okay, I have passed from incandescent rage stage to just wanting to explain things calmly, so I'll post

Hello, I would like to tell you what it's like to put your loved one to sleep from the medical side.

This...might be a long thread. Buckle in.

So, in a perfect world, this would be a decision the patient would participate in themselves.

This should now be a legit discussion you have with your family members.

If you don't let people know what your desires are -- well, they won't know. And they'll hesitate.

No one wants to be the bad guy who pulls the plug. And without clear guidance from you, your family is going to feel guilty.

No matter what they decide.

So please, please, please, have those talks. Even though they're scary. They're important.

Onwards:

So once it's decided, via your decision, prior discussion with your family, the existence of a POLST (a document where you delineate what kind of medical care is acceptable to you) or at the bedside as your condition deteriorates....

the doctors will write the orders for 'comfort care' and/or 'compassionate extubation'.

If you're not intubated (ie not on a ventilator) then they'll probably downgrade your care to a lower level floor, where the nurses will be able to give you medications....

to help control your pain. They'll turn off the monitors and do whatever they can to keep you 'comfortable' at that time. That might be feeding you regular food, even if you can't properly swallow or if it's a choice between eating and not breathing --

because if you're with it enough to want a brownie, we're gonna try to let you eat one.

Most people just take a few bites or sips of water and relax.

From our side of the bed, those pleasures seem fleeting, but intense.

And essentially, we'll let you wind down. Giving you narcotics along the way.

Let's hop back to the people who were intubated though, and chase that half of the flowchart down.

In those cases, we arrange a time with RT. Hopefully family is there.

Usually the doctors give us orders for a solid push of morphine. 10 mgs or so?

No one wants to see you 'air hungry'. That's what it is. When you can't get enough air in. It's horrific to watch and I am certain it is horrific to experience.

The RTs will deflate the cuff holding your breathing tube in and take it out of your throat. Your throat will be sore.

Hopefully the push of prior meds was enough to make you 'comfortable'. We often times hook people up to morphine drips at this point to give them additional...

pain control, or we commit ourselves to checking on you very regularly, with additional pushes of morphine in our pockets -- sometimes you just get a ton out of the pyxis and return what you didn't use later. 2-4mgs every 2-5 mins, depending on the orders.

no one's gonna refuse you/us more orders at that point, either. Because no one wants to watch you suffer. I once dumped 40mgs into an adult man in let's just say what was a 'quick' amount of time because it was that or have everyone stare in horror as he couldn't breathe...

what I'm saying, heh, is that things can be liberal if needbe

It doesn't always go quickly though. Sometimes people can manage slowly on their own for days (usually getting downgraded like our brownie friend).

The monitor in the room is definitely off

but we can still see things at the nursing station. So we know what your numbers are, and when your heart starts to slow.

We can give you robinul which stops you from salivating so much so it doesn't sound traumatic to whomever's watching....

Our goal, is really just to make you 'comfortable' without pushing you over the edge too quickly. That's what divides it from actual euthanasia, I suppose. It's not planned. It can sometimes take longer than you think.

I always try to prepare families for that....

Once people make the decision about their loved one, they always feel like it's jumping off a cliff -- and they rather think that pulling out a breathing tube is like flipping off a light switch. It's not, always. Like I said, sometimes things can take days.

My goal, bedside, is to try to honor you somehow. To make sure that someone's watching when you go. To hopefully doula your family through that horrified stage where they're all staring at you slowing breathing and over to the story-telling time part.

Once people start laughing because of the stories they're telling inside a comfort care room...I know things are going to be okay.

Losing you is still going to hurt them, but they'll remember you, you know?

I don't know personally how covid is gonna change all that yet. We're on the upswing of our wave at my facility, so it's hard to imagine.

And there are some people who never accept death or dying, who are angry at the world until the end.

And I've seen some clearly tortured elderly patients whose families couldn't let them go. I swear I am not a eugenicist -- but man, people just don't get to live forever. You start breaking down, your lungs, kidneys, hearts, skin, give out.

The american relationship between death and dying is pretty effed. And I know no one wants their loved ones to die. But sometimes we just don't get that choice, you know?

Anyhow.

I have no idea how to end this, honestly.

I don't want to scare you about what's coming.

But at the same time, I would feel like a jerk if I didn't at least try to educate in some small way when/where I could.

Every time I comfort care someone I feel in some small way like I'm killing them. Even if it's not true.

I hate it. And I hate that I'm good at it. Because I'm some sort of weird empathy sponge and families need me.

I buy plants every time I comfort care a patient. I work in a ward with a lot of elderly people.

I have a very, very nice garden. :(

So I guess I'll end with this -- please stay indoors.

All of this shit is going to be horrific enough. I don't want to watch people die if I don't have to. I don't want you to not be there to see it.

No one is going to be there to laugh with me.

I won't know their stories.

I won't really be able to make them feel less alone.

And each time I do my job a little piece of my soul dies.

(My close friends know how close I was to quitting before all this, and this is why.)

and that's all, sorry I got wandery, i started off strong and then i started crying, so here we are.

just stay inside. please. don't make me work harder than I have to.