What’s with all the dead guys? October 21, 2007
Posted by keepbreathing in ICU, death, health, hospital, medicine, respiratory therapy, terminal wean.trackback
Man. I had to terminally extubate another patient today. This brings my total over the last six weeks to well over half a dozen, somewhere around eight or nine I am guessing. This is far more patients than I terminally extubated even in the year or so leading to my arrival here at Sunny Flats…not that it bothers me particularly, but on some level it still feels strange to me to flip the switch and yank the tube. I know it’s laughably naive, but on some level I guess I wish it was different; I wish we actually did save lives instead of just cheating the reaper.
Yes, that’s right. Underneath the misanthropy and the casual disdain for many of my patients, sometimes I really do want to help them. I think that on some levels I am perpetually frustrated by the inability of anybody to really do anything for most of these people. Sure, we can treat the meat and keep people alive; but what’s the point of doing that if their life is just going to be a bunch of misery? In the course of talking to my patients I find that most of them respond better to casual conversation than to any medicine. People really like it when you show an interest in them, and patients just light up if you spend a few minutes getting to know them in more than the cold clinical sense. Maybe it’s just me but I often think that the conversations I have with most patients on breathing treatments do them more good than any albuterol ever will.
Getting back to the terminal weans, it does feel a little funny to be doing so many of them all of a sudden. But I don’t really mind it. A lot of the time, what we are doing in critical care is simply animating meat. I can keep your body alive almost indefinitely: but does that necessarily mean that I should? Sometimes the kindest thing to do to a person is to just let them die with some sort of dignity intact, and too often people die looking like a rabbit in a trap: that final look of shock or terror before the deadness sets in; the panic and confusion of CPR and resuscitation; days and days spent hooked to drips and things before the final bit of life leaves.
Bah to all that, I say. May as well skip the lot of it and just die naturally. And failing that, sometimes it’s best to know when to cut your losses and give someone the closest thing to a natural death that we in the ICU can arrange.
Any thoughts, audience?
we need to make it as painless as possible. I know when it is my time I do not want to be in ICU hooked to machines and tubes. I much rather go in my bedroom surrounded by my loving Angel and the rest of my family. I work at a huge teaching hospital in the south. I see way to much is done to animate meat puppets to use for teaching. I think we need to work hard to save the viable patients and let the ones with no chance at all to have a productive life go off to the deep sleep. I know thats what I would want.
Turning off that Vent is a rough thing to do sometimes but it’s a necessary thing to do also, no one really enjoys doing that (unless your really sadistic), but in a way we are setting a person free who would have no quality of life in our world. It’s hard to not think that we are ending a life I know it goes through my mind when I do that but it’s part of our job. I do get a feeling that the person is floating somewhere in the room looking at us afterwards, just a feeling of course I don’t know for sure.
CPR “saves” are the one of the most depressing parts of my job.
I cringe every time we get a rhythm and circulation back in someone that I know will never have a decent quality of life, or likely even leave the building.
When they’re merely meat on a machine, how have we helped them?
Well, this is all I have been doing this week, as well. Every room in my ICU that had a patient in it the other day was wanting a “celestial discharge”. There is something in the air, I think. . .
There are two ways to look at this. Yes, even though I’m a traditinalist, I cringe when someone finds that heartbeat. I usually keep my mouth shut, though, as we work up the patient another hour and, possibly, even hook up a ventilator.
Sometimes, however, I think using a ventilator on these patients is Gods way of allowing certain families time to say goodbye. Or, when its not a code situation, time to think.
I had an old lady in the ICU this week, six weeks post aortic aneurysm, TRALI, being proned for ARDS, becoming anuric because her kidneys were failing… and they were going to start dialysis at the bedside! And nobody from the family had been there IN A WEEK; the kid with POA couldn’t come in because he “had a cold.” Finally my preceptor (i’m new) called the family and laid it out plain that mom was dying, organs were failing, and maybe it was time to let go. The docs finally wrote comfort care orders and they took her off the vent that night.
From what i’ve seen, it’s often not the primary decision-makers– docs or family members– but those of us who witness the hour-by-hour agony who have to lead the way in letting people have a good death.