PaulaNancyMillstoneJ

Comfort measures are not assisted suicide. When there are no treatment options left, a patient or their family can elect to decline further invasive (and often painful) medical treatment that would ultimately be futile.

For example, the first patient I took off life support had a dead gut due to cancer. The tumors and swelling had twisted her intestines so badly that they were cut off from the blood supply. This is not survivable. The miracle magically appearing donation organ digestive system and massive resection and transplant surgery for a terminal cancer patient is not a real thing. That’s movies. She was already in so much pain. The swelling was putting pressure on her lungs and they were slowly filling with fluid even while we pumped them with oxygen on the ventilator. A dead bowel causes blood pressures to drop significantly. Obviously, we can’t give her sedation or pain meds for the agonizing pain, because if we are still doing full cares, the pain medicine and sedation will make her pressures worse. She is already maxed on critical drips which are cutting off the blood supply to her extremities to shunt it to her heart and lungs and brain. Pure epinephrine (adrenaline) and norepinephrine and vasopressin. Pure fear. Torture. We may be able to keep her alive maxed out on medicine like this for an hour, tops. She is contorting her facial expression on the vent. She is restrained so she doesn’t pull the artificial airway out of her throat that she feels is literally choking her. She gags nonstop.

Luckily, her family understands that this is beyond cruel, and chooses to deny the further aggressive and pointless medical interventions. We compassionately extubate her and untie her hands. She starts taking her own agonal breaths and her family holds her hands. We give her small doses of pain meds to stave off air hunger and pain. She mouths to her family that she loves them, then becomes drowsy and drowsier from her slowly failing lung ventilation. Her mom sang her a lullaby. And she went. Her family all around. (And her nurse went outside to cry.)

We all die. Even though we don’t like to think about it. Lots of people die alone, or in horrible accidents, or when they are completely unprepared. If I got to choose my death, I’d want my family there and I’d want to say goodbye, free from pain, and knowing I was loved.

How do you fit a disguise to the right person? Or the right person to a disguise?

Would you say that the dynamics between coworkers were different from what you might find in, say, a large office or corporation? How did coworkers interact outside of work?

Coding a terminal cancer patient is the most gruesome thing we do, especially when we know it’s against their wishes. I’m sure you’ve seen it and likely done it, but breaking their ribs always gets me. That feeling of broken bone on bone as you try to pump their heart doing compressions sends shivers down my spine. Knowing you’ll bring them back to consciousness with pure adrenaline and electrical shocks a few, or 6, or more times before ultimately failing. It’s inhumane.

“I’m your nurse and I swore to take care of you, but your children aren’t ready to grieve you and are selfish, so they want us to go against your wishes and do CPR so look at my sweating face as I do what I am legally obligated to do and bring you back to agony a few times before you go.”

It is, but palliative care teams and hospice teams are absolutely amazing when everyone is onboard. Before I was a nurse the idea of “hospice” was like a mix between a funeral home and a nursing home where people slowly wither away.

But hospice is amazing. They have so many tricks and techniques to give people the best end of life care. From keeping people comfortable with pain meds and things like steroids for inflammatory pain, or crushed antibiotic pills sprinkled on wounds for the pain of embarrassment of smelling bad when your family comes to visit. They spend a lot of time with people on their service, meeting more than just their physical needs. Their care is tailored and patient centered. I cannot describe how amazing hospice nurses and providers are, and how beneficial their services can be.

Going DNR or hospice when your illness is terminal is the best option for so many people and spares them pain and embarrassment. I have seen so many people die, and a death with dignity cannot be undervalued.

However, when this need first broke most redditors on r/medicine and r/nursing were conflicted because if they (we) we’re dying quickly in the hospital, we’d want it quick and an opioid overdose sounds like a good way to go. Take that with a grain of salt though, because we have seen the most gruesome and tortuous manners of prolonged death and are tormented by them. These are family induced 99% of the time.