Terminal Wean
There are times when, despite all the therapies and the machines, patients just wear out. They tire of the battle of staying alive attached to various technologically advanced, but ultimately painful and degrading, machines. The patients, or if the patient is unable, their families decide to allow a dignified death, and Catherine’s daughter Nancy had decided it was time for her mom to stop suffering.
I myself, and all caring nurses and therapists, find stopping life support psychologically very difficult. We are trained and motivated to help patients using any and all means at our disposal, and it is a tremendous adjustment to stand aside and let someone die. It is even more difficult when we must give medications that, while serving the laudable goal of eliminating suffering and making the patient comfortable, may hasten their death by minutes or hours.
In such cases it is our hospital’s policy to ensure that everything is carried out with the greatest dignity and professionalism:
We had been liberal with the morphine as we reduced the settings on the respirator. We did not want Catherine’s family to see her gasping or appearing to be short of breath. In addition to easing any pain, morphine also reduces the respiratory drive, thereby minimizing any feelings of breathlessness. The only problem we had administering the morphine was that we have always been trained to avoid the respiratory depressant effects of such drugs, and now we were utilizing those very effects. It is possible that in doing so we could hasten death, but at the same time, it is vital that the patient not suffer. It’s a fine balance and one we all wrestle with when we must perform terminal weans.
Catherine’s respiratory rate on the ventilator was six breaths per minute, and she was showing no signs of gasping .She appeared comfortable, as if she were asleep. Her family was with her, seated in comfortable chairs around the bed, Nancy her eight months pregnant daughter, holding her hand. I stood next to the bed as I checked Catherine, and in a gentle voice told the family that now would be the moment to say their final words to her, to tell her things they had wanted to say to her. I explained that even though Catherine may not overtly respond, hearing was the last of the senses to fade, and there was a good chance Catherine would hear their words. Nancy, trying not to cry, began whispering in Catherine’s ear as I left the room.
Twenty minutes had passed and the respiratory therapist, nurse and I entered Catherine’s room. I noticed that the overhead lights were off and only a small bedside lamp was on. Dietary had delivered a tray of coffee, juices, and cookies. The nurse gave more morphine and the respiratory therapist prepared to turn off the respirator. I nodded at him, and as he turned off the machine I removed it from the tube in Catherine’s neck. Because we had given the morphine, she did not gasp or appear in any distress. She rested now, comfortably, as her breathing slowed down. I told Nancy we would be back to check Catherine every few minutes, but to press the nurse call light if they needed anything. With tears in her eyes she nodded.
As I left the room I was embarrassed because I also had tears in my eyes and didn’t want the nurse or respiratory therapist to see me in such a state. I am supposed to set the example of professionalism, but I seemed to be failing. Then I noticed the nurse was openly crying, and the therapist’s lower lip trembled as he tried not to cry. It was then that I had a strange emotion. I felt pride in them both for doing such a difficult job so well, proud of Catherine and Nancy for choosing a dignified death, and lastly I felt hope that Catherine would finally find peace.
Catherine died two hours later, in a quiet room surrounded by her family, no hissing or humming machines, and her close family had a chance to say a proper goodbye.
Thank you for this entry.
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I felt everything you wrote and have a greater respect for the professionals who assisted a close friend of mine in going just as peacefully. –
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Being a human being with compassion doesn’t mean you’re less of a professional. Your patients are lucky to have you.
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This brought tears to my eyes. The tears and the emotions that you and the rest of the staff showed was just compassion and it is something the healthcare field needs. Thank You for this entry.
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*sniffles* now i am all teary. i know you are trained to save life but a dignified end is much better than a machine driven vegetable state. thank you for all that you do. *smiles and hugs you*
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Such a strangely beautiful entry. (Had to shut the door of my office because my eyes were too full…) Thank you for doing what you do, feeling what you feel, sharing what you share.
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Thank you.
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thank you for the work that you do. *~
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Beautifully and compassinately written. I hope you did tell them you were proud of them–all three of you walked a difficult road together.
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I also thank you for this entry. And I thank you and others like you for doing the job that you do, making it possible for patients to die with dignity and for their loved ones to experience them having a gentle death. blessings,
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poignant. thank you~
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A very moving entry.
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It is always a privilege to be at the bedside when this happens. Showing emotion makes you real and relatable to patients and your coworkers. There is little else that connects more than the moments we come into this world and the moments we leave. Beautifully written.
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Oh my goodness! God bless you and your staff for easing Catherine’s pain and showing her respect and dignity. I know her family appreciates you very much.
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I was blessed with a doctor who held my hand while Dad was being revived in ICU and twice with nurses who cried with me while my sister died fighting leukemia. I will never forget the comfort of knowing these professionals really did care, not only for the patients but also the families. Don’t ever apologize for compassion.
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professionalism doesn’t mean cold. do you watch Hart of Dixie? i love the premise of the show . . . young, beautiful, successful doctor was told to see patients as people, not puzzles. i.e. doctors can, and should feel.
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*sniff* *hugs*
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Thank you. This time of year is when I think of my grandmother’s death the most. I was with her. I was the one administering the morphine per hospice approval. She died a quiet death, at home, with me by her side, holding her hand. It was the saddest, but most beautifully amazing moment of my life. In April it will be 8 years ago. I miss her so much during the holidays, but I believe she’s me.
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Professionalism, “holding it together,” being strong or being the strong one, takes its toll. We need the healing of tears . . . we need to grieve, even as professionals, even as the calm or strong ones.
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Sometimes, when I read your entries, I have no words… I don’t know what to say. This is one of those times. Hauntingly beautiful, painfully honest. May the universe continue to give you the strength, courage and compassion that you possess to do the work you do. You share the experiences so well that each time I feel as if I have walked in and seen what you have seen, felt what you have felt…and my heart is touched. I think of you often – and the work that you do – and I feel priviledged to be able to read these stories. Thank you – both for what you do and also for what you write. Take care.
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Your patients are so lucky to have you
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This was a moving entry. It must be difficult, that situation. I would assume most situations are difficult for doctors, though. Odd term though, “wean”.
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It must be so hard to stand by and not fix what’s happening when you are trained to do just that – even when you know “fixing” isn’t the best thing. Thank you for making her comfortable and for making the family comfortable by doing so.
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My family is nearing this point with my grandmother. It’s been about a month now that she’s been in the hospital. It finally hit me this morning on my drive to work that we’re going to lose her…that we’re going to have to let her go.
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Thinking about you a lot these past few months in my life. I’ve met some incredibly kind and compassionate doctors, and soon-to-be doctors…
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You are missed. I just want you to know that. Hope life is treating you gently. Take care.
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You’ve been gone ages. You are missed. Thought of you today. Hope things are okay.
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hi
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That is a wonderful entry. Made me cry too. I wish my Mom had been able to go as peacefully. She definitely had the respiratory distress. I miss you writing here and I hope you come back …
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Whatever happened here …. OpenDiary. Where did we all go and when? I forgot. And then with a friend battling Stage IV Melanoma, I remembered. And yet another with Stage IV Lung Cancer, I can back. And then you were gone, but for this entry. Where are you writing today, CelticDoc? 🙁 Incandesce
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Whatever happened to you? I love OD, but the one thing that I find hard is when people disappear and you don’t know what happened to them. It’s like a little death…. miss you.
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*lip trembling*
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*lip trembling*
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Hey Robbo…big congrats to the BoSox for winning another one!!!!Great series….Big Papi for Pres!!!! well, at least Secretary of Education, because he really schooled them…………ummm, be well and…yeah…i’ll just show myself to the door….
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