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Critical care nurse blog: Giving up the ghost

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Critical care nurse blogger Cassandra Leese on coping with patients who have simply given up

Far too frequently in intensive care, you are privy to the kind of sad stories that Dickens himself would struggle to come to terms with.

In a type of nursing where patients are frequently admitted following overdose, violent altercations and road accidents, there are often sad stories tucked into the medical notes or written between the lines. But none hit me as hard as patients who have quite simply had enough.

Often they are smiling, appreciative souls who have close family and friends and are evidently a popular member of society. They will work with the nursing and medical team and rarely complain, instead being very grateful for all the care they are receiving.

Despite this, for a multitude of reasons, they plainly and repeatedly state that they want to die; for the medical and nursing interventions to come to a halt and to be left alone. Often they have had a long and challenging few years battling myriad medical problems. Sometimes they have lost their spouse and their life, as they knew it, is over. Sometimes they are just very old, and very tired. And yet on we go.

Whilst I am aware of the moral, legal, and ethical arguments surrounding the modern day preoccupation with the prolongation of human life; I can’t help feeling on a more basic, human level, that sometimes it is just wrong. And sometimes we just refuse to listen.

Sometimes there is no place in an intensive care unit for an 89-year-old man, wanting to spend the rest of his days in peace, without invasive lines, machinery, drugs and the endless persistence of the caring professions. And yet we go on.

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Readers' comments (3)

  • After practicing in critical care for 14 years, I became a hospice nurse. In the area (N.Carolina,USA) I worked we primarily kept our patients at home, unless there were changes in their personal situations that required admission to wards for respite or terminal care. I did a lot of teaching, learning, laughing and of course crying. I believe our culture (Western) has much to learn about letting nature take its course. Life saving technology is a wonderful thing, and you are correct about those huge, grey areas in ethics. It is painful to see that technology used in ways that cause more pain without giving comfort. The goal in hospice is to pursue the BEST life left. It is not to speed the dying process as so many mistakenly believe. Hospice nursing has all the frustrations of any nursing job, however the positive side is over and above anything I'd ever imagined. If your situation allows, perhaps your compassion and appreciation for the "finer things" would be best served by exploring the hospice field. Hospice nursing is truly a work of heart-and soul. Be well & thanks for your blogs. I enjoyed both of them.

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  • After practicing in critical care for 14 years, I became a hospice nurse. In the area (N.Carolina,USA) I worked we primarily kept our patients at home, unless there were changes in their personal situations that required admission to wards for respite or terminal care. I did a lot of teaching, learning, laughing and of course crying. I believe our culture (Western) has much to learn about letting nature take its course. Life saving technology is a wonderful thing, and you are correct about those huge, grey areas in ethics. It is painful to see that technology used in ways that cause more pain without giving comfort. The goal in hospice is to pursue the BEST life left. It is not to speed the dying process as so many mistakenly believe. Hospice nursing has all the frustrations of any nursing job, however the positive side is over and above anything I'd ever imagined. If your situation allows, perhaps your compassion and appreciation for the "finer things" would be best served by exploring the hospice field. Hospice nursing is truly a work of heart-and soul. Be well & thanks for your blogs. I enjoyed both of them.

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  • I spent many years as an ITU nurse, which I do miss dreadfully, and I empathised with this totally.

    I used to try and ensure that when patients were dying and they did not have any relatives or close friends to be with them, I spent time just sitting and holding their hand, and not disturbing them with inappropriate interventions.

    Sometimes medical colleagues would view this as strange, and look askance at me as if I had gone mad. But on a basic level most relatives expressed concern that 'their' patient did not 'die alone' and I took great pride in knowing that 'my' patients never died without someone being there with them at the end. On the one occasion where I had gone out to get the close friend in and the patient had died while I was out, I felt as if I had failed, even though the friend was his only friend and I was doing my best to get him to the patients side before his demise. And on many occasions relatives thanked me for 'being there' when they were not.

    But I frequently used to find that patients who were dying would continue on with relatives constantly present by the bedside for many hours, (even days), and the first time the relatives went out for a drink, the patient would die, as if they did not want to go while everyone was watching them and would rather 'sneak off' while everyone had gone outside.

    I think there is obviously a time for 'medical and nursing interventions' and there is a time when it is totally inappropriate, and knowing when that time comes calls for skills nurses possess in abundance.

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