A Critical Care Doctor Discusses End of Life Issues

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Ryan Brown, M.D., a Critical Care doctor at Vanderbilt Medical Center, offers some excellent advice for caregivers. First, he says having an explicit plan beforehand takes away a lot of stress when the patient is in the Intensive Care Unit. When that plan isn’t in place, he sees a lot of dissent between family members, as well as guilt if they don’t do everything possible. The goal is to be the patient’s voice if they can’t tell you what they want. He also recommends that for elderly patients, a gerontologist should be a part of the discussion beforehand since they can be very helpful and can take a lot of stress off of the caregiver.

Dr. Brown says, “Caregivers need to think about what should we do versus what can we do. Do you want to prolong life if the patient is truly suffering or do we want to make them comfortable and let nature take its course? Death is part of life, and the beauty of death is that God is calling them home.”

Dr. Brown says there is no need to fear death, and his hope is that the caregiver doesn’t feel guilty when the patient does die. Also, he emphasizes that there is so much doctors can do to make the patient comfortable now, and Hospice is a huge help in allowing the patient to die at home versus the hospital. He believes that God doesn’t want us to suffer at the end of life when there are ways to help. Dr. Brown has watched many people die comfortably.

He says caregiving is a difficult job with a lot of burnout. It is very important for the caregiver to take care of their own health. These days since most people live longer and die of chronic diseases such as heart disease and cancer, the caregiver’s role can go on for a long time. Dr. Brown typically sees caregivers at the end of their patient’s lives, but the gerontologist sees them throughout the process. He says it’s also very important for caregivers to establish a trusting relationship with the patient’s doctors to fully utilize their experience.

What Helps?

  • Have a plan of action while the patient is still lucid and share the plan with all family members.
  • Talk with your gerontologist about different scenarios.
  • Trust your doctors.
  • Do not fear death.

Scripture Verse

John 3:16 For God so loved the world that he gave his only Son, so that everyone who believes in Him may not perish but may have eternal life.

Prayer

Lord, bless these special healers who are doing Your work here on earth. Give them strength and faith to take the best care possible of their patients. Help them to be an aid to the caregivers as they face difficult end of life decisions. Help us to remember that God calls all of us home as death is a part of life. Death is not to be feared, especially since our stories will end well.

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Caring for Multiple Elders at Home

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Jim’s story is truly an inspiration. This extraordinary caregiver quit his job and became certified as a nursing assistant so he could care for his mother and father along with an aunt in his own home. His own family was supportive of the situation. Living areas became bedrooms, and he slept on the floor for three years. His mother is the only one who is still living, and she has congestive heart failure and a broken hip. His aunt and father died in his care.

His dear father had dementia, which turned into Alzheimer’s disease. When his father was in rehabilitation, he thought he was in jail, so Jim brought him back home where he could be with his wife until his death a year ago. A very private person, the Alzheimer’s disease completely changed his father. Jim spent every day with his Dad and said that his Dad was his confidante. Jim had also worked for his father until 2005 so they were very close.

He also cared for his aunt for several years in his home until she needed to be in assisted living. When his aunt developed Lymphedema in her leg, Jim moved her back to his home so she could die there. She died the day after he moved her home.

While caring for his Dad and aunt, his mother became critically ill with a severe brain bleed. The doctors did not expect her to live and felt that surgery would most likely “leave her a vegetable.” The family was confused as to what to do, so they left the decision up to Jim. He prayed and decided to go forward with the surgery and leave it in God’s hands. Miraculously, she survived and continues to live with the family. Although facing death continuously was difficult on his children, Jim feels that it taught his sons a valuable life lesson – to not give up on people and to allow God to be in control.

During this time his own nuclear family also had major health crises. His wife, Julie, became very ill with Celiac Disease, and her organs actually began shutting down. Finally, after she got on a gluten-free diet, her health returned. Plus, his son, Dave, collapsed on the lacrosse field due to a hole in his intestines.  Additionally after years of not sleeping and eating well, Jim developed cancer in his eye and has lost most of his sight in that eye. Then after surgery on his eye, he had a massive heart attack. Most of us would have given up or become depressed, but Jim and his family have a very strong faith and God has faithfully provided for all of them.

He said his whole family pulled together to help. Jim calls Julie his angel, who never complained despite the financial strain and physical hardship. His three boys were amazing. They also never complained about not taking vacations or not having extra money for things they wanted.  Plus, Jim’s sisters were very supportive and helped out often.

Jim says, “Caring for others teaches you a lot. It taught me to not expect anything in return, that God will always provide, and that you must keep the faith. Also to always look for blessings as they are always there.”

What Helped:

  • Getting knowledge about caring for elders through getting his Certificate as a Nursing Assistant
  • His unshakable belief that God will provide.
  • His strong marriage.
  • His sense of humor and optimistic attitude.
  • His children who also helped.
  • He always counted his blessings instead of dwelling on the difficulties.
  • A genuine love for family and extended family.

Scripture Verse

1 Peter 5:7 Caste all your anxiety on Him because he cares for you.

Prayer

Dear Father, help us learn the lessons that Jim lived to always care for others without expecting anything in return. Help us to remember that You will always provide as long as we keep the faith. Help us to accept Your Will in all things as Jim did.

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