I’ve spent over a decade in critical care, in that time I’ve seen my fair share of patients as they face the end of their life. Whether expected or unexpected, it is always hardest for the families. Many times the patient doesn’t know they’re dying, there are breathing tubes, gastric tube, catheters, sedation and analgesia. While dying is something that happens to everyone it is expected to want to buy more time. It’s so final that often times families can’t let go, they hold onto every ounce of hope that they hear often ignoring the bigger picture. When families know the end is near they try and control the uncontrollable. Even with a wonderful palliative care team helping the family cope, the patient’s wishes are often ignored prolonging the inevitable. What these family members don’t realize is that their family member is suffering. If they could only feel the endotracheal tube down their throat, the aching the body feels from being tied down in bed, the uncomfortableness of having to deficate in bed and have someone else clean you up. What if we stopped trying to fight the inevitable and celebrate the life that the person lived, honor their wishes. Remove all the tubes and wires and make them comfortable and peaceful, allowing them to pass when their body says it’s time. Most health care workers agree, dying with tubes, wires, alarms beeping and unfamiliar faces in a cold environment is not the way we want to go. Often when family finds out their loved one is terminal, the reaction is to prolong the inevitable so family and friends can come say their goodbyes. While a few hours seems reasonable to most, there are times that days go by to allow family to fly in from other states. What health care workers won’t tell the family is that to us, you are prolonging their suffering. When a patient is critical and fighting for their life, families say do everything. No one wants to be the person that makes the decision to give up. There is a stigma behind DNR; that we’re giving up because modern medicine is suppose to heal everything. Maybe if we changed our thinking from Do Not Resuscitate to Allow natural death (AND) families would be more inclined to let the patient pass peacefully. We are not giving up, we are allowing nature to take its course. The human body was not made to live forever and when we try to prolong that, the patient is the one that suffers at a time when most of us would want the environment to be peaceful. Put your wishes in writing and talk often to your family about them . Advanced directives are only as good as the people willing to carry them out. What most people don’t realize when they make an advanced directive is most hospital physicians won’t take the lead and honor them, they want families opinions and will generally go with the course the family chooses. Why on earth would a physician disregard a legal document? Well, that’s because dead people won’t sue you. Even though you’ve made your wishes legally known, most won’t take the chance for fear of repercussion from the patient’s family. We’ve all lost someone close to us, that’s life and inevitable so in the ICU we know what your going through as a family member. Often times we hear, what would you do if this was your family member? Our responses are often along the lines of, it would be devastating and crushing to have to make that decision. What you don’t hear that we are screaming inside our heads are, we wouldn’t want any of this! We wouldn’t want the tubes and wires. We wouldn’t want the monitors beeping or a room full of strangers. If this was our family member, we’d honor their wishes. We’d remove the tubes and try to make them as comfortable as possible. We’d want our family and friends around to celebrate our life. We’d want to pass with dignity and peace. Talk to your family about your wishes and talk often. Choose someone to be your MPOA who will be your advocate, honor your wishes and make your end of life as peaceful as possible.

-Leslie, San Antonio
BSN, RN, CCRN, CLNC