I’m an only child of a single parent. When she had a stroke – and then lost part of her intestines when they became incarcerated in a hernia, resulting in dehydration (and then heart) issues – as hard as it was, I knew her decision was DNI/DNR/”no heroic measures.” As her POA, I could have said anything I wanted to keep her “alive” for my own selfish reasons. But even though doctors and surgeons fought me with “but she’s so young!” when I refused intubation and cardiac catheterization tests, I knew I was doing what she wanted (and, thank God, she had a primary physician assigned to her in the ER that stood up with me against the pressure to “test and try” to extend her life.

Getting the call that she died was one of the hardest moments of my life. I still remember exactly where I was standing when it came… three houses ago. But I also know that her constant 1-2 week cycle of being transferred from nursing home to hospital for dehydration, organ failure, heart attack, another stroke (?), back to the nursing home and repeat… for her that hell was over and she was at peace.

And as much as I hated giving the orders to stop/not start all the tests, it was also freeing in that I knew they weren’t MY orders but HERS.

Had a John Doe come in to my ER, found in PEA in a snowbank in his parking lot of the condo complex he lived in. Was walking the dog, and was found by a neighbor, after an undetermined amt of time.

EMS tubed him and after 2 or 3 rounds of resuscitative drugs, we got him back in sinus. Well, we didn’t have any information on who he was. He didn’t have any ID, wallet, or anything. Initial labs weren’t very revealing other than mildly elevated CKMB and Myoglobin (trops were normal at the time). So, after a less than eventful central and a-line placement, he journeyed to our ICU.

Found out that a couple hours later, the family was located and they d/c’d full support because they knew he didn’t want to go on just functioning. Turns out this guy was a WWII and Korea vet. Lived a long and full life.

We’ve been letting the parents come to terms with this on their own – not pushing them to make a decision about continuing care. However, when the morphine doesn’t work and her brain and lungs are giving out…there’s really nothing else we can do. After updating her mom again today, she actually asked us how we would “do it” if they decided enough was enough.

Tonight enough was enough for their little girl.

It sucks. Hard.

I’m in pediatrics so it may be different, but what many attendings I’ve worked with do is similar to what we did for this patient: present the evidence but don’t give false hope. Be open and honest and let them make the decision. Also, keep them well-informed. Often the more people you have talk to them to keep them apprised of what’s going on (nursing, subspecialists) will make them feel comfortable with what’s going on. It doesn’t make it any easier but I think families feel better knowing they made the decision to stop care rather than having it made for them.

Also that if they are waiting for God to intervene or a miracle…not having a ventilator isn’t going to prevent THAT.

I see this frequently. It puts the healthcare providers in a difficult position. When patients are near death, unfortunately some family members don’t think quite as rationally.