Monday, June 14, 2010

Nurse Follies: Pulling the Plug

I grew up watching Diff'rent Strokes. Everyday. After school. I wasn't such a hardcore fan that I maintained vigil after Gary Coleman died, but when things that you closely associate your childhood with die, it's just another nail on the coffin of your childhood and innocence.


Gary Coleman's life is a sad tale. From what I read, pretty much everyone the guy encountered in his life took advantage of him in some form or another. A lucrative childhood career, and not much left to show for it in his adult life.

So, Gary takes a tumble, is rewarded with a brain hemorrhage as a result. His borderline mentally retarded ex-wife, has him taken off life support two days later.

Gary Coleman had named his ex DPOA. I can respect that she was within her full legal rights to make the decisions she made in regards to his care. now comes out that he apparently had an advanced directive, outlining that he wanted everything done to prolong his life.

The business of Advanced Directives and DPOA and all things pertaining to them are huge gray areas, and I think I would rather eat at a dirt buffet than deal with them, but yet I am exposed to it more often than I would like. I remember a patient that came in with the most impressive Living Will I have ever seen. Detailed, it outlined to the letter what they wanted, and what they didn't want. We knew exactly where the person stood on life-saving antibiotics, life-sustaining drugs, feeding tubes, ventilators, everything. This person also had terminal cancer. He knew he was going to die, and there was nothing that could be done to stop it. He was realistic about it. Every day he spoke with doctors and reaffirmed his wishes. His supportive wife at the bedside, who was also his legal DPOA, also promised to uphold them in the event he could no longer speak for himself.

His children, however, were not on the same page.

Daily, as his condition worsened, the grown children became more and more frantic. They wanted all the stops pulled to save Dad. They begged the doctors, social workers, and their mother. The husband, having mentally checked out, was no longer able to speak for himself. The wife remained resolute, despite the fact that her children were turning against her. They screamed. They tried guilt. They approached staff to try to sway them to their cause (which made us really uncomfortable).There was talk of trying to get the DPOA changed. The wife never wavered.

I wasn't there the day the man died, but I heard it was pretty dramatic, and even the nurses who were working that day were traumatized. There were harsh words, screaming, cursing, threats, and even a physical fight broke out between a couple of the siblings. The wife just remained at the beside, an old woman who had just lost the love of her entire life, and watched as her family disintegrated before her very eyes.

My heart still breaks for this woman.

You may wonder what this has to do with Gary Coleman. Well, I'm getting to that.

So many times, I see patients come in, and they invoke the DNR-DNI. It means if their heart stops beating, or they stop breathing, we let them go. Along the course of their stay, they add components. Yes, I will take the antibiotics. No, I do not want a feeding tube. Yes, I will take this life-sustaining drug...but only for a short while. Usually, the family respects the wishes. Sometimes, they don't. Once that patient enters into a state where they can no longer speak on their own behalf, the DPOA, now large and in charge, can revoke all the previous wishes. Just. Like. That. Only a few times have I seen doctors advocate strongly and refuse, but most go along with it for fear of being sued. I've seen DNR-DNI patients "die", and have their family scream at us to code the patient. If the DPOA is one of them, we have to do it. Patient's own wishes be damned.

You may ask yourself, what is the point of establishing an advanced directive if some asshole family member is just going to revoke it at that one crucial moment? It would seem kind of pointless to even have one to start with if that is going to happen. For staff, it's pretty deflating.

I read an article once about a woman, who had a large family, made her DPOA an unrelated third party, I think it was a lawyer she may have known. Someone who would truly stand firm and defend what she wanted, without their judgement being clouded by emotions or the pleas of family members. I thought this was a pretty good idea, actually. You can make anyone a DPOA, if you are within sound mind. They don't have to be related to you. They don't even have to be a close friend. It could be someone that you trusted enough, knowing that they got your back, right up to the bitter end.

Back to Gary Coleman.

If the story has merit, and he truly did have an advanced directive that said "do everything", then that means his DPOA...his ex-wife who has the intellect of a dog turd, went against his wishes. While his prognosis was bleak, and chances of recovery were slim, and I personally feel that death was a better alternative than spending the rest of your days in a persistent vegetative state, it apparently was his wishes to do so. No matter what reasons she may have had to pull the plug, his ex-wife should have honored those wishes.

1 comment:

Rachel said...

I hate my mother's constant talking about "her wishes," but I'm always complaining about it being "morbid." I know it's's a necessary thing, and I think I'll be able to honor those wishes. I hope I can. I hope I never have to deal with these issues, but if I do, I hope I can do it with honor.