It's hard for me to understand. But then again I work in the medical field and I see the whole picture. It's very common for 80-90 year old patients to come to the hospital in distress. Sometimes it's an easy fix... Antibiotics for a UTI or pneumonia, a catheter for an enlarged prostate, or scope and a couple units of blood for a GI bleed. We quickly patch them up and then send them on their pleasantly confused way. But sometimes things get a little more complicated- the pneumonia turns into sepsis, which puts them into renal failure, and then respiratory failure.
Family Point of View:
Grandma is happy in her assisted living facility, she has friends, we come and visit her, and bring her home for Holidays. She was fine yesterday... I dont understand how this happened so quickly. Now grandma can't breathe. She is gasping for air, she looks in pain, and why aren't the doctors doing something to help her? Sure grandma is a DNR (do not resuscitate) but grandma isn't dead. She's still breathing on her own and has a pulse. All we want to do is help her feel better, not bring her back to life.
Next the doctors come in and explain the situation. "Grandmas kidneys aren't working, and her lungs and body are full of infection. This sickness has made her confused so now you must make the decisions for her. You have 2 options:you can respect her wishes and make her comfortable and support her in a natural death; or you can trial a period of aggressive care and she if she responds." Grandma is a fighter, she wants to see her grandkids grow up, and she could have 5 good years left. We need to at least give her a chance.
Sometimes doctors go in to deep detail of what "aggressive care" looks like. But not all. Now the families are left with this heavy decision. Let grandma die or try and let her live.
Staff Point of View:
"Aggressive treatment" begins. The patient gets a central line ( a large IV going through her chest down to her heart), an arterial line (an IV through a radial artery that continually measures her blood pressure), intubated (a tube down into her lungs connected to a machine that breathes for her), a NG tube (a tube going from her nose to her stomach that infuses liquid food), an insulin drip (hourly pricks on her finger to take her blood sugar), and the list goes on. During all of this, the patient is sedated (on medication to keep her asleep and comfortable). She is hopefully completely unaware of what's going on, she doesn't know her family is with her, and she can't talk.
It's clear to the nurses and doctors that this isn't working. Her kidney are just getting worse, she's requiring higher Fio2, her lungs are filling up with fluid, and she's needing less sedation indicating her mental status is also deteriorating. The nurses are asking each other why we even started down this path. It was clear from the beginning she wasn't strong enough to recover. But the "family" wanted full treatment. And sometimes the word "family" is used with a bit of attitude, a touch of distaste because this was their choice after all.
After a week or so of this, it's time to tell the family the treatment isn't helping. Grandma only has a couple days left. It's time to take out all the lines and tubes and let her go. Unfortunately, she is now too sick to hear you say goodbye. The doctor removes her breathing tube and she never takes another breath, dying right before your eyes.
This is the part I don't understand. Why are families given false hope? Of course if we tell them there might be a chance they're going to try and save her. But the family doesn't know about health care, they don't have all the information, and they aren't in an emotional state to make such a quick rational decision. Sometimes they need someone to just tell them what to do. To say, "Listen... Aggressive treatment might work, but even if it does she will never be the same. Then when it doesn't work, we will have put her through all this pain for nothing. And when she dies she won't be grandma, and you won't get to say goodbye, she won't even know you're here. She's lived a good life. Take her home. Love her in these past few days. Let her go..."
Healthcare isn't all about saving lives. It's also about quality of life and quality of death. I would rather have a good death, then suffer through life saving treatment to have a poor quality of life. I hope someday my family can embrace death and make the hard decisions when my time comes. I also hope our medical field can learn to do the same.
Family Point of View:
Grandma is happy in her assisted living facility, she has friends, we come and visit her, and bring her home for Holidays. She was fine yesterday... I dont understand how this happened so quickly. Now grandma can't breathe. She is gasping for air, she looks in pain, and why aren't the doctors doing something to help her? Sure grandma is a DNR (do not resuscitate) but grandma isn't dead. She's still breathing on her own and has a pulse. All we want to do is help her feel better, not bring her back to life.
Next the doctors come in and explain the situation. "Grandmas kidneys aren't working, and her lungs and body are full of infection. This sickness has made her confused so now you must make the decisions for her. You have 2 options:you can respect her wishes and make her comfortable and support her in a natural death; or you can trial a period of aggressive care and she if she responds." Grandma is a fighter, she wants to see her grandkids grow up, and she could have 5 good years left. We need to at least give her a chance.
Sometimes doctors go in to deep detail of what "aggressive care" looks like. But not all. Now the families are left with this heavy decision. Let grandma die or try and let her live.
Staff Point of View:
"Aggressive treatment" begins. The patient gets a central line ( a large IV going through her chest down to her heart), an arterial line (an IV through a radial artery that continually measures her blood pressure), intubated (a tube down into her lungs connected to a machine that breathes for her), a NG tube (a tube going from her nose to her stomach that infuses liquid food), an insulin drip (hourly pricks on her finger to take her blood sugar), and the list goes on. During all of this, the patient is sedated (on medication to keep her asleep and comfortable). She is hopefully completely unaware of what's going on, she doesn't know her family is with her, and she can't talk.
It's clear to the nurses and doctors that this isn't working. Her kidney are just getting worse, she's requiring higher Fio2, her lungs are filling up with fluid, and she's needing less sedation indicating her mental status is also deteriorating. The nurses are asking each other why we even started down this path. It was clear from the beginning she wasn't strong enough to recover. But the "family" wanted full treatment. And sometimes the word "family" is used with a bit of attitude, a touch of distaste because this was their choice after all.
After a week or so of this, it's time to tell the family the treatment isn't helping. Grandma only has a couple days left. It's time to take out all the lines and tubes and let her go. Unfortunately, she is now too sick to hear you say goodbye. The doctor removes her breathing tube and she never takes another breath, dying right before your eyes.
This is the part I don't understand. Why are families given false hope? Of course if we tell them there might be a chance they're going to try and save her. But the family doesn't know about health care, they don't have all the information, and they aren't in an emotional state to make such a quick rational decision. Sometimes they need someone to just tell them what to do. To say, "Listen... Aggressive treatment might work, but even if it does she will never be the same. Then when it doesn't work, we will have put her through all this pain for nothing. And when she dies she won't be grandma, and you won't get to say goodbye, she won't even know you're here. She's lived a good life. Take her home. Love her in these past few days. Let her go..."
Healthcare isn't all about saving lives. It's also about quality of life and quality of death. I would rather have a good death, then suffer through life saving treatment to have a poor quality of life. I hope someday my family can embrace death and make the hard decisions when my time comes. I also hope our medical field can learn to do the same.
Excellent. I agree wholeheartedly. You have a lot of wisdom for one so young. :)
ReplyDelete