com/profile/06774717062401988853noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-44916154861149111902009-09-29T09:20:05.896-07:002009-09-29T09:20:05.896-07:00It's rather arrogant to assume this occured in...It's rather arrogant to assume this occured in a "third world country" when it, in fact, happened in a very advanced country. They do have socialized medicine but don't feel socialized medicine has anything to do with this particular story. It's a difference in the way the American system thinks about death. We believe that we can all cheat death or reverse dementia or cure anything and everything. I can't tell you how many people I have intubated or followed on ICU rotations who clearly would never survive, or if they did, would be a vegetable. In the country I worked in, the doctors have final say in if they want to perform heroic measures or determine that it would be futile. I was amazed at how many families, when told that their loved one was dying, accepted death and agreed that further intervention would not be needed. It rarely has occured here in the US for me. Most families usually want us to intubated, poke them to get central lines, art lines, and then later they pray for a miracle that doesn't happen. Is that how you want your grandfather treated at the end of his life? I love my 90 yo grandfather and would never consent to have him poked, intubated, and proded at the end of his life- it's inhumane. We spend all this money, energy, and time to try and forego death but sometimes we have to accept that death is inevitable and no doctor, machine, drug, or surgery will save them. In the end, we are only humans and death is something that should be accepted as a normal process of life. Oh, I still believe that this gentleman's potassium should have been corrected and am not an advocate of not treating reversible conditions. <br />doc sensitiveSerenityNowhttps://www.blogger.com/profile/11692300152273949586noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-42694101882198111042009-09-29T08:34:26.200-07:002009-09-29T08:34:26.200-07:00Geez, Dr. D: Your cutoff age for surgery is 48 ye...Geez, Dr. D: Your cutoff age for surgery is 48 years old? Maybe if the 88 y.o. had been 20 years younger?....<br /><br />So far I'm a healthy 50 year old. I would really be unhappy if they start refusing interventions prior to age 75....Gerthttps://www.blogger.com/profile/05377735773222695850noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-58656896254255319042009-09-29T08:19:15.241-07:002009-09-29T08:19:15.241-07:00We take care of our elders till the end. We gladly...We take care of our elders till the end. We gladly serve them regardless of the cost, time and money. While you sit on your high horses and throw your elders in the nursing home, because you are all too busy and hey after all you all have your own life to live, so goes your excuse. <br /><br />I wonder if you are all paying out of your pocket for the care of a dying 90+ year old "loved one" in a hospital. Would you all be as generous. I bet you are all this generaous only because the money for care is coming from somewhere else, otherwise, you'll probably be tripping over each other trying to pull the plug on your dying elders. That's first world????ThirdWorld my a**noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-11087361586754938442009-09-29T07:49:30.035-07:002009-09-29T07:49:30.035-07:00GrumpyRN you are an ignorant bastard. I am from, a...GrumpyRN you are an ignorant bastard. I am from, as your arrogant first and second world compatriots called third world. Yes we are poor but we probably have more moral integrity than most of you. Just look in the mirror and ask yourself if your country is first world in morality, compassion, humanity. People like you makes me sick.ThirdWorlds my a**noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-60674319072722263862009-09-29T06:32:43.098-07:002009-09-29T06:32:43.098-07:00You showed exactly why I find this disturbing:
&q...You showed exactly why I find this disturbing:<br /><br />"until his perforated (my best guess)ulcer seeded his stomach and blood with bacteria....then he would have died an agonizing death over the next days or weeks."<br /><br />The plain fact is YOU DON'T KNOW what would have happened had you treated his potassium. You have no idea. You have a guess - as you said. <br /><br />Do you know how many times doctors - human and animal - are wrong? I've had patients where I thought there was simply no way, but the owners wanted to try - and many of them have pulled through.<br /><br />The simple fact was - in this case - the man had a treatable medical condition (hyperkalemia), and care for this treatable condition was DENIED because someone "guessed" that he probably wouldn't get better from the underlying cause of his problem.<br /><br />There's something very wrong with that.The Homeless Parrothttps://www.blogger.com/profile/02566801733035183569noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-40993794244007012442009-09-29T06:23:07.957-07:002009-09-29T06:23:07.957-07:00As I mentioned earlier the issue of medical futili...As I mentioned earlier the issue of medical futility is very different from quality of life. A doctor is usually competent to determine if a treatment is medically futile or not. <br /><br />I recently had a 88 year old come in with change in mental status, abdominal distention and tenderness. Had he been 40 years younger the obvious answer would have been surgery. At his age surgery was the wrong answer--it would have killed him. I discussed with the family what he would want. They said he would want a chance but they understood that this was likely the end. <br /><br />I gave fluids, wide spectrum antibiotics, and iv morphine prn for pain. The patient actually survived and went home with his family after a week. <br /><br /><br />First of all the quality of life decisions were his family's to make not mine. I made the call that surgery would be futile. But simply determining surgery isn't the right choice didn't mean I could offer nothing to him. (Elderly people can mimic acute abdomen when ill because bowels stop moving easily.) And just because I was trying some a potentially curative option didn't mean I wasn't going to treat his pain. Why do we discuss as if pain control is only for patients we have given up on?<br /><br />We talk like you had only the options of major interventions and hospice-type care. Most of the time there is a middle option of gentle and less traumatic care.Doctor Dhttps://www.blogger.com/profile/15967600225173640437noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-51771537632548683882009-09-29T03:04:33.799-07:002009-09-29T03:04:33.799-07:00Doctor Sensitive,
This is not socialized medicine...Doctor Sensitive,<br /><br />This is not socialized medicine, this is third world medicine. It is a bit disingenuous of you to mention socialised medicine in this context. What started out as a post about being allowed to let someone die in peace when it was their time has changed into something completely different.<br /><br />Yes, in this case it was a compassionate death but it would not be tolerated in any hospital in UK or most of Europe and posts like this has given rise to the 'death squad' nonsense that are being quoted by those opposed to health care reform in the US.GrumpyRNhttps://www.blogger.com/profile/06774717062401988853noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-8908780248478023972009-09-29T00:03:43.580-07:002009-09-29T00:03:43.580-07:00Why couldn't he have surgery? The waiting tim...Why couldn't he have surgery? The waiting time would be too long? No $$?<br /><br />... No need to answer, really, this is probably taking up too much of your time as it is. <br /><br />Sad story though. I have a feeling after everyone's done pissing & moaning in your comments here, that it'll boil down to 'you had to be there; it's different than what we do here.'jnoreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-20886016575618926642009-09-28T23:11:56.099-07:002009-09-28T23:11:56.099-07:00One more point- the family later came to the bedsi...One more point- the family later came to the bedside and was not angry or mad that their loved one was dying. In fact, it was the exact opposite- the family accepted the death and stated that "he had a good life and we don't want him to suffer." In retrospect, if we treated his potassium then his surgical abdomen would have ultimately resulted in more suffering b/c the surgeons there would not have operated on him. He would have sat on the floor in terrible pain until his perforated (my best guess) ulcer seeded his stomach and blood with bacteria. The sad fact is that no matter what we did that night- he would not have cheated death without an operation. If the potassium was corrected, then he would have died an agonizing death over the next days or weeks. <br /><br />Doc sensitiveSerenityNowhttps://www.blogger.com/profile/11692300152273949586noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-32898861379338072712009-09-28T18:00:31.418-07:002009-09-28T18:00:31.418-07:00And PS: I'm a veterinarian and I DO euthanize ...And PS: I'm a veterinarian and I DO euthanize animals. I'm asked every single day of my professional life - is he/she suffering? Do they have quality of life? You know what I tell people? I CAN'T JUDGE THAT. I am not your animal, and I am not you. You know him/her better than I ever will, and you will know. I can only help them understand the medical aspects of disease.The Homeless Parrothttps://www.blogger.com/profile/02566801733035183569noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-66112708882235927882009-09-28T17:59:22.527-07:002009-09-28T17:59:22.527-07:00I feel positively ill reading this. Who gave that...I feel positively ill reading this. Who gave that doctor the right to decide quality of life? Do they teach that in med school somewhere? The arrogance makes me nauseated. This guy was seen once by an attending and given a death sentence. <br /><br />I am stunned and sickened.The Homeless Parrothttps://www.blogger.com/profile/02566801733035183569noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-56234358998831734302009-09-28T09:57:25.133-07:002009-09-28T09:57:25.133-07:00I would like to point out one major aspect of this...I would like to point out one major aspect of this case which everyone seems to be overlooking. This patient had a surgical belly with rebound and guarding. On top of urinary retention and elevated potassium, he had what I felt would be a condition that would require surgery. In this particular country, he would not have been operated on by our surgeons. My attending felt that it was more humane to allow him to die peacefully by not treating his potassium then to prolong his suffering. So the major point of the case was that he had an irreversible surgical condition and a reversible medical condition. He felt it was more compassionate to let the medical condition run it's course b/c it would be a quicker death and more humane death. To the reader who said this is a story to strike fear in socialized medicine, it is not and this did happen. I do believe MDs should have more say in allowing people to die peacefully without suffering. We treat animals and pets more humanely than our own family members.<br /><br />Doc SensitiveSerenityNowhttps://www.blogger.com/profile/11692300152273949586noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-29941320463208367022009-09-27T15:39:10.659-07:002009-09-27T15:39:10.659-07:00Fair enough. I responded rashly. It seemed to me o...Fair enough. I responded rashly. It seemed to me on my first read that you were actively supporting this type of decision makers, doc sensitive. If that's not the case, I'm remiss. If you ARE advocating this kind of choice, then I disagree whole heartedly.BangBangMedichttps://www.blogger.com/profile/17486051066465569661noreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-69663600068175645932009-09-27T14:34:09.415-07:002009-09-27T14:34:09.415-07:00This sure seems to me to be a post to induce fear,...This sure seems to me to be a post to induce fear, uncertainty, and doubt in the general public who fears health care reform. Blindness and deafness are very different. It appears this is indicative of either a flaw in your storytelling or a flaw in your care of this individual.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1408616337296439010.post-5964288691313661952009-09-27T04:43:13.685-07:002009-09-27T04:43:13.685-07:00This is doc sensitive. No this was not my call- i...This is doc sensitive. No this was not my call- it was the attendings. I had already ordered Calcium and insulin/glucose b/c felt it was a reversible condition. I wanted to treat his high potassium. Being from the USA, I found it very difficulty to just "let someone die." Good point about not responding to voice commands- meant to say that he was blind- not deaf.Anonymousnoreply@blogger.com