Thursday, June 10, 2010

My thoughts about family presence during resuscitation

The subject of family members being present during resuscitation is very personal not only to relatives and friends of patients, but also to healthcare providers. Based on a survey study, my own experience of being present during resuscitation of a family member, and my experiences as a professional nurse I strongly believe that family should not be present during resuscitation of their loved ones.
The first resuscitation that I witnessed was during my clinical rotations at the critical care unit/ER where a woman and her sixteen year old son carried a fifty year old man onto the second floor of our hospital. Two nurses and one doctor helped her to put this man on the gurney and one of the nurses walked both the woman and her son out of the room. It was there and then that I was first startled by the thought that the family wasn’t allowed to stay with their dying loved one. The patient passed away and the doctor and one of the nurses went outside of the room to notify the family. I and another nursing student were ordered to clean the room and make the patient presentable for the family. While disconnecting the tubes and bringing the room into order we could hear that woman scream and cry in the hallway. When she was finally allowed in the room she came up to the body, held her husband’s hand and talked to him quietly. It was a shocking experience for me, my first time seeing death up-close and touching a dead body. I finished the day, came home and cried for hours. After a week or so went by, I gradually came out of this shocking experience. I was still disturbed by the fact that the family was escorted outside of the room during resuscitation. I strongly believed that presence of the family members during resuscitation could support the emotional being of the dying patient, make his dying process more comfortable and less frightening, and would provide a chance for the family to say the last good-bye to the dying loved one.
Unfortunately, shortly after graduation, I found myself on the other side of the line. It was me, kneeling by the bed and holding the hand of my dying grandmother, who was being resuscitated by physicians and nurses. This time, I was screaming and crying, not outside of the room, but inside, by the bed, holding the hand of my dear and closest person. I was seventeen. During those 7-10 most horrible minutes of my life, not even once did I say anything that would comfort her death, and not even for a second did I think about saying my last good-bye to her. My grandmother spent ten days in the hospital after suffering massive burns on her body. She was healing well until one day she suffered a mild heart attack and was transferred to the cardiac unit. While being a teenager, I never thought that something bad could happen to my family member, especially to the person that raised me. She passed away ten minutes before midnight on November 24th, 2002.
How ludicrous that I thought that presence of a family member during attempts of saving a life would be beneficial to the patient, relatives and medical personnel. Now, after this horrible experience I realized that it didn’t really benefit me or my grandmother in any way. This encounter with death of a close family member left a scar in my heart and I am sure it was emotional and distracting for the doctor and nurses to observe my reaction which may have in turn prevented them from doing the best job they could. I yelled at the nurse and almost hit her, when she turned off the oxygen flow and was about to take off the oxygen mask. I ordered the doctors to continue the chest compressions. After the healthcare team pronounced my grandmother dead, I begged them to continue resuscitation and blocked the door with my body in order to keep them in the room and continue CPR. I was becoming helpless, at the same time aggressive, and I refused to accept the fact that my grandmother had passed away.
Weeks afterwards, this day seemed like a bad dream. I was hoping that I would wake up one day and my grandma would be cooking my breakfast and everything would be fine like it was before. I spent three sleepless weeks with a horrible picture of my grandmother in the casket, the sound of dirt hitting the coffin lid. Later, I was still alone with no-one to support me around. These emotional experiences were aggravated by seeing my grandmother die and witnessing the resuscitation.
Today is May 2nd, 2010; my grandmother would have turned eighty-two on this day. The image that I see in my head is of my grandma holding my hand, closing her eyes and a straight line on the monitor. I don’t feel that I expressed much needed love or provided support to my grandmother during the last few minutes of her life; instead I feel terrible that I haven’t had a chance to say “Good-bye” and say “I love you more than anything in this world.” Even if my presence would have stimulated her will to live in any way, nothing could have changed her physical condition. Her kidneys failed to perform and her heart would have stopped. Instead, if she heard me screaming while she still could, she would probably be worried about leaving me all alone. I really feel terrible about the fact that she left this world worried and concerned and possibly not in peace. Up until now I do not feel that medical personnel did everything possible to save my grandmother, even though deep inside, as a nurse, I know that there was absolutely nothing else they could have done. Being present during resuscitation didn’t help me cope with my grandmother’s death in any way; instead this scene keeps hunting me several years later and will probably stay in my mind forever. I am more than sure, that if I would have stayed outside of the room with the nurse and was being updated on grandmother’s condition I would have coped much better with her death, would have told her my last good-bye, and it would have helped me to accept the reality faster.
Besides my personal experience, I have conducted a survey study over a period of one week on people’s opinions regarding family members being present during resuscitation. Here are the results of this research: twenty-two percent of all participants said that at least one family member should be present during resuscitation. None of those twenty-two percent were healthcare providers. And other twenty-two percent stated that presence of a family member should be offered and discussed with the patient and his family prior to the critical moment. Again, none of the partakers were related to healthcare industry. And the last fifty-six percent, sixty percent of which were in healthcare industry and other forty percent in technology and computer science, stated that family should not be present during resuscitation attempts due to the pressure and stress on healthcare providers, risk of interference and potential injury, and resulting emotional difficulties from the mental trauma undertaken by family members during resuscitation. All fifty six percent agreed upon family being kept outside of the room with a nurse or a social worker keeping them aware of the patient’s condition. Based on this research I can tell that family presence during resuscitation can be offered depending on special circumstances, but in most cases family members should be encouraged to stay outside and be kept well aware of the situation.
As a nurse I strongly believe that while in the hospital, patients and their families should be viewed as one, cared for, and taken in consideration during patients’ care. Even before the terminally ill patient is admitted to the hospital, his/her family should be under close supervision of the healthcare providers due to the risks of developing mental and emotional distress. Families should be offered the emotional and psychiatric support not only after the death of a family member but also before in order to guide and prepare them for the worst. Families need to better understand the situation and accept the fact of what’s coming to ease the burden of coping with the loss.

Determinism or a free will

Do we have a predetermined fate that awaits us or do we make the decisions ourselves?
I am going to speak for myself because I don’t want to offend anyone, especially religious people.
I personally do not believe that we have a fate that is awaiting us. The only destiny we might have that is definitely predetermined for all of us is the death. Every living, breathing, kicking creature ends up dying. Other than that we are not preset to what we are going to do or who we will become. We make these decisions ourselves based on the circumstances, based on the actions of other people, and based on the outcomes of our own actions. Of course there is always a chance to calculate the possibility of someone else’s actions by determining what you are or somebody else is going to do. Just like playing chess, people calculate the probability of the next five steps.
Of course I am not denying the fact that we are influenced by the outside laws, like physical and electromagnetic laws. If there weren’t any laws of Nature, we wouldn’t be able to survive. But we still control our thoughts. For example, I know I cannot fly, because I don’t have wings, but I can still dream about flying. Therefore the law of gravity doesn’t affect my thoughts. Also let’s say someone made me very angry and I am thinking in my head, that I would like to hit this person. But I choose not to. As a result I am not driven by the electric activity in my brain to raise my hand and hit that person, instead I chose to create another electric activity that will allow me to turn around and simply leave. Based on this I can say that we do have a free will and laws of nature, physical and electrical laws are helping us execute our free will. Choices we decide to pick, actions we choose to make are executed with the help of laws of nature, but not always driven by them.
What are your thoughts?