26 year old who just had a stroke.
35 year old who has multiple brain masses.
52 year old who never woke up after surgery.
22 year old braindead from a massive car accident.
19 year old paralyzed from the waist down in a snowboarding accident
87 year old who went into sudden cardiac arrest and now has multiple broken ribs. She later died in the ICU.
These were all real patients of mine. Healthcare isn't a pretty job but it gave me a tough dose of reality. People say they couldn't handle the smells of working in healthcare but I assure you, you'll get used to the smells. Let me assure you, you'll get used to the smells. These moments are the worst part of my job. Although it's not all bad. Those moments remind me that I still have compassion for people and healthcare hasn't completely chewed me up and spit me out just yet. I think my heart drops a little bit when I see an elderly person is full code. Full code means we do everything in our power to save them. That includes a tubes to help them breathe and eat.
I'd much rather hold their hand as they pass instead force a feeding tube in them, restraints that tie them to the sides of the bed so they don't pull at all the tubes, or hold them down as I try to get a blood pressure.
If we can decide how we want to live our lives, we can decide how we want to die.
After a certain point we are torturing the patient just to prolong their life. That's not really living. I've done CPR on too many people who, had they just understood, likely would have opted for a DNR and died in a more dignified and humane way. I am all for life-saving measures, but reality is less glamorous and less optimistic than TV makes it out to be.
People with advanced illness, or even simply advanced age, should really consider what they expect from their future and weigh that against the idea of being tortured on a gurney with the small chance of survival, only to be miserable in a hospital bed with an even smaller chance of returning to a normal or even fair quality of life. At this point in my life, of course, I would opt for all life-saving measures for myself (though I would rather be dead than be chronically in a vegetative state), but at some point in life, the scales should tip. Ignoring the issue and just accepting the default potentially leads to increased sadness and anguish for yourself and your loved ones down the road.
Family members long gone show up and stir the pot, questioning the plan of care and undermining the staff caring for them.
I once had to call security on a woman who was harassing staff after a patient was put on hospice. The cancer had spread to his entire body. He cried if I took a blood pressure on him.
He had cancer for 7 years and she never visited him. I think she felt guilty.
I prefer to think of the chaos as inadvertent and that the disturbers are just using an ineffective strategy for coping, which for them also includes guilt over the estrangement. Extending life gives another chance to have the relationship long ignored. The delusion, for them, is that even with that, they would most likely revert back to avoiding the relationship!
Can't stress enough how important it is to have this conversation NOW. Let your loved ones know what your want. Take away the burden of having take that decision which inevitably carries a huge amount of guilt. Haven't met the first patient that has not told me they want to die at home and NOT in an ICU. Start the conversation, let your wishes be known, and get an advance directive. Get your stuff in order. This WILL happen. It's just a matter of time.
Quick Guide for you
Brain dead - Lights out; nobody home. Or as I say, the wheel is spinning, the hamster is dead.
Persistent vegetative state - Lights on; nobody home.
Coma - Lights out; somebody home.