Monday, April 15, 2013

HCR -- A Nurse's Plea for Mercy for Dying Patients

The Health Care Blog is down at the moment but I received a copy of a comment left overnight at one of the most  widely-read posts ever to appear there, How Doctors Die. I think it first appeared at Zocalo Public Square but it has been replicated several places and has drawn many comments wherever it has appeared.
Do read the post if you haven't yet done so.

But for now, here is another well-spoken response from a health care professional on the front lines. She knows what she's talking about and so do I. One of the most difficult parts of being a care-giver is seeing how often people facing death cannot get permission from family members to leave.  The result is protracted suffering.
Author: Leigh RN
I work as an RN in an extended care facility, which is rapidly changing to a complex care facility. We are finding that more and more, rather than admitting people with dementia that can no longer cope at home, we are getting very frail elderly with complex medical histories who have been hospitalized and treated multiple times. 
More and more of these frail elderly are being admitted as full codes, with requests to transfer to acute care or ICU as required. Many of these admissions and their family members have no idea what they are signing up for when they request to be a full code and that prolonging life is not the same as improving quality of life. 
It seems to me that a lot of family members think that in order to show their love, they need to request all measures necessary to prevent death. I think that all health care professionals need a bit of a tune-up in how we approach these kinds of conversations with the seriously ill and their loved ones. Sometimes it seems that they need "permission" from us to stop they are somehow disappointing themselves and their loved ones by not agreeing to all necessary treatment. 
It is a conundrum, for sure, but I feel that I see a lot of unnecessary suffering every day in my work-place as a result of this desire to show love and devotion through invasive and sometimes futile procedures. It seems as though no one is allowed to die of old age or ill health any more, but rather only through treatment failure.

Someone I know well said that pneumonia was once called "the old man's friend" because that was the way life ended years ago for many elderly people, before what we like to call "modern medicine" developed so many scientific miracles. But when we speak of miracles it is important to remember that although Jesus miraculously healed many people they all eventually died.

This chart appeared at Kevin, MD with comments by Dr. Stephen C. Schimpff. about how the official causes of death have changed and multiplied over the last century. He points out that...
As our population rapidly ages there will be increasing numbers of the chronic diseases that come with aging such as visual and hearing dysfunction, mobility problems, arthritis and Alzheimer’s. And as society persists in eating a non-nutritious diet and too much of it, avoiding exercise, having chronic stress and (20%) smoking there will be literal epidemics of obesity, hypertension, coronary artery disease, stroke, chronic lung and kidney disease and cancer. Just as sanitation and vaccines made a huge impact on the diseases of a century ago, so too could aggressive preventive measures to assure health and wellness make a difference in this century.
What is evident is that the causes of death have switched from acute illnesses to chronic illnesses.

He argues that lifestyle and better coordination of multi-specialty care would prevent most of these modern diseases. He's correct, of course, but unless and until that multi-specialty care comes to pass (and it still seems to be moving in the opposite direction) we will be faced with situations like those described by the nurse's comment.

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