Teabaggers would have us believe withholding heroic lifesaving efforts at the end of life is an outrage.
What. A. Joke.
Here’s what really happens.
What exactly does ‘pulling the plug’ mean?
It usually specifies what is called “DNR/DNI”, which means do not resuscitate/do not intubate.
Resuscitation involves CPR. We all have heard of CPR and have probably seen it on ER or some other tv show. Basically it involves pushing down fairly hard (about an inch) on someone’s rib cage.
Now Grandma is about 97 and has osteoporosis so guess what happens? Yep, now she has broken ribs on top of that life-threatening illness.
Have you ever bruised just a single rib? I have and I can tell you it hurts. Especially when you breathe, which is about 12-18 times a minute, on average. Now Grandma has every freaking rib broke. I’m sure that feels real good. This is why a lot people pass on this particular bit of fun.
Chest compressions, while effective in breaking Grandma’s ribs, prove ineffective in reviving her heart, so we have to move on the next fun thing: defibrillation or shocking the heart. Most of us have probably seen this on tv—a doctor rubs two paddles together with goo, places them around Grandma’s heart, yells clear, shocks her and then her body jumps six inches off the table. While the current models use less juice than the older ones, it is still a very painful shock or set of shocks to Grandma.
Intubation isn’t much more fun than resuscitation. It involves sticking a tube down grandma’s throat in order to help her breathe; this is because Grandma has become suddenly critically ill. It is very traumatic and damages the throat and is extremely uncomfortable for Grandma.
It's so uncomfortable that we have to knock grandma out with propofol (of Michael Jackson fame) or the like, just to get her to breathe with the machine and not fight it. Sometimes even propofol doesn’t work and Grandma becomes miserable, constantly battling against a machine that forces her to breathe. Now remember, we already broke all her ribs during resuscitation and the machine is expanding her chest 18 times a minute. Ouch. Sure hope those pain meds are working.
Intubation has other joys as well. After a few days of intubation the doctors have to cut a hole in grandma’s throat and place the tube there instead of through her mouth. If they don’t do that, grandma will get something called VAP (ventilator associated pneumonia) and will die, wasting all those heroic, expensive efforts to keep her alive. So as much fun as intubation sounds, it may very well prove to be futile if Grandma doesn’t get well real quick.
Grandma is too sick to eat, but she will die if she doesn’t get nutrition. Since we aren’t pulling the plug on her, we have to place a feeding tube. This involves inserting a tube quite rapidly and unpleasantly down grandma’s nose (NG tube) or through her abdomen into her stomach or small intestine/jejunum (g or j tubes). Anyone that’s had an NG tube can tell you how uncomfortable and sometimes just downright painful they can be.
If a J or G tube is selected, doctors will have to perform surgery on grandma to cut open Grandma’s gut to place the stomach or jejunum tubes. Cutting hurts and will hurt after the surgery when grandma moves.
Let’s not forget, these are just the measures to resuscitate Grandma. She still has an underlying illness. She’s going to need more surgeries, more treatments, scans, etc. Many of these procedures prove to be just as invasive, painful and uncomfortable as the measures taken to resuscitate her.
If Grandma decides this is not how she wants to go out, in constant pain and tortured by the very people that are supposed to heal her, then she may be placed on what is called ‘comfort care’. This involves measures to make the last hours comfortable, like pain meds, oral care, avoiding the use of IVs or taking of vital signs (blood pressure cuff = uncomfortable) and positioning in bed for greater ease.
But this diary isn’t about comfort care. We aren’t quitters, hell no! We’re going to do every last invasive thing for grandma that the best medical minds can conjure up, even if it kills her!
Unfortunately, Grandma didn’t make it, even though we tried our best. Fact is, people die. She spent three months in the ICU and while medicare kicked in their share, her med supp insurance policy didn’t cover much else so now grandpa is bankrupt.
If there is little to no hope of recovery, why would anyone choose to spend their last days like this? How dare people like Palin and Grassley promote such crap about pulling the plug. If you are planning to torture your Grandma this way don’t be surprised when my colleagues and I look at you like you are an idiot. And we WILL talk smack about you at the nurses station. Loudly.
Update: Thanks for all your thoughtful and heartfelt comments. There are some very good ideas presented there. However I need to go to bed-I worked last nite and I'm now beginning to hallucinate I keep hearing call lights and iv pumps...