Calling all NHS workers!!

[Nc4post99]

I apologise that this isn’t an aibu.

but I really need some clarity from some ITU workers preferably consultants or anyone who has experience there.

its nearly a year since my dad died in ITU. It was harrowing. A rollercoaster of hope and despair. I’m struggling. This has been made worse by the fact my mother is insistent that they (drs)killed him, and did all in their power to make sure he died. She says they put that line into your arm and after that you’re a goner, apparently they did it to my grandmother too. I’ve told her this is nonsense. But it’s clearly psychologically impacting me as I’m having regular nightmares.

please, is this a thing? Do you have any clue what she’s talking about? I can go into detail with what happened, it’s massively outing but I don’t care, if that helps.

(im On a wait list for grief counselling btw)

EOL patients stop eating and drinking naturally as they approach death. We don't force feed them. IV fluids can be given and mouthcare for comfort.

Unfortunately family often think that food will save their relative and force them to swallow, leading to aspiration. I've had to ask people to stop spooning food into patients' mouths whilst they're unconscious because relatives think they're helping. Sometimes people actively choke, usually they silently aspirate.

@Nc4post99 it is worth asking about a debrief. I obviously don’t know the processes at this particular hospital.

I spend a lot of time time talking and explaining thing to family members and I am never surprised by how little people manage to take in when their loved one is unwell. It is so difficult but completely understandable. And there is often an added layer of guilt. This sounds like both you and your mum are really suffering and I hope you get the answers to the questions you want to ask, but I warn you they may not be the answers you want.

are you an ITU nurse, headstone?

if you witnessed that, what did you do about it?

Burnedoutdr it’s not nonsense sadly. It happens when doctors decide the patient’s quality of life is going not be really poor so instead of continuing using an ng tube or inserting a peg and sending the patient to a nursing home they start end of life proceedings. Some of these patients could potentially live for much longer in nursing homes.

Well thanks for making me feel awful!

we wasnot eol then and the drs and nurses said it was fine for him to have them and encouraged it actually

If their quality of life is shit it's inhumane to PEG someone and shove them in a nursing home to gradually wither away. Is that what you'd want for yourself? Your mum?

Quality of life is significant though. Why would someone want to live for years being artificially fed with very little quality of life? This is exactly why there should be more dialogue about advance care planning when people are fit and well.

You're contradicting yourself here. One minute you're saying you're worried you made him aspirate and feeding was withdrawn. Then you're reacting badly when I discuss aspiration and saying food was encouraged. It can't be both.

Maltester71 I just work on a general ward. EOL pathway wouldn’t start in ITU anyway the patient would be sent to another ward first after discussions with the family. Quality of life is important, however imo even if someone has significant brain damage they may still get something from life. It’s hard looking after someone who is dying from lack of fluid and food.

Yes but youve said twice ‘in my opinion.’

the whole point of EOL decisions is that they don’t involve personal, emotionally informed opinions

@Nc4post99

I think you should ask for a debrief with the trust and probably stop listening to you mum.

She is clearly uninformed at best.

Pts in ITU are there for a reason, the staff are trying to make them better, not kill them or just let them die.

However we cant save every pt.

We really need to be having frank conversations with the general public around death and expectations of health care

Even with some hcp going by this thread

@headstone We do EOL care all the time on ICU!!! And seems you have very interesting views on quality of life….

I’m not sure you’re right suggesting that there’s some element of euthanasia going on in hospitals. That’s not been something I’ve ever witnessed.

Which I why I asked what headstone was doing if she thinks she’s witnessing euthanasia ‘in their opinion’

Ive never worked in ITU , I always thought it was just for those patients that could survive. I’m just going on a recent experience which tbh has upset me a little bit and some of my colleagues.

I was just about to say exactly this. I work in EOL care with many people who have an ITU background. It’s a natural move with their previous experience.

I have experience of ITU from a personal perspective too. My dad was in his 80s but there certainly was no evidence of them ever giving up despite us being prepared that he was sick enough to die. He was transferred back to a ward and discharged home eventually.

@headstone We can’t predict perfectly who will and won’t survive ITU so of course we have deaths on the unit

What sort of nurse are you, Headstone? Are you an RGN?

Yes I’m a registered nurse. It’s something I’ve discussed with my colleagues and the EOL nurse. She thinks the nursing staff should have been involved with the EOL discussions involving this patient. I think it’s fair to say not all HCPs are in agreement all the time.

Yes that’s true, certainly. Are you referring to the OPs relative?

the day before he died feeding was withdrawn. He was in ITU 11 days, that’s 9 whole days when feeding was taking place, they initially recommended a straw so he could take minimal amounts from when he was admitted as he was unconscious on admission. Then when he was taking too much by the straw got a cup from occupational therapy. Then when he was a bit stronger and balance of fluids was right he was having cups of tea and ice creams and a few normal meals, being fed by staff.

but it was your tone, of your post, really hurtful. If you see patients, please use more tact

Countbackfromten presumably though your patients die from their illness and not just from removing food and fluid?

Headstone when you say you’ve discussed it with colleagues and an EOL nurse, do you mean this particular case? I’m confused

maltester71 yes I’m talking about one particular case. Usually I agree with the EOL decisions.

so you’re not talking about the OPs relative?

you said ‘this case.’

Why were the nursing staff not involved? Who WAS involved? Why did they make their decision? Did they agree? Was due process followed?