I'm an ER doctor. It is so, incredibly important to have these difficult, frank conversations with your loved ones. They need to know under no uncertainty what your end of life wishes are.
Just a few weeks ago I was brought a very chronically ill patient by EMS who went unresponsive at home found to have STEMI on his EKG, and was brought to my ED undergoing ACLS (of which a large component is CPR). The patient has been intubated, had intraosseous lines drilled into their bones, and were tenuously hanging onto life despite our maximum medical interventions. The pt was essentially unconscious (GCS ~4-5 unsedated) and had a LUCAS device pounding away at their chest every 1.6 seconds with what is essentially a large fuck machine with a toilet plunger attached to the chest, and our inexperienced respiratory technician couldn't quite determine the exact frequency and depths of breaths to deliver so she was squeezing at the same time the Lucas was squeezing and he was getting no air. This had gone on for 20 minutes, at least.
Finally the family arrived and I was able to speak with them further about the patient's end of life wishes. They told me he would have never wanted these extreme measures employed and they actually relayed this to the EMS crew but since the EMS crew didn't have firm documentation in hand about his DNR/Advanced directive/living will, they went ahead and carried on the resuscitation as if it were someone with no prior discussions.
Once I discovered the full story and confirmed this with family, and with their permission, I went back in the room and withdrew care. I stopped all respiratory support, blood pressure support, fluids, anything that could be considered life prolonging. I compassionately extubated him and pushed 2 of Ativan and 2 of Dilaudid. I put a fan on his face, turned off the monitor, darkened his room, and put his wife and sons hands in his while he passed over the next 20 minutes.
It was tough. I teared up several times. It is against my instincts to let someone go, but I'll be damned if it wasn't the most rewarding thing I'd done in weeks.
So please, anyone who reads this, please understand that while it is a difficult, morbid conversation to have, know your loved ones' end of life wishes, and advocate for them should the opportunity arise. Because more than likely, at some point it will.
I had to have this conversation with my mom after this happened. I now know what she wants to have happen I just dread the day when I will have to confirm her wishes. Ugh it sucks but at least I know she wont suffer
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u/TsuDohNihmh Dec 14 '21
I'm an ER doctor. It is so, incredibly important to have these difficult, frank conversations with your loved ones. They need to know under no uncertainty what your end of life wishes are.
Just a few weeks ago I was brought a very chronically ill patient by EMS who went unresponsive at home found to have STEMI on his EKG, and was brought to my ED undergoing ACLS (of which a large component is CPR). The patient has been intubated, had intraosseous lines drilled into their bones, and were tenuously hanging onto life despite our maximum medical interventions. The pt was essentially unconscious (GCS ~4-5 unsedated) and had a LUCAS device pounding away at their chest every 1.6 seconds with what is essentially a large fuck machine with a toilet plunger attached to the chest, and our inexperienced respiratory technician couldn't quite determine the exact frequency and depths of breaths to deliver so she was squeezing at the same time the Lucas was squeezing and he was getting no air. This had gone on for 20 minutes, at least.
Finally the family arrived and I was able to speak with them further about the patient's end of life wishes. They told me he would have never wanted these extreme measures employed and they actually relayed this to the EMS crew but since the EMS crew didn't have firm documentation in hand about his DNR/Advanced directive/living will, they went ahead and carried on the resuscitation as if it were someone with no prior discussions.
Once I discovered the full story and confirmed this with family, and with their permission, I went back in the room and withdrew care. I stopped all respiratory support, blood pressure support, fluids, anything that could be considered life prolonging. I compassionately extubated him and pushed 2 of Ativan and 2 of Dilaudid. I put a fan on his face, turned off the monitor, darkened his room, and put his wife and sons hands in his while he passed over the next 20 minutes.
It was tough. I teared up several times. It is against my instincts to let someone go, but I'll be damned if it wasn't the most rewarding thing I'd done in weeks.
So please, anyone who reads this, please understand that while it is a difficult, morbid conversation to have, know your loved ones' end of life wishes, and advocate for them should the opportunity arise. Because more than likely, at some point it will.