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How Doctors Die: An ICU Nurse Responds

Note by Michael Dowd: A week ago a colleague sent me a link to an obscure blog that had “gone viral”:

“How Doctors Die — It’s Not Like the Rest of Us, But It Should Be"

Tremendously moved, I decided to do my part in spreading this sobering news and vital perspective. One of those who received my email was a young nurse, newly certified for working in the Intensive Care Unit. Below is her response (slightly modified for confidentiality).

Her story brought me to tears of joy and gratitude when I first read it. May there be ever more nurses with the training, the courage, and above all the heart exemplified by this unheralded young hero.

_____

Response by a young “Intensive Care Unit (ICU)” nurse:

Thank you so much for this timely article. Only two months ago I participated in an "End of Life and Palliative Care in the ICU" class, where I was genuinely moved/tormented by the suffering my fellow nurses and I are surrounded with in the ICU.

A peaceful, gentle death is so valuable — and so rare.

I recently cared for a young adult cancer patient at the end of her life.  She came to the ICU after having a bone marrow transplant to deal with the "pre-leukemia" she had developed, owing to an aggressive chemo regimen initiated several years earlier for her breast cancer.

By now, her whole body had deteriorated to such an extent that she required a mask that forced air into her lungs in order to oxygenate.  She spent two weeks in our hospital’s ICU, with her lungs progressively worsening.

All the nurses knew she was not going to leave our unit. But her oncologist kept telling her to “fight it out!”

Finally, and this was on my shift, with her parents at her side, “Gloria” (the name I'll use) finally said that she just wanted the pain to go away.

Suddenly, everything changed.

I had just brought into her room her evening meds — literally thousands of dollars worth of antibiotics and anti-rejection medications.  None of it mattered anymore.

I took down all the unnecessary tubing, started a morphine drip and administered Glycopyrrolate (which dries secretions and softens the "death rattle").

This felt massive to me. I remember this mix of emotions: sadness, relief, and an overwhelming sense that I was a part of something huge.  I still cannot wrap my head around it.

I was able to help transition one profoundly suffering human being from a regimen of “Come on! Power through! Endure, endure, endure!” to, “It’s okay, Gloria. You fought so, so hard. Now close your eyes, let your pain fade, and rest.”

It was beautiful.

Gloria died the following day — not on my shift, but I felt so happy that I had been able to share the transition with her and her parents.

To think of everything we had put this woman through in hopes of an inaccessible cure is just ... sickening.

Medicine has gotten to the point where we've gone as far and as invasive as we can go. I wish people — both we professionals and the public at large — would begin to prioritize a dignified death above all.

Family members need to know that there is far more beauty in spending quality time (rather than simply a quantity of time in the hospital) with their unalterably disabled and ultimately incurable loved ones.

Sadly, when family members must make medical decisions, too often those decisions are influenced by a subconscious need to palliate our own emotional suffering. As well, an irrational fear that we will otherwise be guilty (or at least will feel guilty) spurs good people to say “yes” to absolutely every intervention that forestalls death.

Though I wish everyone could die at home surrounded by love and comfort, I know it is the nature of those battling cancer to often push themselves far past their ability to survive the journey home.

It is my duty to honor this incredible fight and allow them to pass peacefully, without pain — and to let them know that accepting death is the greatest victory.  

~ by an ICU nurse, posted by...
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