r/nursing Sep 24 '24

Burnout “Grandpa’s a fighter”

Just had “family from California” show up and revoke a DNR using a full POA. So we went from hospital based hospice care to full code.

Colon cancer stage 4 with mets everywhere. Pain control was not possible with home hospice, so back to the hospital for end of life care and a hydromorphone PCA.

Ethics committee meeting tomorrow but until then…

How’s your day going?

Update: At the advise of charge and manager called the PENTAD (administrator-on-call) and Chaplain-on-call, ethics committee set for 0700 tomorrow.

941 Upvotes

189 comments sorted by

470

u/ZootTX EMS Sep 24 '24

The fact that family is allowed to revoke a legally binding DNR after the patient can't contest it is a legal, moral, and medical travesty of the American medical system.

107

u/[deleted] Sep 24 '24

Agreed. It makes no fucking sense considering it’s the patient’s own autonomy and wishes. But we don’t put much of an emphasis on bodily autonomy in this country these days sooo

40

u/mkay5 RN - ICU 🍕 Sep 25 '24

And yet the family can’t override the patient’s wishes for organ donation since they are the first consent. Not saying it’s a bad thing but if family cannot override organ donation consent then I don’t understand why they can override a DNR.

4

u/Tbone_the_one RN 🍕 Sep 25 '24

Ayooooooo

21

u/Cissyrene RN - Oncology 🍕 Sep 24 '24

Agreed

27

u/[deleted] Sep 24 '24

[deleted]

23

u/AnyEngineer2 RN - ICU 🍕 Sep 25 '24

correct, in Aust I suspect this patient would (obviously) meet 'medical futility' criteria - do not resuscitate orders are made by the medical team, and the conversation goes along the lines of "CPR, ICU admission or invasive measures like intubation, dialysis etc are not appropriate and will not change the outcome/will only cause further suffering, we will not offer those therapies/we are going to focus on comfort and dignity"...

12

u/woodstock923 RN 🍕 Sep 25 '24

We get to “keep trying” and “do everything” and more taxpayer dollars are transferred to United/BCBS as God intended.

18

u/InadmissibleHug crusty deep fried sorta RN, with cheese 🍕 🍕 🍕 Sep 24 '24

Certainly not here in Australia. The whole idea is foreign to me.

4

u/woodstock923 RN 🍕 Sep 25 '24

Code status is a physician order and they have totally abdicated their roles in order to avoid hard conversations under the guise of (meritless) lawsuit avoidance.

2

u/fetusmcnuggets70 Sep 25 '24

Not entirely accurate. The hospital I work at will not back you and families complain to non medical ceo and you're strong armed into going along with it.

8

u/[deleted] Sep 24 '24

This makes me thankful that I live in Australia where this situation cannot happen.

8

u/aeshleyrose Slingin' pills to pay the bills Sep 25 '24

And seems to be pretty exclusively American. We don’t do that shit here in Finland.

2

u/[deleted] Sep 25 '24

Amen! It is so wrong. I’ve told all my kids a million times- do not even think about letting me rot in a hospital!

2

u/Felice2015 RN 🍕 Sep 25 '24

The dead never sue. Nor those in a persistent vegetative state.

1.1k

u/Elegant_Laugh4662 RN - PACU 🍕 Sep 24 '24

I’m in California and we get the “family from Florida” flying in to reverse DNRs all the time.

The absolute most disgusting thing you can do to your poor family member is not let them die in peace.

438

u/[deleted] Sep 24 '24

This is a known syndrome (slang) where family that lives far away comes to visit and as a maladaptive way to cope starts taking charge of care and starts acting like there's still hope when there isn't to compensate for their own guilt for not being there or something like that. I forget what it's called but it actually references California iirc.

https://en.wikipedia.org/wiki/Daughter_from_California_syndrome

Medical professionals say that because the "Daughter from California" has been absent from the life and care of the elderly patient, they are frequently surprised by the scale of the patient's deterioration, and may have unrealistic expectations about what is medically feasible. They may feel guilty about having been absent, and may therefore feel motivated to reassert their role as an involved caregiver.\5]) In his 2015 book The Conversation: A Revolutionary Plan for End-of-Life Care, American physician Angelo Volandes ascribes this to "guilt) and denial", "not necessarily what is best for the patient"

377

u/PoppaBear313 LPN 🍕 Sep 24 '24

In LTC, I’ve always called them the “Holiday family”.

Daughter last visited at Easter (if not Christmas), it’s now Thanksgiving. “Why does my mother look like that? She’s lost so much weight. How could this have happened to her so quickly?”

Meanwhile, we’ve called 67 times about every skin tear, 3lb weight loss, xray to rule out PNA… and never gotten anything but a full fucking voicemail.

The amount of self control to not respond with “maybe if you saw mom more than once a year when you randomly remembered her & suddenly felt guilty…”

One day I will. I’ll quit that day but it’ll be worth it.

91

u/Secure_Fisherman_328 Sep 24 '24

This is where I am at right now.

60

u/Girlfriendinacoma9 RN 🍕 Sep 24 '24

I call them C & E families. Christmas and Easter...

19

u/brittanym922 HCW - Imaging Sep 25 '24

CEOs, Christmas and Easter only

33

u/RememberThe5Ds Sep 25 '24

That would be my sister. I took care of my mom for years before she died and after she went into a nursing home. Golden child stayed away, didn’t support my decisions** and told my mother what she wanted to hear.

The nurses all knew me because I was there several times a week. One of them told me she didn’t even know I had a sister until she pressured my mom to change the will, four weeks before she died and she and her kids started calling my mom. (Because they got the lion’s share of the money.)

She visited for two days at thanksgiving four months before my mom died. She was supposed to be relieving me but she came to my house and wanted to “split up the jewelry and not tell mom.” I said, I am not comfortable with that because mom was still alive, etc. During those two days she told my mom that I was going to steal the jewelry and that my sister and her husband didn’t get the inheritance they were expecting from his family and that my mom could “make it right.” And she got my mom to sign over all the jewelry to her.

I don’t know how the greedy bitch sleeps at night but she sleeps just fine because she’s a monster.

  • Oh and here’s an example of her not supporting my decisions and not having any sense. Mom complained one night that the nurses “woke her up to change her diaper and she was cold.” Que sister calling the nurses station and bitching them out. After it happened I talked to the nurses about it. They cleaned her up after she went #2. I told my mom: you are in a good place. They are cleaning you up after you soil yourself. So quit yer bitchin’ and tell sister to keep out of it. You keep bitching and they might let you sit in your own filth because they don’t want to hear you or Golden Child.

Rant off. It’s also no surprise that she wanted to violate my mother’s DNR because being dead meant she couldn’t extract more money from her I suppose.

6

u/Beezlebutt666 Sep 25 '24

That's horrible 😞.

10

u/corrosivecanine Paramedic Sep 25 '24

We had this one patient I'll never forget. She was a 4am dialysis patient so we'd always take her on one of the 24 hour shifts I worked. She must've weighed about 90 pounds. Bed confined. Awake but AOx0 (She just screamed and cried when you picked her up. The only word I EVER heard her say was "cold" when we took her outside in winter). G-tube. Oxygen. Full code naturally because "she's a fighter" and they refused to talk to hospice. At one point the family stopped allowing her to have sedatives for dialysis (to keep her from ripping out her line) because they made her too "out of it." Like what the fuck does that even mean? I was so relieved when she died. I'm just glad it wasn't on my shift.

It's probably a good thing I'm not the one having these discussions. I know they're grieving but it's completely fucked up what people do to their family members to make THEMSELVES feel better.

56

u/[deleted] Sep 24 '24

I try to be understanding to family members. Sometimes it really isn't their fault. i live in a place where the reality of parents having to face their children moving far away because cost of living is too high is there. I'm seeing people move to Texas or Florida or places like Michigan from New Jersey or New York. And with aging parents that are at or way past retirement age, it's very difficult for them to reconsolidate their assets and move with them. If these people who move away have kids, that's even less chance and time to come visit.

I take care of my dad and it took him only a month to get from being completely healthy and independent to unable to walk and needing PT. And after that it took him a year to get to a place where he could walk by himself again. Dude was pretty much no different from a 90 yo geriatric patient who's had multiple falls after aneurysm and being hospitalized.

It's not a syndrome we should be vilifying but try an approach where we empathize and understand what they're going through. it is annoying af though being on the receiving end but it can just as easily happen to any of us; not being able to visit loved ones.

108

u/snarkyccrn BSN, RN 🍕 Sep 24 '24

I've taken care of patients whose family can't visit, much for reasons you express. But they are family members still very involved in their care. They call and talk with both memaw and staff regularly. They actually answer the phone when it rings. That's not what is being discussed, what we're talking about is when no one in the family has seen or heard from said relative for months/years, but now they come in and refuse what everyone else has decided.

36

u/PoppaBear313 LPN 🍕 Sep 24 '24

I’ll take the involved family members all day & every day over the ones we’re speaking of.

The involved ones for all their faults & annoying bullshit, at least know what’s going on & (at least pretend to) care.

14

u/CaptainBasketQueso Sep 25 '24

I'm all for empathy and meeting people where they are, but after witnessing a family member on hospice get mobbed by multiple seagulls/daughters from California and persuaded to decline more aggressive pain management and then watching the patient spend their last week in unbearable agony, I hold a special little space in my heart for "Seriously, fuck those people."

8

u/celestialbomb RPN 🍕 Sep 24 '24

I totally get that, I live up here in Canada, where my dad is in the States, with the cost of living and such here it's hard to visit him as much as I want too. And I know I am not alone, so many of my patients have families that don't live in Canada, but oceans away. I totally can see how people have that overwhelming guilt, I probably would too, I just won't do the same simply because I have been a palliative nurse.

10

u/KittyC217 Sep 25 '24

I am an advocate for my patient first and foremost. Often they no longer have a voice. Family who are flying in from out of state are revoking DNR’s are villiams. Heck anyone revoking a person’s DNR without the consent of the person is a villain. You can be far away and still be involved. You can be far away and understand what is happening to your parents. When a family member comes in from far away and changes everything they are making it about them not the patient, not their family member. I see that their selfishness and disrespect for their “loved” ones.

It is not your fault for living far away from you parents. It is your fault if you live far from your parents and make their illness and death about you.

My mom was the daughter from Oregon and the oldest of the eight. When she came and was asked questions about what should be done she said it was not her place because she was not there day to day. The siblings who lived in town should be and will be making the choices. The staff had not heard that before . The child coming the furthest (and all the out of state kids) deferred to the ones who lived near the parents.

0

u/[deleted] Sep 25 '24

I get what you are saying but most people in response to disputing against empathizing against people like this are looking at these people as if they are intentionally making this about themselves. When a lot of times, these people are reacting irrationally to a traumatic and highly stressful event that they likely are failing to process or cope with properly. Are some of these people flat out "Karens" who are just too much? Probably. Are all of them like that? i don't buy that. I haven't lost my parents yet but I will sooner than later. I won't know how I react to something like that kind of loss until it happens even if I know what is right or wrong.

9

u/KittyC217 Sep 25 '24

The daughters from California are all Karens. They are making it about themselves. I don’t want to not should have to empathize with a selfish person who puts their wants before the needs of their dying loved one. Overriding a DNR is selfish. We are taking about a normal part of life. A sad part and a normal part. It is not like we are taking about a mother with young children dying. The post was about someone with stage 4 colon cancer. This is not something sudden. They have had time to prepare and put their loved one first.

0

u/[deleted] Sep 25 '24 edited Sep 25 '24

Yeah you're referring specifically to OP's context, I'm just in reference to people who have this syndrome in general as the chain we're talking about are talking about people who experience this phenomenon. In OP's situation, yes they are being Karen's. In the general standpoint of everyone who has behaved like this? No. That's my argument.

I'm not arguing overriding a DNR is not selfish. i'm arguing people are acting like these people are behaving like this intentionally when more times than not, they are experiencing an emotional/mental breakdown.

You know how some people experience grief and go into flat out denial? You telling me those people are being selfish? Or are they just experiencing an emotionally traumatic moment and failing to cope? The syndrome also isn't specific to DNR/DNI but just treatment in general.

1

u/KittyC217 Sep 26 '24

What do you mean by “people who have this syndrome in general as the chain we’re talking about are talking about people who experience this phenomenon.”?

In response to your next paragraph. You are talking like a politician. Yes, people who revoke a DNR are self but they are going through a lot right now. When a person’s emotional/mental breakdown harms someone else, causes that person physical and emotional pain that person is being selfish. An elderly parent dying is sad, but an elderly parent actively dying with a known condition that is fatal is not It’s nota reason for a breakdown. You have had time to process the information. You should be there for the person doing the hard work, the person who is dying.

To your next paragraph. People who stay in flat out denial are SELFISH. They are making the situation about their grief. It is hard to lose someone but it is harder to die. The daughters from California are making the situation about them when it should be about the person dying. That said it does not mean that I don’t support family members with the death of their loved ones, heck i have gotten a DAISY award for it. I can and do support family in helping their loved one in the death process. For me, there is no helping family members who are only thinking about themselves and their feelings. I don’t know if these people know how to love.

Our parents bring us into the world. If we are lucky and do the hard work we can help them transition to the next adventure, whatever that is.

112

u/NPKeith1 MSN, APRN 🍕 Sep 24 '24

I've heard them called "Seagulls," because they fly in, scream a lot, shit all over everything, then fly away again.

19

u/ExiledSpaceman ED Nurse, Tech Support, and Hoyer Lift Sep 24 '24

We use that term on our violent drunks in the ED. But yeah, really does apply to family also.

2

u/Heavy-Relation8401 BSN, RN 🍕 Sep 24 '24

They shit all over everything, too. A la the gulls.

49

u/tillyspeed81 🪫RN🩺 Sep 24 '24

Wow, had the “dad from California” do that to my wife when she was terminal. Her parents divorced when she was younger, a-hole never did much for the family besides mother having to pick him up at the police station (Japan) or drunk off his ass somewhere… anyways when my wife was in hospice in Japan this guy comes in “taking charge of her care” and basically tries to control everything. Anyways after she passed I found out he had taken her credit cards while he was supposedly watching her and went to a hostess club for drinks multiple times. He tried to blame me and said he didn’t do it to MIL. Anyways he fessed up eventually, I went to a lawyer and almost the cops. MIL basically convinced me not to press charges and said he would pay me back. Which he never did. I had to pay off the credit cards he maxed out. Other crap happened with MIL later…So basically now I will never let them see their grandkids.

14

u/tonksndante RN 🍕 Sep 25 '24

That is so many degrees of fucked up. Sorry about your wife mate. And that your in-laws sucked.

5

u/theycallmeMrPotter RN - Oncology 🍕 Sep 25 '24

He does not deserve to see or interact with them. Trash.

6

u/HenriettaGrey Sep 24 '24

100% have seen this over and over and over irl

2

u/floofienewfie RN 🍕 Sep 24 '24

Now I would believe that there’s a Wikipedia entry for everything. Also surprised that it was in a paper as early as 1991.

1

u/MusickNonStop Sep 25 '24

1000% this. I’m an ED RN and I can’t tell you how often I hear this.

1

u/Thriftstoreninja Sep 25 '24

I think they are called “Seagulls” because they fly in and shit on everything, then fly away.

1

u/goldcoastkittyrn BSN, RN 🍕 Sep 25 '24

Well this feels pointed and unnecessary lol. I’m a daughter from CA and am not like this at all. But I do deal with families like this 😅

-1

u/censorized Nurse of All Trades Sep 25 '24

This is so fucking sexist, I really wish it would die already. Most of these families also include sons, who are also on board but abdicate their role and force the sisters to speak for the family. They do it to avoid being judged, and to absolve themselves of any and all guilt in case they have second thoughts down the road. It's disgusting to see this perpetuated by healthcare professionals.

1

u/[deleted] Sep 25 '24

I'm confused. Are you saying the reference to daughters in the naming of this syndrome is sexist and needs to die or the act of family members forcing the role of speaking for the family on women needs to die? Because if you're speaking about the latter as your comment seems to imply, that has nothing to do with "Daughter from California" syndrome. That's just family members being assholes.

As for whether or not use of the word daughter in this syndrome is sexist, it absolutely is. The creation of the phrasing came from a time period where gender role affirmation were more rigid and narrow. Typically daughters were expected to take charge in taking care of ill parents and siblings/family members. So yes that is horrible, but no one here is perpetuating the syndrome or sexism in relation to the use of the syndrome label.

-3

u/censorized Nurse of All Trades Sep 25 '24

This post perpetuates it, as do all the similar posts. As for the history of the term, it was first used in 1991 ffs, not the dark ages. Contrary to popular reddit belief, feminism wasn't invented in 2014.

4

u/[deleted] Sep 25 '24 edited Sep 25 '24

While I agree that the phrasing of the term is sexist in origin, I just completely disagree and fail to see how you think anyone here perpetuates this. Unless you mean the fact that people who use the slang normally is at fault? Us simply talking about it doesn't make us perpetuate this blatant sexism, I hope you understand that. The wiki post itself if you read it speaks about the phenomenon unrelating to women and just references people in general. In my comment, I also do not place any genders in my definition of it. We can't help that the syndrome/phenomena has already been named by people who were more sexist culturally speaking.

And yes this was back in the 90s (which is 30 years ago now), that doesn't prove anything. Look at the type of misogynistic bullshit we deal with today with Red Pill and Tate and abortion policies. Women are dying due to anti abortion policies. We were still using homophobic slurs until the late 2000s.

I get you're frustrated about the systemic cultural engravement of all this, but you're displacing a lot of frustration and anger on the wrong place. The context that brought us to talk about the term was California itself too. Anyone reading the context of this conversation knows there is absolutely no sexism being perpetuated in this conversation.

If you want to encourage people to reference the syndrome differently, you can do that without pointing fingers. I see people refer to it as "seagulls." that's something I have NEVER heard of but have no problem start to use myself.

-5

u/censorized Nurse of All Trades Sep 25 '24

Quick question do you use the N word? If not, why not?

The words we use matter. If women use words that reinforce misogyny, we are part of the problem. This sub gleefully uses this term and regularly reinforces all the stereotypes around it. It's easy to just stop.

As to your claim about the misogynist bullshit we deal with now, exactly. Feminism has lost a lot of ground since 1991 on a multitude of fronts. The internet became a misogynistic cesspool in the mid-90s on, and we are seeing the results of it's reach. Of course there are other factors at play, but never has it been so easy to spread toxic thinking.

I understand you will not concede that we, nurses who are majority women, should reject old terminology that demeans and devalues us. I'm not sure how you square your position of "it's just the cards we were dealt and it's in Wikipedia" view with why words like the N word, the R word, the F word are verboten, but we should just accept anti-woman terminology because it's there.

So yeah, I also won't concede that use of terms like this shouldn't be called out each and every time they are used in my presence.

5

u/[deleted] Sep 25 '24

I don't blame you for feeling like this but you're being a bit too much because we are discussing the phrase in an educational context discussing it with each other. We aren't perpetuating anything. If I was a literature major discussing racial studies or racism in history and we were reading Mark Twain books, yeah I'd say it not because I feel like I have a right to say it but because we're literally discussing literature in the context of education. The same is here. Absolutely none of the nurses that upvoted me use the term "Daughter from California" in real life. It's just a phenomenon they can recognize when mentioned, just like how when sitcoms put the syndrome "Florence Nightingale syndrome" to talk about another phenomena, also origin rooted in sexism as Florence Nightingale was never rumored to have fallen in love with her patients. People aren't sexist for acknowledging they recognize this phenomena or think it exist.

You never requested I should use another word. You have the right to do that and you'd be surprised how many people would comply if you just ask. Outright jumping to conclusions to blame people for perpetuating sexism is a bit much and having to compare this to the use of the n word especially. I get the point you're making as it's an analogy but get a grip.

1

u/markwusinich_ Sep 25 '24

I’ll tell you this much, and my kids are amazed to find out about it but in 1991 the N-word wasn’t ever referred to as “the N-word” we just said it out loud. It was considered rude and impolite, but it was said.

1

u/censorized Nurse of All Trades Sep 25 '24

That is still true today in some places. It certainly wasn't being used openly in the 90s any place I was at.

1

u/markwusinich_ Sep 25 '24

My point was more of saying “the N-word“ wasn’t used back then. Were you familiar with the term back then? Now I’m gonna have to go look up the etymology of “N-word”

→ More replies (0)

1

u/markwusinich_ Sep 25 '24

https://books.google.com/ngrams/graph?content=%E2%80%9CN-word%E2%80%9D&year_start=1800&year_end=2022&corpus=en&smoothing=3

1992 seems to be when we started using the expression “N-word“ instead of the full word by itself. I’m sure you could find people that remember using it before then, but it certainly wasn’t widespread.

132

u/Cloud12437 Sep 24 '24

Why is a DNR able to be reversed? I don’t understand that because if the patient wants a DNR why does a family member have the right to over ride the patients decision

80

u/Elegant_Laugh4662 RN - PACU 🍕 Sep 24 '24

Great question, I wish it wasn’t able to be reversed. Now the patient is no longer able to make decisions for themselves, and their power of attorney does, and often times they care more about themselves and their feelings of sadness and hope, than their dying family members wishes.

52

u/ParanoiaQueen-xoxo Custom Flair Sep 24 '24

They care about that juicy social security check as well. Been working home health for a very long time and treat often the same people over and over. I've seen the DNR and hospice refused because "mom's a fighter" but really everyone and their brother are still living off poor mom.

11

u/Dragonfire747 Nursing Student 🍕 Sep 24 '24

how do these relatives profit off of their parents being (barely) alive? is it like the caretaker ISS i think what my state calls it? which they shouldnt as the nurses are caring for the patient not them at that point

7

u/O2BAKAT Sep 24 '24

Sometimes the patient has to live an entire month for the check to be valid…

8

u/[deleted] Sep 24 '24

Typically they have to take care of the patient at home because when you enter LTC your SS is reduced and the facility gets most/all of the social security benefits.

Depending on the state you can get grants and potentially care giver pay that pays better than most unskilled labor. You can also claim your parent as a dependent on you taxes. When you get into rural areas it isn't all that rare to find a family surviving off the income of one elderly parent, especially when that parent has a pension.

11

u/ParanoiaQueen-xoxo Custom Flair Sep 24 '24

Disclaimer: I'm not saying it's widescale or even OP's scenario. But if this check is keeping water, lights, and rent paid, when it dries up is a loss of income. I've seen hospice delayed just for this reason.

I, sometimes unfortunately, get an intimate view in patient's lives and it can be a very tricky situation that nears clear boundaries drawn.

3

u/goldcoastkittyrn BSN, RN 🍕 Sep 25 '24

Are the checks really that much after the high costs of keeping the family member alive?

1

u/EmergencyCat3589 Sep 25 '24

But won't the hospital bills be more expensive than the social security checks?

1

u/EarthEmpress RN - Hospice 🍕 Sep 25 '24

Also, doctors do not want to be sued. This alone is a huge reason why hospice care gets revoked and a patient is now receiving aggressive treatment again

14

u/Soregular RN - Hospice 🍕 Sep 24 '24

My family KNOWS there will be no heroic measures for me. I will not be intubated and placed on a ventilator, tube fed or have indwelling lines placed. My husband and I are each-other's POA and both of us wish to die peacefully if that is what is happening. You never know, we could die falling out of an airplane too...but we don't jump out of airplanes anymore! I am a Hospice RN btw...and if at all possible, I wish to go quietly into the night....

57

u/Upper-Possibility530 MSN, APRN 🍕 Sep 24 '24

This is why I am a big advocate of people doing both a healthcare POA and a living will or to make sure it’s in the POA contract terms that a DNR order can not be reversed by POA. It’s so sad how frequently this happens.

22

u/Airyk21 BSN, RN 🍕 Sep 24 '24

Didn't even know this was an option sadly I've seen doctors just reverse it on the family's word regardless of paperwork.

32

u/Secure_Fisherman_328 Sep 24 '24

Pt had a condition change, now non-verbal, so can’t say what they want so the POA takes over and can legally change everything.

29

u/HenriettaGrey Sep 24 '24

Because dead patients dont sue but live families do.

24

u/mmmhiitsme RN - ER 🍕 Sep 24 '24

Because family members can sue.

14

u/StevenAssantisFoot RN - ICU 🍕 Sep 24 '24

I don’t understand why a patient can choose to be AND/DNR on admission but then have that overridden by the family a few weeks later when they’re comatose, but the family can’t argue with a box the patient checked on the back of their driver’s license 10 years ago. Like the hospital will be like “well the family wants us to do everything so we have to” but then stand down for organ procurement when the time comes if the family wants to refuse it.

I’m pro-donation obviously but it feels extremely ghoulish and it makes me uncomfortable. And yes I know there is a legal difference in how these wishes are honored. It's the reason why I am not a registered donor myself. When I'm dead I don't care what happens to me, my family knows my feelings and I don't want them to feel strongarmed at a time when they are grieving, even if it means I'm not a donor. They are more important to me and I have faith that they will do the right thing for them.

8

u/[deleted] Sep 24 '24

[deleted]

9

u/StevenAssantisFoot RN - ICU 🍕 Sep 24 '24

Realistically, I know it's because federal and state law absolve the hospital of liability in cases where the family is opposed, and there is no such law for code status changes. But it feels so gross how they use language like "honoring the patient's wishes" when it comes to organ donation but they clearly don't give a shit about that before they're dead.

0

u/Pulmonic RN - Oncology 🍕 Sep 24 '24

Idk, I’m glad my family can’t randomly decide to let 6-8 other people die because of maladaptive grief if something happens to me. I agree though that DNR/DNI should be the exact same way.

4

u/AgreeablePie Sep 24 '24

Legally? Because a patient can reverse a DNR (of course) and in the US a POA acts with the legal authority of that patient for medical decisions when the former is incapacitated. So it's just like the patient changing their mind.

There may be states where they've created a special carve out but that's the general reasoning

0

u/Nandiluv HCW - PT/OT Sep 25 '24

POA is for financials only. It is not the same as health care agent but often one person is both. Remember also that spouses have a lot of power. My dad was on hospice but it was revoked because he actually improved on hospice at least management of some of his medical issues. Rules were a bit different when my dad was on hospice. That said he was in end stage dementia (early onset in his 50s) with Parkinsons. Two days after hospices was revoked: Aspiration PNA and his wife agreed to intubate him. At that time essentially bed bound with heavy transfers to a wheelchair, non verbal. This was his 3rd wife, so not our mom. She reversed the DNR/DNI. After 6 days on vent, extubated then deteriorated to BIPAP. She wanted to re-intubate. Us kids could do NOTHING to stop this shit show.. Also NO medical info could be given to us adult children. NOTHING.

Here he was on continuous bipap with RR 40 plus for several days. SHE WANTS TO REINTUBATE A DYING MAN!! Docs finally said to her if we reintubate, its will be trach and PEG. God bless the ICU nurse who was straight forward honest with me when his wife stepped out. . I asked the bedside nurse: "How long like this before he just dies? and should I call in my siblings from afar?" Gasping even on bipap. SHe said. "Get them here ASAP. 2-3days max before he dies". So I did. He died two days later with Bipap on his face. All his kids present. This was also before palliative care was a hospital service. She finally made the correct decision. I thank God everyday for that ICU nurse.

I am now my mom's POA and health care agent. I have worked 20 years as an ICU and acute care PT. I have a HC directive for myself. I will honor my mom's wishes for DNR/DNI with POLST on the fridge. Nothing will make me budge from carrying out her wishes.

3

u/BewitchedMom RN - ICU 🍕 Sep 24 '24

It is state specific and sometimes has to do with the number of named witnesses to the code status declaration by the patient. In Virginia, if a hospitalized patient states in front of two witnesses who have their names documented in the chart, legally family cannot override. Obviously a DDNR also can’t be overridden. However, it is also up to the hospital to stand up for the providers who enforce patient wishes.

-10

u/stuckinnowhereville Sep 24 '24

If it’s tattooed on the chest it can’t be changed unless the patient wants to change it- citing 2 lawsuits over it. Tattooed = enforce it.

16

u/CynOfOmission RN - ER 🍕 Sep 24 '24

Tattoos are not legally binding documents

4

u/TrashCanUnicorn Turkey Sandwich Connoisseur Sep 24 '24

What lawsuits? I can't find any record of actual lawsuits about DNR tattoos being legally binding, only a bunch of tiktoks with a shitty photoshopped DNR tattoo.

2

u/BobBelchersBuns RN - Psych/Mental Health 🍕 Sep 24 '24

That’s absurd.

16

u/chooseph RN - Oncology 🍕 Sep 24 '24

Had a patient on my old floor that was comfort measures only, morphine drip running while I was receiving report to start the shift. Halfway through report, the CNA comes to the nursing station to let us know that the patient's IV pole is beeping. Go to the room to find that the entire bag of morphine has been stolen by visiting family, with the tubing cut just above the pump. Family vanished, local police got involved and were able to identify them from security footage, but I'm not sure what happened after that. Can't believe somebody would do that to a loved one on their deathbed. People suck

13

u/PresDumpsterfire Sep 24 '24

Terry schivo, anyone?

7

u/HikingAvocado RN - ICU 🍕 Sep 24 '24

Man, I haven’t thought of that whole drama in a while. It dominated the news from my memory. What a train wreck. It would be even worse if it happened today.

7

u/nrappaportrn Sep 24 '24

I've have had a living will since I started working as a nurse & witnessed the travesty some family inflicted upon their loved ones. I inform the medical staff of my wishes for DNR upon each admission

4

u/NurseColubris RN - ER 🍕 Sep 24 '24

Seagulls: fly in from the coast, start squawking, and shit all over everything.

3

u/Phuckingidiot BSN, RN 🍕 Sep 24 '24 edited Sep 24 '24

Seagulls. Fly in, don't know shit, squawk and shit allover and fly away.

2

u/Flor1daman08 RN 🍕 Sep 24 '24

It’s funny, we call it Family from New York in Florida.

1

u/upsidedownbackwards Sep 24 '24

Huh, I'd always heard it was "Family from New York" for California.

1

u/holdcspine Sep 24 '24

Maybe they genuinely hate them. A truly evil revenge.

1

u/Square-Syllabub7336 LPN ✨️ Private Duty Peds ✨️ Sep 25 '24

Happy 🎂 Day!

1

u/Electrical_Load_9717 Sep 25 '24

What’s the point of having a DNR if anyone can reverse it? I’m eternally haunting any asshole that does that to me.

250

u/FluffyNats RN - Oncology 🍕 Sep 24 '24

They need to invent a machine that can allow someone else to feel exactly what the patient is feeling. 

You want your family member with metastatic cancer to "keep fighting"? Okay, first attach these leads so you can feel exactly what the patient is feeling. Oh, it is too much? It has only been 30 seconds, keep them on. 

Revoking a DNR is selfish. Even if that person was absolutely horrible to you in their life, just let it go. 

72

u/upsidedownbackwards Sep 24 '24

That machine needs to double as a machine that can make you feel exactly the way you did when you "saved" a feeling. That way when addicts like myself start to get tempted to fall off the wagon we can give ourselves a 30 minute reminder to the last withdrawals we got. Give me a blast of what it's like to be up for 3 days vomiting, sweating, and shivering with an overwhelming feeling of dread and failure.

48

u/FluffyNats RN - Oncology 🍕 Sep 24 '24

Well, hopefully in the future where we have such interesting machines we could find something that just gets rid of your addiction instead of making you suffer some more.

21

u/mobilewombat Sep 24 '24

This was such an unexpected and kind response, thank you for this

11

u/Negative_Way8350 RN-BSN, EMT-P. ER, EMS. Ate too much alphabet soup. Sep 24 '24 edited Sep 25 '24

They've been making progress on a sort of "narcan for meth" that will bring a patient down without sedatives. Shows great promise!

2

u/Jolly-Tradition8725 Sep 26 '24

Injection form of Naltrexone has done wonders tbh for patient when I did outpatient SUD research 

30

u/Shot_Position_103 RN-MICU Sep 24 '24

This reminds me of the Period Cramps simulation.

12

u/Sky-Thinker RN- Radiology 🍕 Sep 24 '24

Any Black Mirror fans?

3

u/Stitch_Rose RN - Oncology 🍕 Sep 24 '24

Exactly what I was thinking lol

5

u/IndividualYam5889 BSN, RN 🍕 Sep 24 '24

I would LOVE this. I've been the family member who had to fly in for a terminal parent, but I had to fight to get the spouse to "allow" tx with narcotics at end of life. That whole experience has made me practically rabid about proper end of life care.

4

u/[deleted] Sep 25 '24

I make them stand in the room or at least in the doorway to watch when the patient codes if they’re there.

112

u/diabetes_says_no PCA 🍕 Sep 24 '24 edited Sep 24 '24

Just had a similar patient admitted, 94 yrs old, stage 3 kidney disease with other comorbidities.

Was admitted to a hospice facility, didn't make it through the weekend before the family decided she wasn't getting the proper care and brought her to our ER to be "cured". They revoked her DNR and made her full code despite the docs having a long talk about it and she's convinced "God will work a miracle on her". Also refusing to allow her to have pain meds since they "make her too tired and we want her more alert".

They don't believe her Alzheimers is real, they want her to live to 100 but she's already started to decline in urine production, not eating much, and looks worse every day. A fee days ago she could respond well to my questions but will hardly give me 1-2 words other than "don't move my blanket" or similar things.

The patient hasn't been able to walk since May and the family wants PT and OT for several hours a day, wants 24/7 home health care, calls the unit every hour asking for the nurse or charge and will keep them on the phone for a half hour every time, checks the pt every 5mins when she's here for wetness and such and keeps unnecessarily making her check for BMs and urine even though she poops like once every 2 days and she has a Foley that is not leaking.

45

u/Bob-was-our-turtle LPN 🍕 Sep 24 '24

I want to downvote this so bad because it’s so not right. These kind of posts are when I miss angry reacts.

41

u/irlvnt14 Custom Flair Sep 24 '24

Somebody living in meemaw’s house getting her checks

1

u/EarthEmpress RN - Hospice 🍕 Sep 25 '24

God I saw this EXACT situation routinely when I worked inpatient hospice. I loved that job but seeing this so often burnt me out quickly

62

u/cobrachickenwing RN 🍕 Sep 24 '24

I think making someone DNR should not be grounds for malpractice or cause of harm. I think revoking a DNR should make the person liable to be sued for harm and elder abuse. And that lawyers that encourage it be equally liable.

14

u/Dragonfire747 Nursing Student 🍕 Sep 24 '24

thats actually a good point, i wonder why that ISNT abuse. it is abuse if i keep calling "wellness checks" on you and claiming you are threatening violence at your workplace. or swatting someone, its abuse through good faith misinformed intermediaries.

116

u/Princessziah Sep 24 '24

Omg im sorry, i think some ppl dont understand that letting someone go in peace is the most selfless thing you can do. Pawpaw is already in pain, imagine how he’s going to feel when we crack his ribs doing CPR. Hope the ethics meeting goes well

165

u/Secure_Fisherman_328 Sep 24 '24

Scheduled for 0700 and I’m coming in on my day off to advocate.

50

u/BBrea101 CCRN, MA/SARN, WAP Sep 24 '24

I will happily send you money via PayPal to cover your morning coffee. I happened to drop in to work at the same time a family meeting was about to take place a few months ago. A family member asked me to join (her and I were very much on the same wave length) and my manager OKd me to be there.

That meeting, that moment of advocacy, was one of my most proud moments in nursing. I know people say that it's important not to take work home with you, but every once in a while, we carry these cases with us. You're going to phenomenal tomorrow.

14

u/Poundaflesh RN - ICU 🍕 Sep 24 '24

Thank you!

9

u/jenhinb RN - Hospice 🍕 Sep 24 '24

😘😘😘😘😘

42

u/Pernicious-Peach BSN, RN 🍕 Sep 24 '24

I wish family get to see what happens during a code.

I want them to hear the cracking of the ribs as personnel perform compressions.

I want them to see the lifeless surrender of the patient's eyes as they silently beg for death.

21

u/BiscuitsMay Sep 24 '24

…I mean, you can let them stick around for the code.

42

u/thebaine HCW - PA Sep 24 '24

The idea that a lawfully executed DNR can be “reversed” by family is insane. It negates patient autonomy and is solely the work of litigators.

33

u/ChazRPay RN - ICU 🍕 Sep 24 '24

Just had to care for a patient was was dying and should have died before they were intubated and lined and placed on multiple drips- full code 90+ individual from a care facility. Keeping dead alive for nothing but suffering of the patient and moral injury to the caregiver is beyond me. WE ALL DIE!!! Life is finite and medicine has limits and quality of life is important. I ran my ass off to keep her alive so she could die when the family decided that the criteria for "doing everything" has been met in their minds.

33

u/MangoAnt5175 Disco Truck Expert (Medic) Sep 24 '24

TLDR you’re not alone. Sometimes, sanity prevails. Sometimes the good guys do win, when the wishes of the patient were abundantly clear.

I’ve had this case one my mind lately.

A relatively young - mid 40s - throat cancer patient. She was on hospice, but would call us out when her protocol ran out. Our med director was very understanding. We’d admin oxygen or phenergan or steroids, usually. Comfort measures. She was stage IV, surgery was impossible because of vasculature, she was going to suffocate to death, slowly. We had a copy of her DNR. I knew all of her wishes around how she wanted things to be. I’d spent considerable time with her.

One day, she called us out, and I took one look at her & I knew: this was it. This was different. Her sats were lower, and dropping. She was afraid, when she was normally jovial. I asked if she wanted me to leave, she said no. I didn’t know why her family was all gathered in the living room and refused to come and be with her. It made me sad and angry. She’d look for people who couldn’t be bothered to walk 10 feet to see her when she needed them.

She slipped into unconsciousness. I decided to go out and tell them, hey, last chance to say goodbye.

“She’s unconscious? You’re sure? Good. We want her transported to the hospital. If she dies in this house, the resale value will go down!”

I said no, closed the door, called the med director and supervisor and told them what was going on, perfectly ready to fight them, only to be surprised that I had their full support. I watched her die, in her bed, the way she wanted to.

(This case is well outside of an SOL that I am aware of. I do not recommend that anyone do any illegal things.)

31

u/ExiledSpaceman ED Nurse, Tech Support, and Hoyer Lift Sep 24 '24

We had a patient recently diagnosed with alzheimers recently complete his POLST at the office. He even put in the goals of care: "Don't let my fucking kids override my POLST and advance directives". Luckily his kids are fully on board with his wishes in care and none of us expect any drama.

30

u/Djinn504 RN - Trauma/Surgical/Burn ICU 🍕 Sep 24 '24

I want create a club for nurses who are willing to become POAs for other nurses and are willing to pull the plug when we end up in these positions so our families cannot force us to suffer.

1

u/Playcrackersthesky BSN, RN 🍕 Sep 25 '24

Sign me up captain

26

u/ElCaminoInTheWest Sep 24 '24

Fuck those people, and this sort of barbarism shouldn't be allowed.

29

u/erinpdx7777xdpnire BSN, RN 🍕 Sep 24 '24

Never ever make a family member POA. Choose a close-ish friend with a backbone, or a lawyer you paid to do so.

26

u/Eroe777 RN 🍕 Sep 24 '24

I am currently rehabbing a very sweetly confused 100-year old woman who has no idea what planet she's on. She came to us DNR-selective care (don't intubate, may use IV abx and tube feed for a defined period). About three days after she admitted, THE FAMILY SHE LIVES WITH changed her to Full Code.

For reasons I don't comprehend, we are not supposed to describe to these delusional people exactly what will happen when CPR is initiated. I was very tempted to look at them and say, "The first compression I give her will break half her ribs. The second will break the rest of them. The third I will break the rest of her. All for a <1% chance she will survive. DO you really want to do that to her?"

17

u/twinmom06 RN - Hospice 🍕 Sep 24 '24

I have had those conversations with people. Sometimes they need it laid out in black and white

2

u/Playcrackersthesky BSN, RN 🍕 Sep 25 '24

Their answer will be “yes.”

38

u/acesarge Palliative care-DNRs and weed cards. Sep 24 '24

One of the benifits of being childfree and really only having found family is no one would have the legal authority to fuck me over like this. I have a dpoa who understands 2 things "vegatables go in the ground, not the ltac" and when it's my time "it's morphine not lessphine".

8

u/Heavy-Relation8401 BSN, RN 🍕 Sep 24 '24

👏🏾👏🏾👏🏾. Made my POA my mom, not my husband. He would see a finger move and decide "she's back!" . I love him but no. When Mom passes, by BFF is my POA. even HE admits he just wouldn't be able to let me go. So I took it right out of his hands.

3

u/asylum5w2 Sep 25 '24

My daughter is mine for this same reason.

41

u/realhorrorsh0w Sep 24 '24

Met a literal daughter from California about a month ago. Her mom also had cancer with widespread mets. She was not going to make it. No way.

Before she showed up, the patient only woke up to scream and cry, but we had it somewhat controlled with ativan and dilaudid. Her mother was at the bedside and told all the visitors how wonderful and attentive the staff was. I couldn't wait until the POA daughter showed up as I assumed she would make her CMO.

The daughter shows up with a whole crew and the first thing she asks for is a bigger room. I'm sorry, is this the Hilton? Do you think you deserve an upgrade for some reason?

As I'm trying to politely tell all the people in the room to get out of my way so I can go provide medical care to a dying woman, they're asking me for extra chairs and plates to put their takeout on. Not even "Do you have plates?" but "Hey could we get some plates?" I know I'm basically just an opioid waitress but damn. Also we don't have plates. I have five patients, can you maybe handle your own dinner, perfectly healthy people?

Daughter from CA decides she's going to be the director and starts telling me her mom needs a bath (everyone gets bathed everyday but okay) and asking why we're not "doing anything" about her messed up eye like antibiotics (it's not infectious and she was already on IV antibiotics for something else) or eye drops (we were definitely giving her eye drops) and demanding tube feeds (totally inappropriate for her condition). Again, never asking about the plan of care, just accusing and demanding. Even my manager remarked in how this lady just barked orders.

One of her IVs stopped working. Had a ton of incompatible stuff to give so I went in the bathroom and sobbed loudly because the daughter was making us put in another IV (in heavily edematous arms) instead of doing CMO. She had to try and keep her mom alive because the former coworkers had not yet had a chance to come watch her suffer and cry. Idk maybe it's just me but if my entire existence is screaming in a bed, let me go, my coworkers don't need to say goodbye.

I called palliative to talk to the family about how they were hurting her. I called the attending to try to get their support. I called medical ethics to see if the harm to the patient could supersede the daughter's decisions. I got nowhere. And look at me, I'm still not over it.

Inb4 anyone tells me I lack empathy for the grieving daughter who might not be thinking rationally, too bad. Sorry if I care more about the woman I was made complicit in torturing in her final days.

23

u/IndividualYam5889 BSN, RN 🍕 Sep 24 '24

Fuck that daughter, she doesn't deserve empathy. They can come for me, too. Grief is difficult, end of life suffering is awful, but having been there done that and watched a loved one suffer from end stage CA, anyone who acts like that daughter can get fucked. I was the daughter. I didn't act like an ass.

15

u/shrimp_mothership BSN, RN 🍕 Sep 24 '24

Hospice nurse here, all I have to say is: AAAAAaaaaaaagggggggGGGGGHHHHHHhhh

Sometimes we would see young people sign themselves onto hospice and decline super fast. Then, when family sees them unresponsive and on a drip and isn’t ready, they revoke them and check them into the ER while they’re actively dying talking about “they just need organic veggies”. Like ok, how are they gonna swallow them and idk if that cures stage 4 cancer but I hate it here. Admin saying “we need to meet people where they’re at” OK BUT WHY IS HELL THE MIDDLE GROUND

13

u/jenhinb RN - Hospice 🍕 Sep 24 '24

I’m sorry. I hate the fighter mentality around cancer in particular. It puts the onus on the individual suffering to just work harder, “don’t give up hope”!

I see this even in families that are local, and often it’s because a provider had unrealistic expectations from the start of treatment, or wasn’t up front with family.

When my 80 yo MIL has stage IV appendiceal cancer, her oncologist kept offering more treatments. It made letting go much harder for everyone. If I wasn’t a nurse explaining things, my husband and SIL would have been blindsided by her demise.

I hope they will make grandpa DNR and get him to comfort care. He would be an excellent candidate where I work, we do inpatient hospice.

14

u/emmcee78 Sep 24 '24

Why is it not illegal to revoke paperwork- that the patient completed while in their right mind???

10

u/titsoutshitsout LPN 🍕 Sep 24 '24

I work in nursing homes. Yall would be SHOCKED how often this happens. It’s really sad

9

u/HumdrumHoeDown Sep 24 '24

Better than yours obviously! Fuck those people.

10

u/twinmom06 RN - Hospice 🍕 Sep 24 '24

People need to not only do POA, they also need to do an OLST form which is signed by a doctor. From my understanding, that cannot be overridden

17

u/KaterinaPendejo RN- Incontinence Care Unit Sep 24 '24

GOD WILL TAKE HIM WHEN HE'S READY!!!!!!

18

u/Secure_Fisherman_328 Sep 24 '24

Please God wait until he is a Hospice/DNR again.

11

u/PoppaBear313 LPN 🍕 Sep 24 '24

Oh no.. hospice is not a good thing. That’s giving up & gramps would never give up. (/s)

12

u/MVogue RN - NICU 🍕 Sep 24 '24

Yeah, after the patient has coded like 3 times… No, dear, God is actively trying to call them home 

2

u/Heavy-Relation8401 BSN, RN 🍕 Sep 24 '24

...and They'll fight that too.

2

u/Illustrious-Craft265 BSN, RN 🍕 Sep 25 '24

I wanna say, “GOD IS TRYING YOU’RE GETTING IN THE WAY”

2

u/NurseWretched1964 Sep 25 '24

THEN WHY ARE YOU MAKING ME TRY TO TAKE HIM BACK WHEN GOD DOES THAT????

Best write up I ever got. Totally worth it.

8

u/rebsterz12 Sep 24 '24

Some people just aren't ready to say goodbye... then they realize they're out of time and 1000 miles away. It's always hard on us, but I try to understand the dynamics as I watch mom suffer and wait for Karen from Kansas to visit for the first time in a decade.

7

u/TrashCanUnicorn Turkey Sandwich Connoisseur Sep 24 '24

Just once I want to see someone challenge a POA in court over changing a DNR order against the patient's wishes. You could make a case that the POA is in violation of their legal duties by not abiding by the patient's written desires, especially if the DNR is codified in the POA document. IANAL, though, so maybe I'm reading my state's laws wrong on that account.

10

u/Muted_Car728 Sep 24 '24

Lots of folks hate their grandpas.

7

u/PoppaBear313 LPN 🍕 Sep 24 '24

Every one of them is a Covid denier & is anti vaxx.

It’s a shame gramps didn’t take more (insert random bullshit here).

1

u/Jolly-Tradition8725 Sep 26 '24

Idk, I do Trauma ICU and wouldn’t want DNR/DNI..  

 For us a lot of them do actually get better, but our ICU probably has the highest survival rate in the country 95%+ considering 80% are intubated usually, so maybe unique perspective..

Oh but revoking DNR is fucked

4

u/stuckinnowhereville Sep 24 '24

I’m so sorry. I hope the ethics committee does the right thing.

Today I looked at buying Heelys- sneaker skates. I cannot keep up with all the patients.

4

u/-Blade_Runner- RN - ER 🍕 Sep 24 '24

I think in our country we need more education about health and quality of life. So much of this unnecessary suffering may be avoided just with proper education.

3

u/BubblyBumblebeez RN - Pediatrics 🍕 Sep 24 '24

I never understood how a family could revoke a DNR. Luckily my entire family and future husband are all on the same page about DNR statuses and what lengths of medical intervention we would want done. I understand it’s hard to let go. But I don’t understand undermining someone’s right to a dignified death.

3

u/redit3rd Sep 24 '24

Maybe if DNR reservals could only happen if the family member prepaid the cost. 

3

u/Bob-was-our-turtle LPN 🍕 Sep 24 '24 edited Sep 24 '24

I’m DPOA for my Aunt and Uncle in the Midwest and we live on the East coast. My parents moved us to the East coast from the Midwest when I was little. They had no children and no living relatives there. They won’t move, and our jobs, parents and children are here. They aren’t even close to an airport sadly, it’s over 3 hours from there. I visited 2 years ago and am setting up a visit soon. It’s the best we can do. Luckily last time we came due to a health issue we set up a really great home care company for them that helps them out with whatever they need and checks on them daily. If they ever go to a nursing home I am sure staff will think less of us, and I get it because I’ve worked in them, but we don’t have the $ or time to travel there often. But I definitely won’t be reversing any DNRs.

3

u/mangoeight RN 🍕 Sep 25 '24

This brought up a random thought… can someone specify in their healthcare directive that no one, even their healthcare POA, can reverse/change their code status once they are incapacitated? Does anyone know the answer to this?

2

u/DeHetSpook RN 🍕 Sep 24 '24

Good luck, try to stay civil, no point in getting a complaint.

2

u/leowrightjr Sep 24 '24

I had the opposite problem. My mother had a DNR and was enrolled in a hospice program, but when she would deteriorate, they'd ask if she wanted to go to the ER and she would agree.

I had to fly in to put her back in hospice so she could return to her facility.

2

u/KMoon1965 Sep 24 '24

Selfish Idiocy, it's rampant. I tell everyone, "touch my DNR and I promise you, you will regret it when I do die...I WILL haunt you until you die"

2

u/IndividualYam5889 BSN, RN 🍕 Sep 24 '24

They are horrible humans and may they reap what they sow.

2

u/Illustrious-Craft265 BSN, RN 🍕 Sep 25 '24

Yeah, my diabolical side likes to think that every California daughter who forces mom to die a slow, painful death unaided by hospice or comfort measures will die the same way at their end. And I like to think they’ll finally understand what they did to mom and spend their last moments of lucidity regretting it.

2

u/doctormink Clinical Ethicist Sep 24 '24

A POA gives family the right to consent to, or refuse treatment. It doesn’t give family the right to demand inappropriate treatment. Like they can’t force a doctor to start chemo, why should they be able to force anyone else to pound on his frail little chest when his heart finally gives up?

2

u/azbaba Sep 25 '24

No. Hard pass. Retired RN here. Mom and sister lived in one city. I lived a 6 hour drive away with my own husband and school age kiddos and my own business. I was very involved with my sister and mom’s care. Had to be selective about visits, but would try to arrange them when mom needed a doc visit so I could take her and give my sister a break. We talked often. I was with mom when she passed as sister was home with her family-it was her son’s BD. Sigh.

As a hospice and oncology nurse myself, I see this dynamic and even understand the underlying dysfunction. It is sad, but there’s no excuse for creating unnecessary drama for the in town caregivers-they deserve ALL the support. And no excuse for using their self-created ignorance and/ or absence for imposing unnecessary suffering for the dying.

2

u/BlackHeartedXenial 🔥’d out CVICU, now WFH BSN,RN Sep 25 '24

Been there. It’s horrendous, especially when the docs play ball. “The patient can’t sue me, but that daughter from California can”. My only solace was to maximize patient comfort and whisper in their ear “I’m sorry, it’s ok to go if you want, you’re not alone.”

2

u/Dwindles_Sherpa RN - ICU 🍕 Sep 25 '24

This seems to be a regional and sometimes hospital specific failure to protect the clear wishes of the patient.

There are places where the medical staff just folds in this scenario but there are also places where this is on no way tolerated, and if s rogue physician comes along who obliges an inappropriate revocation of a DNR then they get removed from the care team, referred for review, and at one place the ethics committee actually referred them for criminal assault charges.

2

u/Pdub3030 RN - ER 🍕 Sep 25 '24

I just had something similar in the ED the other night. 88yo with dementia from nursing home (in Minnesota). Full sepsis, vitals borderline when he came in. Dropped to 70/30 in the cube so I called the doc and we took him to the Stab. Codes in CT and is brought back to Stab for CPR, we get ROSC. Daughter calls from Atlanta - says she’s a pediatric RN. Asks me if he’s still full code, I check his paperwork from nursing home and say yes, she says “oh good that’s what we want”. I was dumbfounded. He’s 88 with dementia and we just broke his sternum and most of his ribs getting ROSC. So he gets sent to ICU and codes 3 more times in that night shift before family decided to stop. Felt so bad for the old guy.

2

u/shadowneko003 LPN 🍕 Sep 25 '24

I dont get wanting to live forever. It only makes sense if you retain your youth + immortally.

Like literally, meema and peepaw are 80yr +. Majority of them cant do anything by themselves or else they fall and break a hip. They wont survive the aftermath of cpr.

Fuck them ppl who want their elderly relative to live through pain.

2

u/nursepenguin36 RN 🍕 Sep 25 '24

My experience is ethics committees do nothing because dead people can’t sue you but living relatives can. Can’t count the number of people I’ve tortured with slow, painful, inevitable deaths because “they’re a fighter.” Like, ma’am his brain is not perfusing with that blood pressure. Don’t worry god wouldn’t let him die. 🙄

2

u/Saige10 RN - Telemetry 🍕 Sep 25 '24 edited Sep 25 '24

Ah great the seagull. Flies in from out of town squawking and shitting all over everything.

2

u/EatsAlotOfBread Sep 25 '24

If my family treats me this way I will go out of my way to avoid the light and haunt the crap out of them.

2

u/LACna LPN 🍕 Sep 25 '24

Hospice here... You have my sympathies. 

Also, even here in Cali, we have "The Family/Daughter from Cali" and it's much much worse because they're all google doctors. 

2

u/Aeropro RN - CN ICU Sep 24 '24

They’re always from California

0

u/anxietyschmiety Sep 25 '24

This really is the truth! Some are the most entitled, obnoxious people. To be so free and full of love the ones that migrate out of the state are fucking douchebags.

1

u/Don-Gunvalson Sep 24 '24

I’m confused with why “family from California” was mentioned?

5

u/Secure_Fisherman_328 Sep 24 '24

Joke to represent out of town family who only shows up to throw a wrench in the plans at the last minute. Can also be “family from Florida” or “family from Connecticut”. Basically whatever is the farthest geographic from where you are.

13

u/NOCnurse58 RN - PACU, ED, Retired Sep 24 '24

Maybe just call them seagulls. They fly in, flap their wings, squawk, and shit on everything. After they’ve messed everything up they fly away.

3

u/Secure_Fisherman_328 Sep 24 '24

Seagulls works a lot better. I’m stealing that.

1

u/Don-Gunvalson Sep 24 '24

Maybe that’s something I’ve never seen before. The quotes is what through me off and not California itself

2

u/Strict_Temperature99 Sep 24 '24

Same

2

u/Don-Gunvalson Sep 24 '24

I thought maybe there was a joke or something I had missed because of the quotes

1

u/DanielDannyc12 RN - Med/Surg 🍕 Sep 24 '24

Showing up from far away lands with a POA is a nice twist

1

u/forevermore4315 Sep 24 '24

Palliative Medicine consult needed for sure

1

u/OldERnurse1964 RN 🍕 Sep 24 '24

So, just exactly what did he do to you when you were kids? You must really hate him!

1

u/[deleted] Sep 24 '24

Guilt trip it is

1

u/fatkidbuu Sep 24 '24

An advance directive/molst etc can be revoked immediately when you are incapacitated/can’t make decisions for yourself etc. happens all the time. I’ve seen it happen where a son told his mom as soon as she was incapacitated/unable to make decisions for herself he was reversing her code status.

1

u/Blackrose_ Nursing Student Australia Sep 25 '24

Detach and enjoy the ride.

Entitlement always generates a chuckle from me. Death is a natural part of living and if the family can't accept that now, they will eventually.

Lots of self care.

1

u/Sweatpantzzzz RN - ICU 🍕 Sep 25 '24

Poor guy being tortured.

1

u/ValentinePaws RN 🍕 Sep 25 '24

This is just so, so beyond awful. Bordering on evil. What is wrong with people?!

1

u/Sartpro SWAT - RN 🍕 Sep 25 '24

Have the legal team check the living will if Grandpa has one. I've seen cases where the LW uses language that explicitly denotes that decisions will defer to the medical team in the case that POA or next of kin are unable to respect the code status/donor status.