Original meme based on my experience in neuro ICU. Sometimes the docs could be better with convos about prognosis😅
[ART] I made a poster to help new players understand stats, inspired by u/Vindexrix & u/tan620
How is it only Wednesday my Dudes?
"Remember Republicans, the Democrats already had 17 witnesses, we were given NONE! Witnesses are up to the House, not up to the Senate. Don’t let the Dems play you!" (Jan 29, 2020)
Anarcho-Capitalism: an infantile disorder.
Who is your favorite and least favorite Democratic nominee?
There’s a patient in the NICU that is pretty much terminal. They’re alert and awake with bright eyes and wiggle around gleefully but their lungs are failing them. Despite a bunch of conversations with the attendings, the mom hasn’t accepted they’re dying. :(
Ugh. If I was the mother I don’t know if I could accept that either.
So sad. We had the same scenario with a trisomy 13 kid. So many deformities, internal and external, with horrible and painful contractures. Very aware and expressive. Life expectancy only a few months, but mom was still demanding he be full code and get open heart surgery. She told us she knew a "miracle" would happen so we should go ahead and do all the surgeries and repairs we could. Had soooo many care conferences. Last I heard he was getting a surgery...poor child was in pain just existing, now add a heart surgery.
That's why I'll never do Peds. If a kid died on me, I'd go back to bar tending.
Pt only opens eyes to pain, can only partially move one side of body, groans unintelligibly
Family: “See! Mom’s opening her eyes! She’s doing SO much better! I can’t believe no rehab will accept her!! But don’t worry, we’ll keep trying! Someone has to take her eventually!”
God, I want to cry when a lovely, dedicated family keeps going “when Mom/Dad wakes up.” I don’t want to be the one to crush them, but I also don’t want them to continue torturing their loved one.
What would you do in a situation like that? I'm in nursing school.
Thank you! I learned about quality over quantity of life when it came to my beloved cat.
Doctor: There is a very low probability your loved one will live through this. And if he/she does, he/she will not have the same quality of life as before (due to trach, peg, physical deconditioning).
Family: So you’re saying there’s a chance grandma/pa will make it?
Had a doctor say a patient had at best 10% return to normal brain function. Family took it as a good chance
Yes theirs a chance. Theirs also a chance you win the Powerball. But to be fair hope is never a bad thing. Keeps us all happy at the bad times.
"They're a fighter"
"They're one sneeze away from dying"
A glass cannon can still fire a shot?
I've seen doctors spend hours trying to convey the grave situation a pt is in, and get totally ignored for hours.
Literally had a patient maybe two months ago where the doc told the sister “his conditioning is worsening, he could very well die in the next day or two”.
I came in, vital signs were okay. 3 am rolls around, BP 67/dogshit, labored breathing.
Call sister, tell her when she comes in that his current clinical picture is not good and consistent with someone imminently dying and he could die at any second or live for a handful more hours. I told her that his BP was not compatible with sustained life.
He died shortly after shift change and the sister “wasn’t aware he was going to die”
Had an ER doctor ask an elderly patient’s daughter about his code status and if they had had any conversations about it. She was like “Oh...no. But you know what? My mom would know! She’ll be here in thirty minutes or so. She’s on her way.”
Doctor: “............I’m going to need you to call her...”
It went right over the daughter’s head that he couldn’t wait thirty minutes to know that.
Absolutely. I’ve had this happen several times since starting residency. And I’m pretty straightforward in my explanations.
They’re just in such denial about how the body physiology and medicine really work.
My dad passed away last year and I was mentally prepared for him to die while we were in the ICU. My mom who is not very educated and is super religious, told me that her religious mentor said my dad would “wake up” in 5 days’ time. I told her I’d convert to her religion if that really happened (I’m super non religious but honestly it would’ve been a miracle if my dad woke up). He was in severe liver failure, with CAD, had coded already and they achieved rosc, GCS of 4 on no sedation, intubated, hemodynamically unstable on pressors.
Despite this, I couldn’t help but want to be hopeful.
The degree of my mom’s denial that he was going to die was over the roof. She prayed every day and was one of those annoying family members that gets excited when the patient opens their eyes a little, even if no one’s home in there. She confidently told the nurses all the time that he would wake up.
It actually seriously affected my emotional well being while we were there because she was getting in the way of my own grieving process. She was so adamant that he’d wake up that it pissed me off. She only accepted that he was going to die when his BP was bottoming out, he was actively seizing, and the doc told her he was dying.
Then she and my dad’s family got him discharged AMA, all medications/pressors and vent were disconnected, transported him via ambulance (while he was seizing) 30min to his family home so he could die there as was culturally necessary according to family.
He obviously died during transport (obvious to me, my mom couldn’t tell and I didn’t tell her). No pain medication was given for transport because they didn’t want to cause him to die faster. My poor dad never wanted to be in pain while passing. He was a great dad who deserved to die in peace. It’s disgusting what family does to patients because they can’t accept the facts. I regret that I couldn’t have advocated for my dad. My mom wouldn’t listen to anyone and even on her best days is highly driven by her emotions, not logic.
This was painful to read. Im so so sorry. I can imagine my mother doing something similar (she is very religious as well). Let's hope he's at peace now.
If it helps at all, I’ve got a friend with seizure disorder who tells me you’re not aware of a thing during and immediately after. I’ve witnessed her seize and sometimes it looks like she’s aware but she’s not-she often asks what the hell happened after. So if he was seizing, he probably didn’t consciously suffer.
I'm so sorry to read this. My dad died 2yrs ago after a massive cerebral haemorrhage. He 'lived' 4 days in the ICU after it and I was fortunate enough that although none of my family are medical, they all agreed that he was already gone and we should do everything to make his passing as comfortable as possible. He had a GCS of 4 on no sedation too. The only person who couldn't accept it was my grandmother (his mum), who swore he purposefully squeezed her hand and she was convinced he'd 'pull through'. Fortunately she didn't stop us making any of the decisions we did though like one-way extubate him etc. My gran just died 2 days ago after going downhill massively since dad's death over the last 2 years. I think losing dad basically killed her. Sometimes denial gets i the way of reason and it's terrible. I hope you are doing as ok as you can be x
Thank you for sharing this story. I appreciate it, and I'm sorry for the pain that these events put you through.
I watched this happen when my MIL was diagnosed with an aggressive astrocytoma. She'd become mostly unresponsive after a failed resection but had made it known before the surgery that she did not want radiation should the resection be unsuccessful. There seemed to be a creeping group acceptance that death was going to be the outcome fairly soon when a stoner cousin casually mentioned that "cannabis is the wonder drug doctors don't want you to know about!" His younger sister and MIL's mom, especially, really latched onto this idea and it just became one more hurdle to process in the race towards acceptance that MIL was dying.
Anyway, I'm sorry about your father. My husband and I lost our mothers almost eight years ago now. The first year was definitely the hardest although I still think about my mom almost daily and I think my husband would say the same for his.
I have to ask. What culture is this?
Wife of imminently dying patient: "I'm concerned about how I'll manage to take care of him when I take him home."
Me: "Well, don't worry about it too much...."
My mother died of lung cancer last November at the age of 55.
My mom also had an 8th grade education. The doctor said "the prognosis is very very poor given the advanced stage of your sickness. We can attempt to make you comfort for the time being." Verbatim.
My mom smiled at her, a little excited. I stopped the conversation and asked my mom if she understood. She said yes. I then used terrible laymans words to reinforce it.
My mom never did, up until hours before her death when I refused to let the staff intubate her, believe she was going to die.
If the doctor literally just said she was going to pass and keep her comfortable, why would the staff try to intubate her? That’s terrible that you had to refuse that. The goal would be to keep her comfortable not stick a tube down her throat. I am so sorry about your mom. My mom also passed from cancer. It sucks to see your loved one go through that to say the least.
Me all flu season with the 20/30 year old patients that have ended up trached and pegged after coming in with the flu (and 2 of them majorly stroked on Nimbex), but decerbate posturing towards their families' hands, totally means they are following commands... But Ts&Ps will fix it!
Oh, fuck me, I ended up in emerg with this flu. Its really scary to think it could have ended up like that.
Please explain there were more complications than just the flu? Thats so young
20 and 30 year olds???
Every family believes that their family member (patient) is a fighter and that a miracle will happen to bring them back to baseline. Unfortunately, in the Neuro ICU world, it's the exception rather than the rule. If they're sick enough for the family to be telling us that they are a fighter and will pull through, they probably won't make it.
You sound like you’re good at ATI
I hate when patients family members ask "so how often have you seen situations like this?" because the next question is inevitably "and how did that person do? are they ok? did they go home?"
it sucks. because I would say 75% of the time when a family member is asking a question like this, the answer is "yeah, I have seen this before. and they died. it was a long, scary, drawn out battle with wayyyy more aggressive treatment than they needed, because ultimately none of it mattered anyway."
but you can't say that.
critical care can really be a bitch.
But I so wish we COULD say exactly that, because that is reality most of the time. And some families really do need to hear it. Also, personally I would rather someone who has experience in something that I have none in tell me the absolute truth, no matter how rough the truth may be. Sometimes it angers me how we mainly end up sugar-coating things for people I think it does way more harm than good in the long run.
I currently have a pt on my neuro floor that has been in a persistent vegetative state for 100+ days. He had a heart attack at home, family did cpr, ems brought him in. No neuro recovery is expected, on HD, has a PEG, terrible wounds now from laying in bed for so long no matter how often he is turned, fetal position, trach. Thank god palliative put him on a schedule for pain meds. Can’t discharge anywhere because of all of the above. His wife finally decided she will consent to withdraw care in a month.
I told my husband if he ever kept me alive like that I would haunt him.
ETA: this pt is in his 80’s btw
That's not nursing it's gardening....
I've threatened my whole family(wife included) that I'd haunt them if they did that shit to me.
Also warned any of them who wanted me to be mpoa(am for father) on my mindset regarding these decisions if they're unwilling to sit down and talk about their end of life expectations/desires(he isnt) just so they know what to expect I would do.
Pts fam: God is going to heal my mom.
Me: Well, technically she was dead at the scene and is only alive because of EMS
Fam: She is going to walk out of here, just you watch
Me: she has tried to die several times since then, she is on 4 pressors, no sedation, and her brain is herniated
Fam: She is going to be a walking miracle
Me: she deliberately made the decision to NOT wear her seat belt, and the accident was her fault. She killed the other driver.
Fam: Just watch, it's all part of God's plan.
I don't really say that, but lord knows I'm thinking it.
My CHFer’s fam: He’ll be better in no time! God’s going to heal him!
Me: Sure, he could very well be better but they need to make lifestyle & diet changes
Fam: Brings CHFer whataburger.
Ive always wanted to reference the downing man story to patients who blindly rely on God.
She’s on her way to God and he’s gonna kick her ass to hell
And here I was,thinking "those are good! That's great this person said this!"
What's the 4th pressor?
“He’s a fighter, he will walk out soon”
Pt is 90 years old with terminal cancer and also in ARDS
So you’re saying he’s invincible
Last week I told my DNR patients family that if he poops and I have to turn him to clean him, he will die. That got the message across loud and clear. They withdrew care in the morning.
I have had 1:1s where I spend the entire 12 hours of my shift trying to explain the amount of torture we are putting their loved ones through (a couple 3 in a rows). None of them ever pulled the trigger to make them CCO. It's demoralizing on multiple accounts and the top reason I left the Unit.
Ugh. My father in law was diagnosed 2 years ago with cancer. Adenocarcinoma of the colon, with mets to the liver, lungs, bone, lymph nodes, etc. They showed the PET Scan on the screen and he was lit up like a fucking Christmas tree. They then said chemo is an option, we'll let you discuss, we'll come back soon and walked out.
Being a nurse, they both looked at me and asked what that meant. I, very kindly, told them it's bad. That it's most likely end-stage, stage 4, consider hospice etc. Mother in law absolutely denied this and told me I was being pessimistic and I knew nothing, I was wrong, yada yada. Husband remained silent through it all, but at my urging, said everything he needed to say to his dad and made his peace with it.
She chose intense chemo. Put him through 4 rounds where he lost weight, vomited constantly, they put in a PEG and colostomy, he was in constant pain.
He died within 3 months. My husband is furious that his mom made those choices. I wish she would have just morphine'd him up and let him go peacefully.
Even worse when they're praying for a miracle... and you're just waiting for them to cone.
"See, he started moving when we played his favorite music!" Actually... He started having myoclonic twitching when we turned down his meds at that same time... That's a really bad sign.
Not sure if patient is declining or grandma is doing comatose disco dancing
Ugh, this had to be the most frustrating thing about Neuro ICU. "Oh, she moved her arm when I talked to her." Uh, yea but that's about all she will ever be able to do "No, she'll be great! We've been praying and I know that the lord will heal her."
3 weeks later and they're still in the ICU getting a trach and peg.
Glad I'm done with that shit!
Soooo relatable lol. “She’s a fighter!”
Had a patient once that got shot in the head and still be alive. I mean he was trach’d and was there for over 5 months. The family kept posting on facebook and any social media that he was getting better and what not. Mind you he was a vegetable. They posted a video of him using an exo skeleton and said “HE’s FINALLY WALKING!”
He died a week later. Not sure how this relates it was just annoying to see
Keeping it real.
Family: so we think that the best case scenario that the provider briefly mentioned is the only possible solution and anything else would be soul crushing
Nurse: sips bang nervously
I didn’t even know that was a thing! I work on a med onc unit now and love it (most days), but critical care/CVICU are where I’d like to end up in a few years.
It’s a circle.
Reminds me of the poor case of Eva Sherbondy. The family is very active on Instagram, posting updates every few days. Basically a severe TBI left this previously healthy 7 year old with only a functioning brainstem. Her life now consists of seizures, tube feeds and misery. But the parents are adamant that she will one day "wake up" and God will provide her with "100% healing". Even with multiple frank discussions with the medical team... Its really heartbreaking the false hope these people carry.
LTACH RN here, Miracles do happen & I am surrounded by them every day I am at work. The H&P’s could be a novel for each patient. I’ve seen people that should have been dead 10 times over and then they do walk out. Unfortunately, I also see vented patients that the family won’t give up and they live like that for months with no end as well.
I had that with a brain cancer patient who had growth and 1.7cm shift after a resection. The family was told she had about a 2% chance of surviving. Family was like "we know she'll pull through for her children and us!"
They refused to even talk to the hospice doctor like the oncologist suggested. I think she passed not even a week after that.
We had a patient on dialysis, trach, vent, PEG tube. The son wanted his parent kept alive no matter what so they could go on a dialysis cruise. Really sad. Another terminally ill patient had a daughter who had power of attorney for the patient, but was afraid of her brother who wanted everything done. She only made the patient no code when doctors agreed not to discuss it with the brother.
Wow everyone thanks for all the responses! I started feeling bad about throwing the doctors under the bus with the caption. So, I guess if I had to post this over again, I wouldn’t do that. Anyway, carry on.