Denying death as a society

Beautifully written. I wish it were easier for family members to grasp when their loved ones' time has come. I am thankful that my last two terminal patients were able to speak their minds before it was too late for them to do so and pass peacefully.

Yes our present society is the land where everything has to be perfect, bigger and better than is ever possible. Expected pain score is 0/10 and we are entitled to live forever.

I agree. It is one of the frustrating things I do no like about ICU. Even more frustrating when family finally agrees to DNR then revokes it when the time comes.

Don't forget the ANGRY in denial patients and family, and coping with their open hostility, barely concealed contempt as if they hope you will screw up and vindicate them. I always wondered WHAT they were vindicating.When I worked medical oncology we did the comfort care for most of the hospital, while the patients (or more likely, their family) committed to denial end up in ICU and working in ICU must really be something else, just for this. We had a gentleman actively dying from metastatic lung cancer, had been on the floor for over two weeks slowly deteriorating. His family insisted upon full life support for him, for 'religious' reasons. I was in charge one night while we were waiting for him to code . . . and the family explained a little of their views. A DNR to them meant 'taking it out of God's hands". MOST of our comfort care patients became such without drama, but some did. It was the minority, though. That minority ends up on ICU and I can only imagine how this is for ICU nurses. My heart goes out to you all.It's not just denial of death. There are cultural issues too, that you won't learn on your mandatory education. From a Filipino friend I heard that to her family, a DNR means 'giving up', and you must fight fight fight to live, no matter what. My friend is a nurse and she admits she knows 'better', but this stuff goes deep down and isn't easy to change. Her mother is in her 90's and she dreads when this will be an issue for her and her family. I've been with people who truly felt assaulted when DNR was suggested for their terminally ill family member. I've witnessed contempt and disgust from nurses and doctors when a family refuses DNR or comfort care instead of plunging on with chemo and radiation. I don't think that's right either.We can't forget there are two sides to the patient bed. Ours is quite different, but not 'better'. We don't help anyone deal with their denial by condemning it or judging it. I don't have any answers, as if there WAS an answer to this. I don't want some nurse or doctor dictating the life and death of my child any more than the next person.

Thanks for the reality check. I remember reading - in a book of writings by nurses - the line "the soul that we will not let go gracefully back to God." That's what this article evoked for me.Well and courageously done.

Quote from Gooselady... . . . and the family explained a little of their views. A DNR to them meant 'taking it out of God's hands". ...

I remember two patients well. They were kept alive for financial reasons. One, his pension stopped when he died and his wife would have drastically reduced finances, only the basic government amount. The other because her guardian was entitled to receive her payments from a oil and land treaty.Take a look on You Tube. An ICU nurse did a video with similar thoughts, DNR to the melody of Nickelbacks Rockstar

Sometimes I wonder if some of this is due in part to terminology. Do not resuscitate sounds like we intentionally do nothing to help the patient. Terminology such as allow natural death makes it sound as though we know the time is here, and we're going to allow it to happen while ensuring comfort.

Great read... it really is unfortunate how much our society avoids/fears death. Sometimes it really is the best thing.

Some of the situations that I see the families feel obligated to keep trying and they need someone they respect to relieve them of the guilt and responsibility, to tell them it's time.As much as we see end of life, not everyone has had practice in ending treatment nor feeling confident that they know when it's time. We often give them options but they still have to choose. In simpler examples, how many times have you gone to your vet to ask for advice re your pet and they lay out every option objectively when all you want is for them to tell you it's time? I recently went through this with my older horse. My previous old wise vet would have told me straight up that it's time and taken the guilt ridden decision making off of my shoulders. But the new young vet who took his place would only lay out the options and put the entire responsibility on me, without so much as a hint as to what she would choose. Which was fine and I made the decision I thought was best for my horse, but this wasn't my first time, I've had years of experience with these ethical issues and this was a PET, not my human parent or child. We have legal restrictions on what and how we as nurses can advise but it's something to take into consideration when we're judging people for not making the decision we think they should.

I agree with Libby.A measureable portion of the denial we see is in part the fault of the health professionals who have interacted with these families over the course of time. Our aversion to providing the honest truth about these diseases and conditions along with responsible discussion is costing us. Our willingness to stop talking because the patient or family is uncomfortable with the facts surrounding their health is benefitting no one. Our experience and expertise in sugar coating bad news has elevated the importance of preserving "hope" above the importance of educating to promote informed decision making.When I am dealing with patients and families with strong religious faith in a God of miracles, who also believe that they must somehow do "everything" medically to allow God time and space to perform His miracles I ask them if they think God requires that. Did God require that when He raised Lazarus from the dead? Did he require that to touch and heal the lepers or the blind man? God does not require us to put a person on a machine in order for Him to perform a miracle. He may do it at any time under any circumstance. Yes, the family and friends of the infirm often went to great trouble to bring their loved ones into the reach of Jesus for His healing; even to the point of tearing a roof off of a building. The key is the nearness to God, His touch, His healing, His love and mercy and compassion...and the family helping that the ill/dying to get near enough to experience it.Death is not easy, but there are worse things than death. Or so I believe.

Quote from toomuchbaloneyI ..... Death is not easy, but there are worse things than death. Or so I believe.