A terminal wean…or is it? October 3, 2007
Posted by keepbreathing in death, my life, respiratory therapy, terminal wean.trackback
The other day, I had to do a terminal wean on a patient who not half an hour earlier had been coded and extensively worked up in the emergency department at a cost of many thousands of dollars. In a tragically ironic way, the patients family had decided that they wanted everything done up until we actually did it, whereupon they suddenly changed their minds and asked us to stop doing everything that they had demanded that we do not an hour earlier.
The therapist who had been caring for the patient got squeamish and made up an excuse to ask me to do the wean, which was fine. Terminal extubations are not for everyone, but I don’t usually mind doing them, and as such my squeamish comrade went to eat some lunch while I killed her patient. The nurse shooed out the dozen or so family members who were in the room, and as soon as they were out of the room I slipped the ET tube out of the patient and shut off the ventilator. The patient didn’t do much more than grimace a tiny bit when I removed the tube. I wiped her mouth off and suctioned her mouth some, then cleared away all of the tubing and accessories to keep them from the family’s mind. The nurse looked concernedly at the patient.
“Is she even breathing?” Terminal weans seem to go one of two ways: either the patient dies straightaway within a few minutes, or the patient lives forever and makes us all look like a bunch of idiots. Keeping this in mind, I observed the patient for a moment and put a gloved hand on her sternum. My hand didn’t move a millimeter.
“Nope.” The nurse tucked blankets around the patient as I peeled my gloves off and beat feet out of the room, dodging the family members crowding around the door and zipping away to the relative sanctuary of the breakroom, where I joined my squeamish friends in lunch.
Time passed.
I went out of the breakroom and went about my business. I was on a different end of the unit than Terminal Wean Lady, and so I didn’t pay her much mind until a trip to the supply room brought me past her room. I glanced in and saw a bunch of people crowded around the frail old womans body. Poor folks. They can’t bear to leave her even though she’s dead. I grabbed my supplies and went back to the office. Squeamish therapist grabbed me and asked about the dead one.
“Hey, how’s my extubated lady doing?” she asked. She seemed unusually gleeful.
“Dead,” I replied. No sense mincing words.
“No! She’s alive! She’s doing pretty well actually.” I cocked an eyebrow.
“She was dead when I left the room, anyway.”
“Well, she started breathing again a few minutes after you left and she’s actually not doing that bad. Isn’t that funny!” I laughed a fake laugh with Squeamish Therapist, and then went on my way, feeling a shameful anger that my prognostication had been proven wrong–however short-term my incorrectness would prove to be. After all, all of our patients will be dead someday…we can solve a lot of problems in medicine, but times inexorable march will always win in the end.
What really bothers me about this is that I just know that when I go back to that unit, the lady I terminally extubated will be reintubated and on all kinds of drips because she was looking so good after they pulled the tube out the first time! Nothing is worse for a patient and a family than having the carrot of false hope dangled before them, to be followed by the sharp blow to the head of the stick of reality. That’s life for you, I guess.
This will be the most depressing thing I read today.
People are retarded.
I volunteer to be the reality stick beater for the world.
“but she’s breathing!”
I really don’t know who is to blame, but sometimes it’s the physician, who just does not speak the truth to the families. And sometimes it’s the families, who do not want to hear the truth.
The patient is the one left on the chopping block, whether they know it or not.
Please don’t anyone do that to me, if my time comes in this fashion.
We have a patient right now, whom I WISH they would terminally wean, but half her family is very against it. Instead, Mom is going to rot on a ventilator in our bed. Sorry, that sounds a little jaded, doesn’t it?
I feel your pain. I hope that the woman took matters into her own hands and checked out of your high quality motel. . .
I participated in my first terminal wean last week. You want depressing? It was on a woman was brain dead after suffering some sort of intracranial hemorrhage. This happened directly after her delivery of twins. I was never able to find out what caused it.
The family decided to discontinue life support after her EEG. They made the right decision, and I admire their courage.
It was probably one of my more difficult experiences as a student. I was very apprehensive about taking part in it because I didn’t want the family to think we were making this some kind of spectacle.
Maybe spectacle is too extreme, but you know what I mean.
My first terminal wean was as a student too. It’s a weird feeling the first time…I know what you mean about not wanting it to be a spectacle, though.