“I just want to be clear who has the final say on life support”

Very powerful article. Thank you for verbalizing your feelings, thoughts and emotions Dr. Dragan. Sometimes it is forgotten how truly difficult and painful it can be to put aside our emotions when we are caring for our patients.

My great aunt was 93 when she had a heart attack. She was resusitated returned to her nursing home in a much more dependent state. She was furious she had been resusitated but would not sign a future dnr. So I listened to her sadness and frustration for two more years until she died.

I watched many of similar situation while in chaplain Residency (CPE). I wrecked my heart as I witnessed patients dwindling, but family still holding on to the littlest hope. Witnessed it in the ED, PICU and adult icu. Patients and families need to prepare for such situations by decision on what care can be rendered and when to end heroic measures.

The hospice nurse who explained this to my dying mother did a remarkably compassionate job of describing a horrible scenario. (I hadn’t been able to get through to her.) Mom looked at her and at me and stated, “That would be hard for my family to watch.” She signed the DNR.

This is a huge reason ever person should have an Advance Directive stating how they want their end of life treatment handled. I understand the sister’s grief and desire to prolong the patient’s time, but I also know the doctor is corrrct. What is coining is inevitable and terrible. I wish the idea of death weren’t so terrifying as it is to so many people. It happens to everyone who lives and should be recognized as a part of living, not as something to try to stop. I know it varies tremendously when it happens, but being able to leave this world gracefully and in a state of grace is so much less traumatic for all involved

Excellent article and chillingly accurate, both as the daughter who was making decisions and a nurse who provided some hospice care to patients some days weeks or hours before death -too late due the decisions of loved ones to “ give back” to their loved ones and not” give up”.
My time working in the hospital has shown me that there ARE THINGS WORSE THAN DEATH! Your article is is an example of some of those. Hospice is care and peace before death, could add quality since it’s inevitable quantity will not happen.

Powerful. Thank you.

There is a place to be alone! Getting out of the way and letting things happen is sometimes the very best thing we can do.
Love your writing Vlad!

Bravo Vlad! Scris cu compasiune si intelegere,sper ca oamenii sa rezoneze cu tine,si cu noi.

SO well written. This captures so well the many heartbreaking conversations I have had through residency and now as an emergency physician.

Thanks for articulating this experience from a physicians point of view. We need more conversations around the life support topic before we are in crisis mode with a loved one. Our family went through this when faced with the life support decion for our dying mother. What made it easier was she herself gave the hospital staff instructions not to initiate life support. What made it harder was her 90 year old senile husband had power of attorney and he overturned her wishes when our mom was unconscious. In the end she was only on life support for a day, and had no vital signs once the machines were disconnected. The husband, our stepfather, was satisfied in his mind that he had ‘tried to save her’. As her daughter I felt she was betrayed; my feeling was they had forced my mother to die twice, and forced us to watch her die twice. Now, years later, I’m still sad that we were not able to honour our mother’s wishes and that even in the act of dying she was owned by her husband. I offer this account to other readers in the hope that it will help them sort through some issues and questions before a time of crisis. Each caregiver needs to really ask themselves if they are acting on behalf of the loved one or meeting their own emotional needs by prolonging life through artificial means.

Thank you Vlad for sharing.

Thank you for this honest reflection of the thoughts and feelings that are so hard to put into words.

Very well-put. Reminds me of reflections in “Being Mortal” by American surgeon Atul Gawande. On one of several points, this piece is exceptional in that it shows us end-of-life considerations from the medical side and this is re-assuring. We want our health-care, essential people to know and feel the difference between quantity and quality of life in the last days. Thanks.

so powerful and honest, and so sad to witness human body degradation…thank you for being so real

Thank you for this! Looking out at that too common trauma through the distressed doctors eyes. It’s a new lens on an old conversation. Shedding new light.

This is so powerful. We often get caught up with our own jargon about advanced directives, power of attorney…Level 3/4 that we miss connecting with the most important question. This is a wake up call.