JohnC Posted December 12, 2018 Posted December 12, 2018 16 minutes ago, Sweet Lou said: My wife wanted to pass away at home and she did after a 6 year battle with a very tenacious form of breast cancer called, HER 2. We had a lot of help from family, friends, neighbors, the county nursing facility and the traveling nurses where I live. My health insurance covered the rest. She had a DNR which was by her own choice and it was put in motion while she was still well enough to do so. She also had a living will that was very descriptive with step by step instructions. It didn't make her death any easier, but it did make her final wishes easier and closure more accepting. Before her early departure, she was employed in the ICU/CCU Unit of the local hospital, not far from where I still live. I dislike saying it, but she had experience watching people die. Good Luck BBB. It's not easy Sorry for your loss.
Sweet Lou Posted December 12, 2018 Posted December 12, 2018 Thanks a million Augie! It's been almost 16 months for us and we're both doing pretty well. She wanted us to celebrate her life. And that is what we've been trying to do. 3
KD in CA Posted December 12, 2018 Posted December 12, 2018 (edited) 11 hours ago, bbb said: I agree with all you're saying. But, my mother had made comeback after comeback. She was on life support and came back. If she wanted all this stuff (that I have signed that I DON'T want) - they should not be hounding her and us to sign off on stopping them. Why even have the living will or whatever it's called in the first place?!?...................It was incredibly excessive and made me start thinking there is something financial going on here. Follow the money. Of course there's something financial going on. Resources are limited and they should be utilized where they will do the most benefit. I don't mean to be a prick cause I know it sucks when your parents die, but you didn't say how old your mother was, why she needed to make 'comeback after comeback', or what the comebacks consisted of; all things which should be considered when evaluating end of life care. It it may not have been relevant to your situation, but we need to do a whole lot less of keeping people alive just for the sake of breathing in this country. Edited December 12, 2018 by KD in CA 1
ExiledInIllinois Posted December 12, 2018 Posted December 12, 2018 (edited) 59 minutes ago, KD in CA said: Of course there's something financial going on. Resources are limited and they should be utilized where they will do the more benefit. I don't mean to be a prick cause I know it sucks when your parents die, but you didn't say how old your mother was, why she needed to make 'comeback after comeback', or what the comebacks consisted of; all things which should be considered when evaluating end of life care. It it may not have been relevant to your situation, but we need to do a whole lot less of keeping people alive just for the sake of breathing in this country. Just imagine if everything was in cold socialized system... And a whole bunch of people chose to be a "frequent flyer." What a strain on the system. That whole debate about "death panels" has a bit of unsexy truth. What if everybody chose to hang on? Who's the one's making the decision that a patient is failing to "thrive." Modern medicine can keep anybody kicking... Bedridden, intubated, etc... This is a very touchy and emotional area. I would hate to have to be the medical professional that was dealing with a patient that had "full code" and kept on bringing them back where there is no hope to thrive. So much damage each cycle and a drain on the system. The system seems pushy, cold, clinical... But how does one get some to stop clinging emotionally? AND yikes, religiously? Lucky with Our father, he's in the VA system. You know me, I am a Leftist, pro-socialized medicine... Even I acknowledge, the system would go off the rails if it could NOT "nudge" people to think more clinically and with less emotion. What a huge can of worms this opens up between private-public systems, resources, etc... Ethical questions, don't even get religion involved. Now mix in dying with dignity, the people that have to take care of these patients... Which is very, very hard work. This is a vocation, do we have enough people to answer the call? bbb I wish your friend and you all the best. It's gut wrenching what my siblings and I are going through. This easily can tear apart families forever! I can't lie to you... We are testing the family bond between us! Our Mother passed away almost 20 years ago in February, 1999. She was the family strength. She would never want us torn apart over these issues. I look to her guidance to allay the tensions that we are dealing with. Edited December 12, 2018 by ExiledInIllinois
bbb Posted December 12, 2018 Author Posted December 12, 2018 1 hour ago, KD in CA said: Of course there's something financial going on. Resources are limited and they should be utilized where they will do the most benefit. I don't mean to be a prick cause I know it sucks when your parents die, but you didn't say how old your mother was, why she needed to make 'comeback after comeback', or what the comebacks consisted of; all things which should be considered when evaluating end of life care. It it may not have been relevant to your situation, but we need to do a whole lot less of keeping people alive just for the sake of breathing in this country. I posted this on another board that is health care related and they blasted me for just the opposite reason. Saying it's not financial. It's about not wanting to break ribs with CPR, not wanting the patient to suffer, etc.
ExiledInIllinois Posted December 12, 2018 Posted December 12, 2018 48 minutes ago, bbb said: I posted this on another board that is health care related and they blasted me for just the opposite reason. Saying it's not financial. It's about not wanting to break ribs with CPR, not wanting the patient to suffer, etc. But... It is that too. Has to be awful. Some think: "First do no harm" is in the original Hippocratic Oath. It's really not, but it's relevant and used in later versions: https://www.thoughtco.com/first-do-no-harm-hippocratic-oath-118780 "...The takeaway point of "first do no harm" is that, in certain cases, it may be better to do nothing rather than intervening and potentially causing more harm than good..."
davefan66 Posted December 12, 2018 Posted December 12, 2018 Being a Registered Nurse, I’ve had this conversation with family members more often than I care to. I’d much rather be having a conversation about getting better and going home. Why do we discuss DNR with patients/family? No, it’s not financial. No, it’s not because we don’t want to break ribs while performing CPR. As a member of the team caring for your loved one, I am intimately involved with their diagnosis and long term prognosis. If the patients prognosis is fair, good or better, the patient will remain at the hospital until they are medically stable to move to the next level of care (rehab), or better enough to go home. I’ve never seen the patient or family members petitioned by staff to sign a DNR for financial reasons. If a patient is still sick and condition worsens and codes several times under our care, if not already, they’d be moved to an ICU environment until stable enough to move out to a medical/surgical floor. If the Doctors diagnosis/prognosis is very poor, then we as the health care team are charged with offering every option we can to the patient/family. There are several options, and they all are the patient, or their family to make the decision what course to follow. Continue the present course of care, either as a full code or DNR, with the goal of a full recovery. Pull back on some care. Offer for the patient to be comfort care meaning no invasive procedures will be done, blood work is stopped, regular medications continue along with continuing eating/drinking if the patient can. Comfort care is usually a part of end of life care, with either Palliative care or Hospice care involved. Why do health care providers discuss a DNR with patients/family? It’s depends on what has happened with the patient and what the long term prognosis is. As a care provider, the worst part of health care that I see are family members that can’t come to grips with what is happening, and cant make the decision to let their loved one pass on peacefully. It’s an extremely difficult decision that carries with it a sense of guilt, and we are very aware of that. We would never have the discussion with family unless the prognosis was extremely poor. Nothing worse than seeing a patient needlessly suffer, it’s heartbreaking. Please understand this. A DNR does not mean we stop care, or stop life saving medications. Everything that is being done, continues to be done until the patient has a medical event that requires CPR. DNR means several things. First off, in NYS we have the MOLST form - Medical Orders for Life-Sustaining Treatment. The MOLST form specifies what to do if the patient stops breathing or their heart stops. Either perform full CPR and intubate (breathing machine), CPR only and no breathing machine, breathing machine only if that’s what’s needed, or a DNR/DNI which is perform no life saving measures. The level of DNR is he patient/family members decision alone. The doctor provides the information to assist in making the decision, but can’t make the decision for the family. That being said, sometimes a patient will rebound beyond anyone’s expectations, as it sounds like what happened with the OP’s family member. But please be assured, any conversation to make a family member a DNR is done with the information the doctor has, the patients history and what the long term prognosis is. I’ve never seen the discussion happen for financial reasons. The patient has a Bill of Rights and we can’t force them to do anything they don’t want to, we can’t. Homestly, anything we say or do is in the best interest of the patient. That’s why we got in the health care field, to care for those who can’t care for themselves and the desire help others. 4
BringBackOrton Posted December 12, 2018 Posted December 12, 2018 (edited) 6 hours ago, bbb said: I posted this on another board that is health care related and they blasted me for just the opposite reason. Saying it's not financial. It's about not wanting to break ribs with CPR, not wanting the patient to suffer, etc. It’s both. In all likelihood, the physicians know that person is going to suffer unnecessarily so they can drink a jello cup through a straw for a month, then be back on the vent. People are too scared to die. Your friend should take solace that she acted in the way her father would have wanted. And you should take solace that you didn’t put your mother through another month in the hospital to fight a losing battle. It’s hard to think objectively about this sort of thing. If I told you you would have a 1 in a million chance to rebound after being intubated for 6 months at 95 years, and “rebound” means supplemental oxygen, dialysis, PT, and a living facility where they wipe your butt, you’d say, “I’d rather just go.” But you ask that question in the moment, faced with your own mortality? You might say “I want everything.” That’s probably not true, you’re just too scared to die. Edited December 12, 2018 by BringBackOrton 1
Steve O Posted December 12, 2018 Posted December 12, 2018 20 hours ago, bbb said: I agree with all you're saying. But, my mother had made comeback after comeback. She was on life support and came back. If she wanted all this stuff (that I have signed that I DON'T want) - they should not be hounding her and us to sign off on stopping them. Why even have the living will or whatever it's called in the first place?!?...................It was incredibly excessive and made me start thinking there is something financial going on here. Follow the money. Will to survive can be strong. My father actually survived (they call it graduated) hospice care four times. They won't take you in hospice unless there is virtually no chance of long term survival. He finally passed after being on hospice a fifth time (hey, he was only breaking his own record at that point anyways.) Before I brought him home for the last time (it was in-home hospice) the Dr in the hospital had told me death was imminent. Not really sure what the definition of imminent is but he lived for 6 weeks after coming home. But yes, the last 5+ years of his life probably racked up 5 times the medical expenses of the first 95 years. There is definitely some financial incentive. Having spent much of the past 6 years caring for my parents in one form or another, all I can tell you is that you may not be doing the best that can be done, all you can do is the best you can do. If you've done that, there is nothing to regret. 2 1
bbb Posted December 12, 2018 Author Posted December 12, 2018 10 hours ago, davefan66 said: The patient has a Bill of Rights and we can’t force them to do anything they don’t want to, we can’t. Homestly, anything we say or do is in the best interest of the patient. That’s why we got in the health care field, to care for those who can’t care for themselves and the desire help others. The word you said above was Option. I KNOW why people get in the health care field. But, I also know that things intervene. (Just like in teaching, and I'm sure other great fields) I had no question about any of this - until they persisted and persisted about it. "Can't force them to do anything" is true, but these doctors were trying to be more persuasive that the guy in Baby It's Cold Outside................and, they eventually were. I never would have brought it up if it didn't just happen again to this case that I'm close to. (The details are a little different because they did not have a DNR or any of that stuff. But, my mother DID have her paperwork. She had made her decision. And, she was sticking by her decision) 7 hours ago, BringBackOrton said: It’s hard to think objectively about this sort of thing. If I told you you would have a 1 in a million chance to rebound after being intubated for 6 months at 95 years, and “rebound” means supplemental oxygen, dialysis, PT, and a living facility where they wipe your butt, you’d say, “I’d rather just go.” But you ask that question in the moment, faced with your own mortality? You might say “I want everything.” That’s probably not true, you’re just too scared to die. I have made my wishes very clear. Just let me go - sooner rather than later! My mother was the opposite, though. 5 hours ago, Steve O said: (hey, he was only breaking his own record at that point anyways. ?
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