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Life Support Issues/Worried that my dad was on BIPAP too long

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Question
My dad who already had a poor heart and shortness of breath went to the hospital for severe shortness of breath. He aspirated there and had a heart attack.

They cleared out his lungs and eventually got him to a window of opportunity to try to get him off the ventilator.

He was fairly lucid though I think his time was mixed up. He was doing pretty well breathing but then it went downhill suddenly and he was put on the bipap. But his heart rate went all over.

We didn't get a lot if direction from the nurses. He stayed on that a couple hours. We asked for a doctor. The doctor said he couldn't guarantee there was no suffering. So then we took off the bipap and dud a morphine drip along with an anti anxiety drug.

I'm just haunted because the bipap machine seems so awful on a non responsive patient. I should have been more proactive and just stepped in. We had watched him take tiny steps forward fir a week. It made it hard to switch to letting go. I hope I didn't allow the suffering to be prolonged.

Answer
Adam,
There is always a process when medical staff in a hospital reverse gears and change the goal of care. It seems when "cure" is the goal, patients get machine assisted breathing but they sometimes don't get adequate comfort medications (although they should). There is fear on the part of medical staff that the medications will interfere with recovery. Medical staff sometimes wait for family to indicate they want to change the goal of care and stop aggressive treatment. How can family do this when they don't really have the experience to understand how ill their loved one is and when they are not given a menu of options to choose from? Without support, family can be made to feel like they are "giving up" on a loved one.  

You all did your part beautifully. You were concerned and went to the doctor and asked if he was suffering. It was a direct result of your advocacy that got him the comfort medications that he needed! You could not have done it earlier because it was not yet clear that you were witnessing his dying process and not his recovery. It sounds like no one told you that his chance of survival was very poor. You did not receive the support necessary for making a decision earlier.  The information you had was that he kept improving, although in small increments. If you had intervened earlier, when he was improving, you may have always wondered "what if?" he had a chance to recover.

When it became clear that his survival was not to be, you all took action that assured his comfort. That was the very best you could have done under the circumstances.

Life Support Issues

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Betsy Murphy

Expertise

My expertise is in end of life care for adults. Identifying when someone is approaching the end of their life. Benefits and burdens of end of life treatments. Managing pain and other symptoms. Providing care for dying patients at home. Advocating for someone who is dying in a hospital or nursing home.

Experience

More than 28 years of experience in hospice care. Currently consulting with hospices to promote access for patients to receive hospice care earlier in the course of their illness. Betsy provides training for hospice marketing staff to effectively work with nursing facilities to help identify eligible patients. She writes Additional Development Request (ADR) letters to Medicare to help hospices get paid for their services and to avoid future claim denials.

Organizations
Hospice and Palliative Nurses Association

Publications
Articles: Clinical Reviews, Advance for Nurses, Nursing Spectrum, Washington Business Woman, www.Ezine.com;www.alz-nca.com.Books: Understanding Medical-Surgical Nursing (FA Davis and Company), Guide to Caregiving in the Final Months of Life (TM Brown publishers).

Education/Credentials
Bachelors of Science in Nursing, additionally trained as a Family Nurse Practitioner and certified as a hospice and palliative care nurse.

Awards and Honors
Outstanding Woman in Loudoun County (VA) by Loudoun County Commission on Women 1997 and 2002.

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