People Talk About "Pulling The Plug" On Someone

A patient aware life support is ending prompts questions.Redditoru/Disimpactionexplained:

Nurse here. Yes, some patients are aware. It is very hard; they seem always brave.

Even we professionals find it hard.

This happens usually when lung disease advances and oxygen needs spike. The patient's brain stays fine, still aware with oxygen support. You cannot keep a bipap strapped to your face forever.

Lung cancer, severe pulmonary fibrosis, late-stage congestive heart failure.

It is terrible.

From Redditoru/cornballin:

"Pulling the plug" actually feels great.

To grasp that comment, you must understand my view of what happens before that moment.

Thousands of patients across the country die, yet families refuse to accept it. I treat them, and every medical fact I learn shows there is no chance. This patient will die, and they will suffer until the end.

I try everything to explain things to the family. Many families are great. But some shut down, refusing to believe their loved one can die. So we keep using "aggressive care".

Aggressive care has a real name. They poke and prod patients, put them on machines, draw blood, place arterial lines. They use invasive procedures.

We do everything to make patients comfortable. Sometimes, that proves difficult. Our best pain medicines often cause low blood pressure and lower breathing drive.

Here is the point: because of family wishes (the patient is too far gone to decide), I must do these painful, needless, and useless procedures.

It is torture. This is often what we give our loved ones in their final weeks.

"Pulling the plug" means the family tells me I can stop torturing someone. It feels amazing.

This is an overstatement. But not as much as you think.

How do we fix this? We need much stronger legal protections for doctors who think further care is useless.

From Redditoru/Porridgeandpeas:

My brother was dying. The surgeon worked on him all day and said, 'if his heart stops again, we don't know if we can restart it.' My mom and I replied, 'It's okay, don't torture him or yourselves.' He felt nothing, but doctors and nurses tried hard to save the 27-year-old. They removed coagulants; his heart rate dropped for hours, stopping around 34. The end was awful; the ICU period was peaceful and weirdly calm.

From Redditoru/Zetsubou51:

I am not a doctor; I am just a son. My mom and brother and I made the choice to pull the plug on my dad. It was the right choice; it was what he would have wanted. Still, it does not make it easier.

After that, I saw death takes many forms. It has shades of gray, I think. Just because the heart beats does not mean the person is alive.

FromA Redditor:

ICU doctor here.

By the time someone reaches that point, it is usually the most humane choice for the patient. My job is to support the family, let them grieve, and help them grasp that their loved one is dying from the end stage of their illness, not from us stopping aggressive medical care. It is always sad, but our goal is to honor the patient and help them have a peaceful, dignified death as much as we can. I only made the decision alone (with a second MD) once, for a patient with no family or friends. That was the hardest time because there was no one else to grieve him.

Honestly? The family accepting that their loved one is dying often brings relief. Providers often feel conflicted about continuing invasive, uncomfortable treatments when someone is in their final hours. Families need time to understand and accept that death happens.

From Redditoru/helenkellerkitty:

In the US, doctors do not actually "pull the plug." After the doctor discusses things with the family and a decision is made, the doctor usually orders the support withdrawal. Unless it is a code situation where the doctor remains in the room running the code and decides to "call it," the doctor is often not present when the "plug" is pulled. This does not lessen doctors' roles in end-of-life care; they are the only ones who can order it. They just do not usually do the hard work.

I do that job. People say "pull the plug" when they mean stopping the ventilator and taking out the breathing tube. As a respiratory therapist, that is my role. I usually cared for this patient for most of my shift, maybe even days, managing the ventilator. When the order comes, I coordinate with the patient's nurse and check with the family about their wishes—do they want to be there? Do they want clergy present? I then remove the breathing tube and turn off the ventilator (what people call "life support"). A nurse then gives medication to make the patient's passing more comfortable and easier for family at the bedside. The nurse often stops giving life-sustaining medications, like those keeping blood pressure high enough to sustain life.

As an RT for four years, I performed this action many times. I cannot give an exact count. I pulled support on four people in one week sometimes. Other times, I did not do it for more than a month.

Death is always surprising and not nice. It is surprising because you cannot predict how long a loved one will live after support stops. I have seen people I thought would not last two minutes live up to two weeks. I have also seen others who thought they would last a little longer pass almost right away.

Death does not look like in movies or TV shows. People do not gasp out final wise words, turn their heads, and exhale their last breath. The body fights to live. Without a breathing tube, most patients do not breathe well. You see a lot of struggle; the body spasms as it loses oxygen. Harsh gurgling comes from saliva and mucus pooling in the airway. This is why we increase morphine and other drugs to lessen the struggle so the end moments are not so traumatic for the patient (who probably does not know what is happening) or the family at the bedside. Sometimes death happens right after support stops, and honestly, those are some of the best cases I have seen. Those who linger cause the most pain to loved ones who thought we would "pull the plug" and everything would end instantly, all the grief hitting at that one moment. Often, it does not. The whole thing can last hours or days while you watch your loved one fade.

Does this sound harsh? I feel numb sometimes. I rarely feel sad for the patient who escapes the Hell on Earth of an ICU when death is the better, calmer choice if done right. Before this job, I watched my sister die in a code. It was traumatic. I still feel glad afterward she avoided a ventilator and long-term hospital torture (she had a terminal illness and we knew she would die). She hated the hospital. She hated the helplessness of needing others for everything to live. Others feel differently. These issues matter when planning end-of-life options (plan now! The end can happen any time, unexpectedly).

When death happens, I feel sad most for those left behind. They now have an empty space where the person lived. I have seen quiet grief, angry grief, and traumatic grief. Some cases hit harder. Some are so sudden and unexpected (often younger people) that they affect me for days. Sometimes, knowing someone's suffering ended feels good, or for those who lived long lives and are surrounded by loved ones. But it is never easy. Never. It weighs...

This sheds light on what 'pulling the plug' looks like in the US. Caretakers and families find it draining. Still, it is a needed part of healthcare. I have seen much life in my career, and those experiences keep me going.

Doctors usually just order the 'plug' to be pulled. Respiratory therapists and registered nurses do the work. Death is not pretty. Choose end-of-life options wisely.

From Redditoru/OdysseyEclipse:

Family, but three years ago... It was sad, but freeing.

My grandfather had a heart attack on his birthday. We did not expect him to survive the hospital, but they got his heartbeat back. He was on machines; his brain was gone (fevers from regulatory failures, unresponsive to stimuli). We gave him 36 hours, as the doctor suggested, since most people in his state won't improve much past that. It gave us time to gather family and say goodbye. He survived on the machines for hours and moved to another ward because the ICU needed space; they knew it was a matter of time, not if he would die. We asked for another brain scan because it took too long. He died while they were scanning. We say he was waiting to give them something to learn from since he loved teaching people.

Love filled everything. We shared stories and cared for him. Waiting and wondering existed between pulling the plug and his death, but it was a good experience overall. Doctors and nurses treated my family, including my grandfather, kindly. They treated him like a sick person, not a corpse. There was a strange comfort.

Death happens to everyone. I gain nothing from worrying too much. Your feelings during it stem from losing the person, not death itself, if that makes sense.

Redditor wrote this.u/MultiTasker33:

I am an ICU nurse. I see death often, sometimes regularly. At US hospitals, nurses (and sometimes respiratory therapists) manage end-of-life care. Physicians explain the prognosis and order withdrawal. Once the order is entered, the doctor stops interacting unless a code blue or time of death occurs. The respiratory therapist removes the breathing tube. Then, the nurse manages everything until the person dies. We stop medications that prolong life. We sit with the family or give privacy while giving medications to ease death. We give large doses of pain, anxiety, and secretions medication. I have seen people die in seconds after stopping life support. I have seen people take many hours.

As a nurse, you sometimes lose sight of needed empathy. You think objectively, but you have the right intention. You do not want anyone to suffer. That is the point. We see families deny their loved one's death constantly. It is easy to get angry, thinking, “how can you let your loved one suffer like this? That is pure selfishness.”

I do not want your loved one to suffer. I know how hard it is for you to endure this. If my mom was 98 and dying, I would still struggle to make that call and say goodbye. My knowledge and logic would vanish. All I would think is, “but that's my mom.” I cannot claim to understand that experience. I know I must try everything to ensure your loved one has a dignified, peaceful exit. I often think, “just because we can, does not mean we should” regarding extreme life-prolonging measures. I have seen horrifying things in the ICU by prolonging someone's life. We must do everything possible until we cannot. Then, we focus all energy on comfort, peace, and coping. I know this is hard. Death happens to every living thing, but it remains surreal. I want to do for others what I want for myself: no pain, no anxiety, absolute peace.