Terminal Wean June 20, 2007
Posted by keepbreathing in death, health, health and wellness, hospital, life, mechanical ventilation, medical, medicine, my life, respiratory therapists, respiratory therapy, technology, terminal wean, work.trackback
I had to do a terminal wean the other night. Those are never fun: the sound of someone sucking down their last few breaths as the ET tube goes out, suctioning the airway out, hoping that the patient doesn’t die before the family comes back into the room while also hoping that they don’t suffer too much either.
This wean was particularly bad. The patient has (had) these really awful, purulent thick secretions that were clinging to the ET tube and that got stuck in the mouth. That on top of the “death breath” made me want to throw up, but puking on patients is often perceived as bad form.
So, I extubated the patient, cleaned up their mouth a little, and scooted out of the room with the ventilator while the nurse finished cleaning up the patient. I didn’t want to run into the family with the ventilator in my hands, so I took a back way out of the ICU.
And there I was, pushing this ventilator (complete with the I/E lines and everything, covered in a big clear plastic BIOHAZARD plastic bag per policy) down the hall, whistling a happy tune and trying not to think too much about what I had just done.
I turned a corner, still whistling…
…and ran directly into the deeply upset family of the man whose ET tube I had just removed. This was a surprise: apparently they had decided to take the back route into the ICU, the route that nobody ever takes, in order to avoid seeing or being seen by a lot of onlookers who would stare at them while they were busy mourning.
They looked at me. They looked at the ventilator that I was pushing. I looked at them. They looked at me for a moment. I didn’t know what to do: smiling is friendly, but they’d think I was a dick. Sympathies would be semi-inappropriate from me at that moment. What do you say? “I’m sorry I took the life support–this machine right here!— off of your dad/husband/grampa. Hope you have a nice day.”
In those few seconds when the family and I were staring at each other, I holding their (now-dead) relatives ventilator and they holding back their tears, I felt worse than I have ever felt before. It was without a doubt the most awkward moment of my entire life to date. I just pushed on past them. We never spoke a word.
I hate terminal weans. I hope the family doesn’t hate me. It’s just part of the job.
Good Wednesday evening Therapist,
The family — or the patient — decided to have the procedure done, I am assuming.
Hating you for doing a job that released the patient from more suffering wouldn’t be very logical.
Doesn’t mean that grieving people aren’t sometimes irrational, but… I’d rather have someone take me out – than continue to ‘live’ without any real quality of life left…
I hate feeling bad. I hate part of the job that makes me ache for what could have been/should have bee/couldn’t be.
I’m also grateful to be part of a system that at least doesn’t leave me to die abandoned somewhere. The patient’s family was there…
Maybe they didn’t know what to say to YOU, felt it would be awkward to thank you, were afraid to ask you if it hurt, or if you’d done that procedure before, or if you felt there was life after death… Who knows ?
Death just isn’t pretty. Not ever.
*stares* I think I might learn to hate the profession I want to go into. Seriously. If it’s this bad for the nurses, it should be even worse for the doctors, but it amazes me to see the shitty excuses doctors can come up with to not treat a dying patient in favor of going to play a game of golf. I just read about this doctor who, rather than treating a woman whose throat was completely closed due to anaphylactic shock, he decided ‘I don’t do emergency trachs.’ Asshole, why the hell are you in this profession?!
Ugh. *cringes and wonders what the hell I’m getting myself into*
Most of medicine is actually pretty good. Terminal weans are rare, but they are unpleasant. Don’t let me grind you down, though: most of medicine is good, and I’ve had several moments where I felt really really good about my job.
They don’t hate you, they hate that they lost a loved one. You have a difficult task and I have a lot of respect for you and others like you. I use to work in the medical field, but my on/off switch stopped working and I got out. Take care, Curt
Funny. Just the other night, I “helped” one of my patients die a comfortable death, surrounded by her family. I agree with Annie. Death is never pretty. It is, however, necessary. And I find most families are grateful for what we do for them, but feel awkward about saying that, especially in their grief.
I’m glad you took the time to take the vent out of the room. Most of the RT’s in my hospital leave it there until after I have taken the patient away. And if you think its bad being caught taking it away, you ought to see the looks on their faces when they walk back into the room and the vent is STILL there. . .