On Death and Dying and Throwing a Good Party
Thought I could make it out of the MICU without a brush with death. I thought wrong.
Why is it that every time I have a patient that we are withdrawing life support on, I always feel strangely like a hostess? It’s like planning a party; a pre-wake, if you will. There may be friends and relatives there. You want to make sure everyone has a good seat, tissues, maybe some ice water to sip on. It’s a very sad, intense, confusing time and you want to do everything you can to make sure it goes smoothly.
I know it sounds kind of crazy, but the more I think about it, the more true it seems. You want to have everything in place ready to go. You want to have the bereavement packet (“What to do when a loved one dies…”) at arms length, but not in plain view. You have to be ready to give it to the family member who seems least likely to fall apart, and you can’t give it prematurely.
The family will leave the patient’s room for the actual extubation. Make sure they have a place to go. An empty conference room perhaps.
Make sure your co-workers are aware of what is happening and will adjust their voices accordingly. The ICU has a strange tendency to be a jocular place at times, despite (or perhaps because of) all the intensity.
Make sure you adjust the monitor settings so they don’t alarm when the patient starts going into PEA.
Make sure you take off the blood pressure cuff and the SCDs.
Make sure the chaplain is ready and waiting.
Make sure the scopolamine patch is ordered before the patient starts to die.
You see? It’s quite a lot of details. And you want to make sure it all goes off without a hitch. Why? Because the family has just made one of the most difficult decisions they might ever make, and you don’t want them regret it. The best thing you can do is make them feel like they did the right thing.