On death and dying

Sometimes it's depressing for me to work around so much death and decay. It's hard on the mind, body, and soul. One of worst feelings for me is having to take care of a patient everyone knows is actively dying except for his/her family. Money and denial are strong motivators. 

Working in the ICU, I see a lot of things happen on a daily basis to the human body that really shouldn't be happening. It's my personal belief that some of the things we do to our patients for the sake of "doing everything we can" fall into the category of cruelty. I believe in protecting human dignity and that is a difference between saving a life and prolonging suffering. Here's my thoughts on dying patients:

1. People die, it's a part of life. 
2. But if you fuck up, you just killed someone.
3. You have a job because someone is trying to die; your job is to not let them.

Remember this line from the ANA Code of Ethics: "The nurse should provide interventions to relieve pain and other symptoms in the dying patient even when those interventions entail risks of hastening death. However, nurses may not act with the sole intent of ending a patient's life even though such action may be motivated by compassion, respect for patient autonomy and quality of life considerations."

What we can and can't, should and shouldn't do is so contradictory. 

-----

On a related note, I've learned a couple things that aren't in the books in regards to keeping your dying patients alive or recognizing that they're about to crash on you. There's no evidence based practice behind these, they're just things I've noticed. 

1. The less you touch your patients, the less likely they are to die. Yes, I know you're supposed to turn your patients often to prevent pressure ulcers and skin breakdowns. But when you see a patient desaturate for 15 minutes or go bradycardic and see rhythm changes from being turned 30 degrees, its time to stop touching them for a while if you want them to live until your shift ends. 
2. The poop of death. The final release. The phenomena of terminal defecation. Excreta ultima. If you've seen it, you know it happens. That massive dump that happens right before a patient codes. I think it has to do with massive K+ loss followed by sine waves and fibrillation, but what do I know. 
3. Patients on long-term vasopressors are going to feel cold. Don't warm them up. The cold is from the vasoconstriction in their periphery, which will eventually lead to tissue breakdown. But if you warm them up, you'll cause vasodilation which is going to drop their blood pressure. Take your pick.