Unplugging loved one from Life Support

Sometimes there is just enough brain activity to keep vital functions going. I feel that if I had enough brain activity to form a thought and my wife told the doctor to pull the plug my thought would be "Why you heartless b**ch!"

Normally the "life support" is or includes a mechanical respirator ... the silence when you turn it off and there are no breathing sounds makes it striking. peaceful, actually.

There is quite a process behind the scenes, including at least two different determinations that there is insufficient brain function (or brain) left.

My (unmarried) sister (3 years younger than myself) suffered 5 strokes over a 3 day period in 1999.

The first one left her paralyzed on her right (dominant) side. She said often and loudly that she would rather be dead to live like that.

The second one came overnight and left her in a coma.

After the next two, they couldn't pick up much brain activity anymore. My mother refused to pull the plug for those two days, saying that she'd take care of my sister for as long as she lived. We sisters argued with her for days regarding this decision. My father stayed out of it.

After the fifth stroke, they picked up no brain activity. She'd gotten her wish and she was, for all intents and purposes, not going to have to live like that.

It still took several hours after the results were in to convince my mother that she'd never get her favorite child back (she was all our favorite, so no problem in the family with that admission), that she was gone and the best thing we could do was say farewell.

In our minds and our hearts, we knew it was the right thing to do. It's what she wanted as soon as it turned bad. We all still cried for days. For that matter, I'm tearing up just typing this. Just 'cause you know it's the best thing doesn't mean that you don't feel the loss and it doesn't hurt.

It's such a difficult thing for anyone to have to do. But I wanted to share an experience a collegue of mine had.

Her father had been ill for a long time after a car accident and they reached a point where he wasn't going to get bette and the decision was made to turn his machine off.

So they did.

What they weren't expecting was for him to take a breath. And then another one. And another.

He continues to breathe on his own, but he is still unconsious and has been for nearly three years. He will most likely never wake up.

His family say this is actually harder than if he had died.

And as he is breathing on his own the law here means he must be kept alive, even when everything else says he should be let to die in peace.

As an ICU nurse I have '"unplugged" my fair share of people from life support-
First life support as mentioned is a mechanical ventalator and can also include drugs that sustain hear rate and/or Blood pressure-
The person has already been determined to have a condition that is not survivable and to remove life support is ussually the kindest and most humane thing to do-

If someone still has brain function- the drips will all be stopped and the doc will order a narcotic drip (Usually morphine or fentanyl) in case they have any pain, and versed, a sedative to help calm and decrease air hunger.

The Doc will remove the breathing tube, sometime we give something that dries up secretions more for the family than the patient- it distress's some people to see their loved one drool and blow bubbles-

The rest is up to the patient- most commonly respirations will slow, Oxygen saturations will drop and then the heart rate will drop. The person will most likely stop breathing for several minutes before the heart ceases to function- if all goes smoothly, the only sound is their breathing, and it is peaceful- sometimes its not, but we try-

I'm going to offer another side of it.

My grandfather had suffered a few massive strokes back to back. The muscles in his throat had been paralyzed and he could no longer eat for himself. He was weak but he could still whisper. He was being kept alive with a feeding tube and IV's.

The whole family gathered to see him and pray. Once everyone was there he pulled the feeding tube out. He said he was ready and that he had been able to see everyone which was all he could possibly wish for. The doctors reinserted it. He apparently wasn't considered enough there to make the decision for himself. Which was bullocks he was completely aware and lucid.

A few of the family members had a problem with it. They weren't ready to let go, but they finally backed down, refusing to spend the last day with him as their show of protest.

The feeding tube was removed for a final time and surrounded by family he grew weaker until he passed in the night. It was tearful and heartwrenching. I was 13. My grandfather was gone and he'd spoken a few special words in German he had taught me as his final goodbye. But it was absolutely the right thing to do.

My grandfather had atypical Parkinson's and then had a stroke on top of it. He died about a year and a half ago.

We stayed with him in the hospital for a while, but then they took him off the respirator. We were all kinda surprised that he kept breathing on his own, but he didn't really respond well. Because he had a living will and a DNR order on file, we ended up taking him home, where he had nothing but some some pain killers and his regular maintenance medications. He ended up passing away in the middle of the night while I was sitting with him three days after we brought him home.

It was a peaceful ending, and we were all glad that he was home. I had the time to call everyone when my grandmother, who was also there, and I realized he was going, and most of them made it in time to say goodbye before he passed.

I can't think of a better way to end it; although the Parkinsons thing was horrifying to watch over the several years prior to that.

voodoo said:

I'm glad that these people passed peacefully.

But one of my characters does not.
I had a friend who took her father off life support
and she said it was pretty bad.
She said he made lots of noises that really disturbed them.

But I think I've found what I was looking for.
Some people make noises...the one I was trying to describe is called the death rattle.
I couldn't find a description of it because I didn't know its name.
Apparently it's quite jarring to hear a loved one make that sound...
even if they aren't in pain when they do it.

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Very true that some people do not die quietly after being taken off life support- But technically the "death rattle' is that sound the person makes after they have died- not while they are dying- small distinction I know.
As a new nurse, I remember having the crap scared out out of me while cleaning a recently deceased body, on turning the person, they left out a very noisy, wet sounding expiraration. Very starteling when you're not expecting it, but to a lay-person I think Death Rattle would mean what you intend it to mean-

voodoo said:

Is there a sound?
I heard that some people (the ones on life support) make sounds.

What does it feel like emotionally?

Part of me always wonders, what if the doctors are wrong
and this person has a chance?

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Not sure what you're asking exactly. Part of my job requires me to be the one to 'pull the plug', although that's not exactly the right description. A person on a ventilator shouldn't be able to make any sound, however, sometimes the cuff around the endotracheal tube that seals the airway, leaks. Or it blows entirely. When that happens, the patient can make sounds because air can flow across the vocal cords. Most of the time, no, a patient can not speak or moan when they are on a ventilator. The breathing tube passes between the cords, and the cuff seals it, so the only air goes down the tube directly to the lungs, and returns the same way. It's a closed system.

When we pull the tube, the patient may gasp, cough, gag, etc. After a minute or so, they can speak, although they'll probably have a sore throat. The machine itself may beep, if the respiratory therapist didn't hit the silence alarm. It's not a big deal though, since they are pulling the tube anyway. Sometimes I'm on the other side of the bed from the vent because it's easier to reach the patient or whatever.

Actually pulling the plug of the vent is no different than unplugging a toaster. It's the ET tube that matters. Also, not everyone dies immediately. Sometimes it's fairly quick, but I've seen them hang on a day or so.

ETA: Not everyone who is taken off the vent is brain dead (when we are pulling the plug--most of the time, we take them off because they are getting better). Some patients come into the ER, are then resuscitated and placed on a vent before it's found out that they wanted to be a DNR. The family comes in and says, "No, he doesn't want this." and the patient can even be awake by this time. (I can think of three cases in the last month, actually) Their disease process is such that the chance of them ever coming off the vent and being well, is so tiny, that they don't want to go through all that only to have the same end result. Often, family will want a little time to gather at the bedside, and the vent will buy them some time. We don't do any of this without the doctors and nurses making sure this is what the patient wanted. Like I said, sometimes the patient can even make the decision if they are alert enough.

I have a couple questions about this topic. First, I've inferred from this discussion that people who are unplugged from life support don't take a very long time to die. Why is it that in some cases (like Terri Schiavo) the person takes such a long time to die? (like days rather than minutes). Is it that some people are able to breath on their own but can't eat, and so die of starvation?

Also, if there is anyone who can provide insight into the legal aspects of these things, I'm a little confused as to why someone like Jack Kevorkian would go to jail for assisted suicides but no one would get in trouble for unplugging a respirator. Are there any substantive differences, besides the fact that in assisted suicides, the person explicitly gives permission to facilitate their own death?

Thanks, and sorry if this is slightly off-topic. I'm just really curious.

Michael Wolfe said:

I have a couple questions about this topic. First, I've inferred from this discussion that people who are unplugged from life support don't take a very long time to die. Why is it that in some cases (like Terri Schiavo) the person takes such a long time to die? (like days rather than minutes). Is it that some people are able to breath on their own but can't eat, and so die of starvation? .

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I can't speak for others, but I live in Ireland where a person who can breath on their own is considered to be 'alive'. This means that even if they are unplugged from LS, if they can breath on their own, then they must be fed and kept alive.

We don't let people die of starvation.

Michael Wolfe said:

I have a couple questions about this topic. First, I've inferred from this discussion that people who are unplugged from life support don't take a very long time to die. Why is it that in some cases (like Terri Schiavo) the person takes such a long time to die? (like days rather than minutes). Is it that some people are able to breath on their own but can't eat, and so die of starvation?

Also, if there is anyone who can provide insight into the legal aspects of these things, I'm a little confused as to why someone like Jack Kevorkian would go to jail for assisted suicides but no one would get in trouble for unplugging a respirator. Are there any substantive differences, besides the fact that in assisted suicides, the person explicitly gives permission to facilitate their own death?

Thanks, and sorry if this is slightly off-topic. I'm just really curious.

Click to expand...

It's actually dehydration that they die of rather than starvation. Starvation can take weeks. And yes, it can mean they are breathing on their own but are otherwise incapable of any higher brain function and so have zero chance of recovering in the case of Terri.

Also in the case of cancer patients sometimes they are so terminal they don't want anything helping them stay alive. So rather than being fed through a tube and kept on an IV, they ask to be unplugged and left to die in peace because their body is slowly eating itself anyway and there is no chance for a turn around.

voodoo said:

I'm glad that these people passed peacefully.

But one of my characters does not.
I had a friend who took her father off life support
and she said it was pretty bad.
She said he made lots of noises that really disturbed them.

But I think I've found what I was looking for.
Some people make noises...the one I was trying to describe is called the death rattle.
I couldn't find a description of it because I didn't know its name.
Apparently it's quite jarring to hear a loved one make that sound...
even if they aren't in pain when they do it.

Click to expand...

You mean cheyne stoking, it's an abnormal breathing pattern where it can look like the patient has taken thier last breath then they gasp again.
If the correct medications aren't given it can almost sound like the patient is drowning in thier own secretions, even if they are it's pretty jarring hearing them gasp for breath.
It freaks families out because they have a moment of relief thinking their family member has passed then the take a gasping breath, and their anxiety starts all over again.

I'm a A&E nurse (ER to the Americans amongst us), and have previous experience of a respiratory ward.