Take a Deep Breath and Go Home

There are many times after a family meeting when I have to take a deep breath and remember that I’m leaving this patient and family and going home to my family. I’m sure we all feel at times that families make decisions for their loved ones that we don’t agree with as palliative care professionals. I have to remind myself that families I often meet with will make decisions that they will live with the rest of their lives. In the future I may remember this patient or that situation but my personal life most likely will not be affected by the decisions of others. This is the reason at times we have to take a deep breath, take a step back and let others live their lives as they see fit. I decided to write this because I most recently did a palliative care consult for an unfortunate male in the ICU. The patient has a history of CHF, liver cirrhosis, renal failure and a long list of other problems. He recently began to physically decline with decreased appetite, weight loss, decreased mentation, hypotension and hypoxia. After several discussions with the physicians, the wife did make him a DNR with pressors since he was already on pressors. He currently has a poor prognosis and all physicians including consultants are documenting “poor prognosis.” Knowing that this patient will get worse during this hospitalization, we held a family meeting to discuss the “Goals of Care.” To make a long story short, the wife decided that she wanted everything done, short of CPR and intubation, because when he dies she wanted to make sure that “I did everything.” We tried to reassure her that when a patient is dying MANY THINGS CAN BE DONE to assure that he is comfortable. We also tried to reassure her that there are ways she can be involved at the bedside while he is dying. Despite our explanations of possible discomfort at the end-of-life with continued agressive treatment, and despite our explanations that continued aggressive treatments would serve only to prolong the moment of death, she continued to voice that she wanted “everything.” Unfortunately we see this quite often as the role of medical decisions and expertise has been given to the families by the physicians. Physicians often say they don’t want to be sued and therefore will present the family with a menu of options and the families can pick and choose what they want. This is why we will see an order such as “Yes CPR, No Intubation,” or “Yes ACLS drugs, No CPR.” Often times the nurses will see me take a deep breath as I walk out of the ICU while shaking my head. I then remind myself that people have to live with their decisions in the context of their culture, religion and understanding of life. I may not agree with it, but I have to remind myself that it’s not my life. I then smile as I drive home knowing that my family is waiting for me at home.


4 thoughts on “Take a Deep Breath and Go Home

  1. I had to smile when I started reading this–I have had this same thought many times. Your experience is validating.

    I can say this, and I hope it doesn’t offend. I have started asking myself what the real harm of ICU care really is. Is it so bad to be on the vent? Is ACLS always so bad? Sure sometimes it’s pretty bad, but most of the time it’s not the worst thing you could imagine.

    I think suffering is in the eye of the beholder. Sometimes I even ask people, are you suffering? If you can show the family that the patient is truly suffering, especially in a truly hopeless situation, there are few families that will opt to continue.

    For the few who do, I will have to refer to your blog post as a source of comfort!

    Keep at it!

    • No offense taken. My blog entry is for people receiving futile care. As we know, in many situations ventilators and ACLS meds etc. is necessary and appropriate care. However, those people on the vent in the ICU receiving futile care comes at a cost. Not only a financial cost (rising insurance premiums to start with) but also at a cost of the overall experience at the End of Life. Much data is coming out that even though we can provide more technology and treatments at the end, it doesn’t translate into a better experience or better family satisfaction. It’s quite the opposite. That is why I have to take a deep breath and go home.

    • I have to remind myself to do this daily since this type of work in the hospital is very challenging. For this reason, I enjoy my time away from Palliative Care and doing hospice care as I don’t necessarily face these issues on hospice.

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