Later that day, we encountered his family, a large group of old Maine Catholics. They seemed to be nice people, but I couldn‘t face them. All I could think was that his family either hated him or had advanced to a state of pure denial. It bothered me, and I couldn’t look at them. It was my first encounter with the dark side of modern medicine, and it was the first time that I ever asked myself: is our help just hurting this man?
I once took care of a patient, who's family was filled with non english speaking devout Catholics. I had no idea whether their religion played into their decision making or not . I can only assume that it did. Their mother was brain dead from a massive stroke. Confirmed by clinical testing. Reconfirmed by brain flow studies. Brain death is clinical death. There is no coming back from that.
On first discussion, their decision was to continue "full support" forever. It would never occur to them to take their mother off the breathing machine. The only thing keeping her heart alive, even though she had already died. Their expectation was to keep her on the ventilator forever and wait for her to wake up.
I don't consider myself to be a religious scholar. I'm not even sure if I did the right thing. But I played the religion card that day. Based on the multiple religious comments that kept presenting themselves during my discussions I realized what this family was looking for was the salvation of their mother's soul.
I told them mother would never come back and talk to them. Ever again. I told them that the respiratory and everything we were doing to her in the intensive care unit was keeping her from finding her salvation. That their decision to continue medical support was preventing eternal peace of their mother's soul. I told them that turning off the machines would allow her to pass on to a place much greater than this.
And less than an hour later, with 30+ family members by her side, the machines were turned off. I'm not Catholic. I don't have any idea what the Catholics preach. I'm not even sure if what I said to the family was religiously correct. But it helped them to do the right thing. And it allowed their mother to leave this earth in one piece. Had I not played the religion card, their brain dead mother would have either died during CPR, or worse, a living dead man.
Have you ever played the religion card?
8 Outbursts:
I'm hoping there was an appropriate referral to the organ procurement organization.
Death is death, whether brain death or cardiopulmonary. You wouldn't have done CPR on that patient for 2-3 days, so there's no reason (other than organ donation) to leave a brain dead body on a ventilator for any length of time.
In my work as an OPO coordinator/clinical director, I've come across many hospitals of all shapes and sizes who weren't willing to commit to this. Give the family a reasonable timeframe to allow others to arrive ("reasonable" generally being <12 hours, in my mind) and then, if the decision is not to donate, the machines are turned off.
Speaking as a Catholic, if the patient is dead, her soul was already off on its salvation journey. Speaking as a clinician, I'd argue that your statement was perhaps theologically debatable, but clinically incorrect, as it suggested that the patient was not dead yet until the machines were turned off.
"If God is going to perform a miracle, He knows just how much time He has in which to do it. He doesn't need us to keep anyone going until He gets around to it."
Maybe they were reading from the Gospel Of Warren Zevon:
They say Jesus will find you wherever you go
But when He'll coming looking for you, they don't know
In the meantime, keep your profile low.
Happy sez...
Their mother was brain dead from a massive stroke. Confirmed by clinical testing. Reconfirmed by brain flow studies. Brain death is clinical death. There is no coming back from that.
Shouldn't that have been the end of the discussion? Brain death=turn off the machines=do not pass Go, do not collect $200.
Probably appropos of nothing except one of my favorite rants> In most states, DNR pre-hospital is a whole different ballgame with different requirements legally and in the paperwork department.Many (if not most) docs, nurses, and others who talk about DNR with patients and a family don't understand and thus don't give a good overview of what will happen when the paramedics are called to either the house or the nursing home.
I consider myself an informed Catholic. I also consider myself to be very pro-life. But, I'm a hospice nurse who, with just a bit of education, understands the difference between 'life' and fantasy land.
If God is going to perform a miracle, He knows just how much time He has in which to do it. He doesn't need us to keep anyone going until He gets around to it. Plus, if you're a (Christian) church-goer worth your salt you've heard of Lazarus....Jesus raised him after he was already dead, no life-support anywhere in evidence.
What you're describing is ignorance, plain and simple. It can be found in many religions. And where there is no religion.
Anonymous, there needs to be many more like you who are willing to gently state the truth. It's crazy to be held hostage by emotional family members who know not what they are doing.
Three words:
Welcome to Italy.
Have you read about their latest position on advanced directives and withdrawing life support? It makes the Terri Shaivo debacle look like a day at the beach.
Fun.
I'm not sure I understand correctly. You state "On first discussion, their decision was to continue "full support" forever". That implies that an opportunity for a "decision" was afforded them. That makes no sense. A brain-dead patient, as you pointed out, is clinically, legally "dead". A non-patient. No decision to be made. It is not appropriate to discuss prolonging mechanical ventilation or other supportive measures other than to allow for organ donation. Having done this many times, I tell them gently but firmly that the machines will be turned off, because the patient is dead.
My family is profoundly religious but believes that God is capable of raising the dead or performing other medical miracles with only 21% oxygen. We asked a very reluctant Catholic doc to comply with the advanced directive of our very old, very sick comatose granny.
Karen
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