Tuesday, November 15, 2011

grandpa's day to die

Grandpa went down in the kitchen. Somehow mentally disabled son was able to call 911. Medics shocked grandpa and got back a rhythm and intubated grandpa. They come to ER and we are waiting to start the hypothermia protocol that lowers the body temperature post cardiac arrest and preserves brain function.

Before we could get started, son who lives in another state is called about how much they want done with Grandpa being that he is 89. Son says that he is power of attorney and makes medical decisions for grandpa. Grandpa has a living will/DNR order. Meanwhile daughter arrives and says she also is power of attorney.. She says that grandpa said plainly he did not want extraordinary measures done.

Doctor explains situation to long distance son and son says he wants to go and get living will document to see exactly what it says. He will fax it to doctor. Doctor says he doesn't need paper, that talking with both son and daughter will be sufficient.

Son wants guarantees about grandpas situation and hems and haws for twenty minutes trying to postpone the decision while doctor patiently explains everything. Son insists he needs to look at the document, saying "don't stop anything for 15 minutes while I look for it". Son will call us back. Son is transferred to grandpas room and talks with sister and they finally decide to not do any more major interventions with grandpa and to remove the breathing tube.

I am listening to all of this at the desk. Grandpa isn't my patient. It is painful to listen to. To listen to son try to make a decision. It is frustrating also because grandpa had already decided what he wanted, but we still have to listen to the family. Meanwhile grandpa sits there waiting while children decide whether to end his life.

You would think that when someone has a do not resuscitate order, that everything would be clear. Its not. I have seen more than a few times, a family override mom or dads decision, and go forward with aggressive interventions anyway. We have to listen to them. The hospital isn't going to put itself in a position legally where they go against the families wishes. Most people also don't realize that DNR paperwork has to be redone yearly.

What happened to grandpa? He was breathing (not real well) on his own and he was groaning loudly when he went up to a room. I really felt for what the family was going to have to go through in the next few hours. I also wondered what would happen to mentally disabled son who lived with grandpa and now is left without someone to take care of him.


hoodnurse said...

This stuff hurts my heart. We've had a lot of it where I work lately. Seems like CPR is always discussed, but feeding tubes and even intubation is always such a grey area. People get stuck in some awful states thanks to either failure to plan or families inability to let go.
My grandma always has always discussed this stuff with me and my cousins since we were pretty young. I remember finding it really upsetting back then, but now that I'm a nurse I understand why she talks about it the way she does.

Anonymous said...

I think mentally disabled son should get a vote too since he's probably the one who will be caring for grandpa if he survives to discharge.

rnraquel said...

I still don't understand why family members can override the DNR. It is so sad and frustrating to watch.

Anonymous said...

Families get to choose because dead people don't sue... but their selfish, pain in the ass children do!