WHAT ABOUT VENTILATORS AND “PULLING THE PLUG”?
By Nancy Valko, RN
Reprinted with the author’s permission from her blog: https://nancyvalko.com/2019/03/08/what-about-ventilators-and-pulling-the-plug/
When I first became a registered nurse in 1969, ICUs (intensive care units) were still new. The first one I worked was set up in the former visitors’ lounge. We learned how to read EKGs (heart tracings) by using a book. By the early 1970s, I worked in a surgical/trauma ICU where we used sophisticated ventilators. We were able to get almost all our patients off ventilators by weaning—the process of gradually lowering ventilator support until the patient can breathe on his or her own.
However, in 1976, I was shocked by the Karen Quinlan case. It changed everything. Karen, 21- years old, had suffered brain damage after apparently taking drugs at a party. She was hospitalized and placed on a ventilator. Thought to be in a “persistent vegetative state”, her adoptive parents asked that her ventilator be removed. The doctors disagreed. Eventually the New Jersey Supreme Court allowed removal of the ventilator on the grounds of an individual’s right to privacy. Shortly afterward, California passed the first “living will”, an advance directive law that permits refusal of “life support” in the event the signer is incapacitated.
My experience with ventilators became personal in 1983 when my baby daughter, Karen, died on a ventilator before she could get open-heart surgery. One young doctor had offered to take her off the ventilator to “get this over with.” I reported him to the chief of cardiology who was furious with him.
In the 1990s, I returned to working in an ICU and was shocked by the development of the “terminal wean” for some patients on ventilators. Often the families were told that there was no hope of a “meaningful” life. The terminal wean involved abruptly disconnecting the ventilator and “allowing” the patient to die. I brought up at least trying gradual weaning and oxygen as we did for the other patients on ventilators, but I was ignored.
After retiring from bedside nursing, I was asked to be with an elderly man on a ventilator who had suffered a massive stroke. The family was told that he would never have any quality of life and would die soon. I tried to bring up gradual weaning. but some members of the family were adamantly opposed. When the ventilator was stopped, I held the man’s hand and prayed while he gasped for air and turned blue. I asked the nurse to at least giving him oxygen for comfort, but she ignored me. Instead, she gave frequent doses of morphine intravenously until the man’s heart stopped after 20 minutes. I’m still haunted by this man’s death.
It’s also important to know that not all machines that assist breathing require the insertion of a tube into the windpipe. Non-invasive positive-pressure ventilation (like the BiPap) allowed my elderly friend Melissa to use a face mask to assist her breathing until antibiotics cured her pneumonia.
WEANING FROM A VENTILATOR