(This article was first published on KevinMD and is used with permission. The author, Debbie Moore-Black, is an RN who has worked in the ICU for over 30 years. She created her blog to share nursing stories, offer ideas to improve care, discuss dilemmas facing patients and healthcare providers, provide a little humor, and offer opinions and insight on dying and dignity. Her stories are a composite of fiction and facts, based on the things she’s seen and experienced.)
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I know. You’re thinking: cold hearted; cruel; heartless.
Am I? Or are YOU?
Grandma Lilly is 87 years old. She’s in the ICU. On a ventilator. Wrists restrained to the side of the bed. She can barely see because her eyes are puffy; sclera edema. Her heart races, 140/minute. Her blood pressure is low. She now has bought Levophed and vasopressin drips because her blood pressure is dangerously low.
She can’t talk to her family. She phases in and out of existence. Grandma Lilly.
End stage renal disease = dialysis.
Respiratory failure = ventilator.
Brittle diabetic. High blood sugars to low ones. No control. She can’t eat. So we feed her by a tube that goes into her nose and lodges in her stomach.
She’s been on the ventilator too long. Tomorrow she goes for a tracheostomy. Tomorrow she also gets a peg surgically inserted to feed her.
She’s bought the ICU package.
Ventilator. Dialysis. Vasopressors. Restraints. Trach. Peg.
And any second of awareness for her is pure brutality.
There is no pretty ending to this torture, except to hopefully escape by dying.
Poor Grandma Lilly.
Oh, the memories! When we were kids, we’d chant for Grandma Lilly. She’d snuggle us up in that rocking chair and read books to us. Let us splash our feet in the puddles after a misty rain. Built sandcastles at the beach. Gave us candy when Momma said no.
She was our heart and soul, and we wanted her to live forever.
But we don’t live forever.
There’s cruelty in putting an 87-year-old with multi-system organ failure on a ventilator, restrained, medicated, disoriented – and wishing for the tunnel to the here-after.
Your memories will live forever.
The ventilator. Churning inspiratory and expiratory breaths – day after day as Grandma Lilly wishes for death.
Grandpa Joe is two doors away from Grandma Lilly. (They are not related.)
He’s going to die also. Ravaged with cancer. But he’s led a good life. And he’s cognitive enough to say he wants to die peacefully with his family and his dog Rufus by his side.
Grandpa Joe is a DNR/DNI and has requested to be “Comfort Care.”
For his excruciating pain from cancer, he is given a morphine drip that flows slowly through his vein.
He breathes slowly. But he’s happy and pain free and surrounded by love.
His room is dimly lit. Music seeps out and fills the ICU hallways. Frank Sinatra, Nat King Cole, Ella Fitzgerald, Billie Holliday.
Boy Scout, Eagle Scout. The only one in his family who earned a college degree.
Campfires, the stories he told, the wisdom and gentle guidance. And here his family sat around him. Good ol’ Grandpa Joe. What a life filled with love. They held his hand as they told their loving stories of him. They laughed and silently wept. Tears of love and happiness and letting go, but knowing the pain and suffering of his cancer would soon be over.
After several rounds of CPR and cracked ribs, tiny little Grandma Lilly died.
Grandma Lilly left this earth tied down like a captured animal.
Grandpa Joe left this earth with quiet whispers of “I love you.”
The choice can be yours.
Go quiet into the night.
This is our last dance.
This story is based on past events but fictional characters were used in compliance with HIPAA guidelines. It is an example of end-stage-of-life dying, and of choices and results that can happen in any ICU across America.
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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.
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What pain and cruelty she suffered– and in the name of preserving her life. Let me not die in hospital here.