The best thing to do when near death is to stay as far away from the medical "society" as possible. You were on top and informed and also close to your dad and that is excellent. Most physicians do not bother to respect the DNR request. You hear the overhead page because a patient stopped breathing and they rush with the crash cart usually ignoring all signs of DNR. They are in a brainwashed mode that takes away their ability to think and stop their actions. Sad but true. To let someone die in peace should be the easiest thing yet it is not. Physicians have a lot to learn about the death process. They see it as failure....and that is a real shame.

I am sorry for your loss. What I do find interesting is that this discussion was headed under an image of a 12 yr old getting her life saved when she had a sudden cardiac arrest at school. Because of a defibrilator she was saved. She now has a pace maker. I agree that the patien and family should be fully informed regarding a "living will" and "medical power of attorney along with appropriate actions regarding pace makers. MSN however did a lowsy job posting this discussion under an image of a 12 year old who will live many years because of a pace maker that is now implanted and the wonderful teacher who came to her rescue. MSN is exploiting the wrong image. They should pay better attention.

Thanks,

I agree, always important to have a living will. The medical society wants to make money, so they will try to keep a patient alive to make more money, regardless of common sense and discomfort for the patient. It is all about $$.

Pacemakers correct many cardiac issues but not ventricular fibrillation that is corrected by a defibrillator. If that little girl has a pacemaker, she evidently went into heart block where it stops beating. The CPR should be sufficient to maintain life until she gets to the ER. Often meds will restore heart block. The automatic defibrillator they show gives a shock to override and stop fibrillation. If she had that condition, it is not a pacemaker she has but and implantable defibrillator. They are now all in one so to speak where they perform as pacemakers and defibrillators as needed. There is however a huge difference between a simple pacemaker and a defibrillator. More leads (electrodes) and the need to replace the defibrillator generator more often than the regular pacemaker. The article was unclear....it left a lot to speculate upon. If she has an EP study which looks at the electrical conduction of her heart, they may be able to correct it and eventually she could be free of that device....that is if she went into ventricular fib.

Easier said than done - how do you know death is near, how can you be sure the ICD is not going to get you going when heart is failing (afterall, that's what they're there for), and, when you stop breathing do you really feel any pain, whatever happens to your body? It may make it easier for someone watching, but I doubt the dying person will feel it as any extra pain that he/she might already been feeling or not feeling any at all - there isn't too much time, if any at all, between heart failing completely and person becoming numb

I have an ICD implanted as I needed it at the time and will continue to have operate until which time I'll have it turned off. But doctors are reluctant to have it turned off since their "cash cow" is dying and want to extract as much money from the family and Medicare as possible whether the patient is 80 or 90. "Hey, money is money." it's too bad but it's true. Perhaps in the not too distant future, some holistic treatment may surface and I can have it turned off entirely since I won't need it any longer. But for now, it's doing the job as intended.

From your comment, tes 1779376. Your brain is numb. Must be a doctor! Beside if the ICD is going off 33 times, something must be wrong and the sight of having your loved one, possibly in pain having to watch this or even the patient having to endure this ordeal.

How I wish someone i had made a better decision on that Sunday morning at 5 am when I took my 89 year old mom into the hospital. She was put on a temporary pace maker in emergency and in minutes slipped into unconsciousness; the intern and staff reassured me that it was the right thing to do, to have a specialist come in and replace the temporarywith a permanent pace maker. Mom had had a number of close calls, and bounced back remarkably. So was this another close call or the real deal?

She never regained consciousness and lingered 5 days more in hospice. The pace maker was the only thing keeping her alive. On the plus side, our small and distant family had time to gather and sit with her--the most time I have spent with my brother since he was a child. Finally, the pace maker was turned down (not off) -- and my mother was gone in minutes. Had this not been done, I am sure she would have been put into a nursing home (as so many are) and lived on in a vegetative state (and in pain) for time untold.

For years now, I have felt sad about not being "smarter" about that morning.

We had a "living will" but again--how does one know if this is just another near miss or the real deal? No one really wants to help you make this decision. It is yours to make. We plan and think we know what to do when the "time" comes, but in truth, we don't have enough information to experience to know when it is "time". When the real test comes, it is an essay question and not multiple choice or even true and false.

When I was a young girl, my mom always advised me, never be one of the last one to leave the party--know when to go home! Now as I grow older, I see that it applies as well to life and death.

I would just like to share my father's experience.

My father has ICD implanted. Few months back it gave 33 shocks to him in just couple of hours. Immediately he was moved to the hospital. The doctors at the hospital started treatment of reducing his hearts bits. Now a days he takes couple of extra tablets to keep his heart rhythm low and also gets his blood work done monthly to check the potassium level in his blood.

We found that him getting 33 shocks in couple of hours by ICD was life-saving.

I feel that there is a misunderstanding here of the medical community as a whole. As an RN working in a long-term care facility, the DNR is critically important to my practice. If a resident who has a DNR order in place 'codes', I am legally and ethically bound to allow that person to die. This happens on a regular basis. I don't keep people alive against their wishes to make a buck. That is horrendous. People have the right to a peaceful, pain-free death.

Where are the right to lifers on this issue? I would think they would want to go to court to sue the doctors so they wouldn't be allowed turn off the device, even if the patient wanted to.

Those would be the same idiots what wanted to keep the Shiavo woman on life support, forever, even though she had been brain dead for years.

This article was poorly researched. The RN caring for the patient will discuss this with the family and the patient, then address it with the doctor. Some RNs are trained on how to turn off these devices and we frequently do to ensure the comfortable passing of the dying patient. Nurses ensure that every step is taken to make a comfortable passing for the patient. And an FYI: The voltage in an AICD battery is not enough to cause a patient to "jump". There was some exaggeration is that description. Electricity is applied directly to the heart muscle for a small battery. There is no electricity being applied to chest muscles that would cause the "jump" so over done by our media.

Pietro Ferrari: Your specific example isn't really a response to my general statement, unless, your brain is dead, that is. And repeating my point (very dramatically) about someone who's watching a dead body twich, was redundant at most (brain-dead at best. orry to be picking on your brain, you did it like those commenters do when they are offended for no logical reason).

And, don't be cursing the doctors and keeping the ICD at the same time - wont do good for your heart. Find another way to keep ypur heart beating or get rid of the ICD, rather than trying to scare away others from using it while you keep it anyway - hypocrite

alumette

Physicians have a lot to learn about the death process. They see it as failure....and that is a real shame.

Unfortunately, Physicians are often held liable in court if the patient (or the patient's family) did want resuscitation and the physicians are perceived to have done less than their utmost to prolong the patient's life. As long as the risk of being taken to court for malpractice is higher for failing-to-resuscitate than for unwanted resuscitation, the physicians will err on the side of resuscitation.

I'm with you firefly. I too have worked in a hospital setting for over 13 years and have witnessed countless patients go into cardiac arrest WITH a DNR and not a single DNR was ignored. It is absolutely illegal and unethical to ignore a patients wishes, especially in these instances. I have never seen a Code Blue called if a patient has had a DNR. And to suggest that healthcare workers do ignore it, especially for financial reasons, is irresponsible and ignorant.

@LpierceRN, the article was based on a report by a Registered Nurse who researched studies on the issue. Those studies indicated that in MANY instances, medical providers are NOT discussing it with the patients or their families. Kuds to you and your colleagues if you are, but it appears that many others are not.

Also, it isn't the media who was describing the "jump" - it was a relative of the patient. When the patient is lying still and not expecting them, the repeated jolts from the ICD could easily have caused him to jerk around in response.

Doesn't DICK CHENEY have one of these?

THERE IS A GOD!!!

I have a story that touches on two points mentioned in the story.

My father had discussed having one of these implanted in him. Sadly for us, on Aug 24, 2001, he suffered a heart attack before the device could be implanted. The EMTs converted dad with their first jolt, but too much time had gone by without blood flow to his brain and he never regained consciousness. On Sept 4, 2001 his body finally caught up with his mind and he passed away. Since he was converted so easily, I have no doubt this device would have saved his life and he may even have still been with us today 10 years later. Don't let people be afraid to get one because they might fear this happening in the end.

One of the aspects of his death that I remember vividly was the fact that the doctor in the hospital dad stayed in, while we waited for the inevitable to happen, told us that if we though dad was in discomfort to call the duty nurse and have her give him a dose of morphine. There were several times we did this. We really knew dad probably didn't feel any discomfort since all his higher level processes were gone but it's hard to sit there and do nothing when you see him pulling faces and grimacing like he is in pain. It was difficult to get one of the nurses to administer the morphine. I think she feared that in his state she might kill him. Or at least he might die while she is giving him the drug and be blamed for killing him. The doctor in charge was a very nice man and pulled her aside and explained why she should give the drug and that if dad happened to pass away at that moment that that was OK. Everyone knew she didn't have anything to do with his death.

I think it can be very difficult for a medical person to preform an action that they know can shorten a patient's life. It can go against everything that they have been taught. It's hard for people who work in medicine to realize it can be as important how you die as how you live.

Gneisenau:

I am glad you had such good, understanding and caring staffers caring for your father in his final hours. And nonetheless, how sad that he didn't get the chance to receive what no doubt would've been a life-saving procedure.

Thank you for sharing. I think in these times, it is more important than ever that people speak of their end-of-life wishes and care with their loved ones--so that a good decision can be made, and one that everyone is comfortable making.

there are some significant misunderstandings on this thread. ONe person posted that drs don't turn off ICD's because its their "cash cow'

Umm..the money was already made. There is nothing to be gained by keeping it on.

eric, I think that person probably meant in daily charges for the room, doctor's visits, etc.

maybe, but if a person's ICD is going off repeatedly and is the only thing keeping them alive, then you will quickly have your priveleges revoked

No doctor is going to risk that for a 50 dollar hospital visit

eric, you must be very young. Tell me where there is a hospital that charges $50 a visit. The going rate at our public hospital's ER is $300--that's the starting bid. Add anything else onto that. That's just for the room. Just sayin'.......

certainly im on the younger side, but I've billed for hospital visits and if you think a hospital is paying $300 for a follow up visit, you've never billed or worked as a physician

here's some proof to back up what i'm saying

http://emuniversity.com/Level3HospitalProgressNote.html

This details the cpt code for the HIGHEST level of follow up note for a hospitalized patient

$77.60

maybe the old time docs got that much, but there has really been a cost push in healthcare lately that have affected physician reimbursement

eric, you are right. I'm not a doctor nor have I billed for doctors. I was thinking an ER visit. I wasn't thinking about the doctor's bill. My mistake.

I do know about the sad state of healthcare in this country though and feel for those of you who are docs. Your job is difficult and the insurance companies, including Medicare, have really cut the payments.

Thanks, Allie, and so sorry about your sister.

The bigger issue, as far as I'm concerned, is that our culture does not deal with death and dying and all the issues around it, well at all. Even oncologists don't like discussing it with their patients (as I learned when my Mom was ill). We don't have to be looking forward to it but we need to be prepared for it. Everyone should have their final plans in place. It is too hard on loved ones to go and figure it all out when they are in shock or mourning.

I have a plan. I am going to die at home...by myself. We are born alone and I want to go alone. I think our loved ones are holding us at a precious time when we need to move on.That transition is best made without an entourage of grieving people who are really trying to hold you back. I need to change that comment I guess " we are born alone".....plenty people are in the mix now but it is not the natural way. We are born alone and naked and we should pretty much do the same as we leave......that should keep visitors out of reach.....that's it. Got it ! who wants to be holding the hand of an ugly naked old lady ??? HEEE

My defibrillator shocked me 19 times over the course of 45 minutes last fall because it was misreading my heart rhythm, aka malfunctioning. "agonizing" does not really begin to describe the pain and misery that inflicts. When my condition gets to toward the end of life, I will asked for it to be turned off. Thanks for the article.

alumette, No one is EVER born alone. Our Mothers are always there, or did you forget whom babies are born from? Perhaps you were trying to be deep and metaphorical, but it didn't sound right. I was present when someone in my family died, and I know that he was glad that we were there. Just because you would be uncomfortable with having people around you at your passing does not mean that everyone should be denied the chance to say goodbye. For many that are terminally ill and know that they will die, they become accepting of their fate and sometimes even relieved. (I have volunteered with many Hospice centers over the years.) So, saying goodbye or having people present doesn't bother them at all, and they often prefer to have loved ones with them at the end. As far as what you said earlier about doctor's being brainwashed and needing to not see a person's death as a failure, you need to remember something. It is a doctor's job to KEEP you alive. They are not brainwashed, they are doing their job. If they didn't try to keep you alive then they would be a very good doctor huh?

I do think that patients, should be given the option of turn an implanted defibrillator off if they feel it is best, especially if they know they are near the end of their lives.

Lainey, I totally agree with you. It's silly, really. The one absolutely inevitable part of life and we don't deal with it well. I am so thankful for the hospital personnel she had during her final stay who told her she didn't have much time left and asked if she would prefer to go home. I am also thankful for the hospice people who were waiting at the house that afternoon. She was awake and alert most of the time. There was a young male hospice worker with her that night who kept her and us in stitches. She asked to watch "our" favorite movie, a silly animated film we all love and she laid there tapping her toes to the music. He must have reran it at least half a dozen times for her. In the middle of the night the air conditioning went out. It was horribly hot so to keep her cool until my son could finally figured out what the problem was the young man filled rubber gloves with crushed ice and draped them on her shoulders and head again giving her and us a good laugh. The next morning around 10 she fell asleep. She would occasionally moan and the lady hospice worker, who had been there the day before, told us that she was beginning to talk to the angels. She told us we should begin to say our goodbyes. She instructed us on what we should and shouldn't say and things we shouldn't do, such as rubbing her hands, as that would keep her earthbound. Holding her hands, touching her, kissing her was ok, just not the drawing motion of rubbing her hands. Whether all this was true or just the hospice worker's idea, I don't know but I do know that by her giving us these instructions we all felt like we had done all we could to help my sis go on her way as easily as possible. It's been over 4 years now but Dear God I still miss that girl so very much. I may have been the older one but she was my rock.

What a beautiful memory, Allie. I'm so glad she got to be with her loved ones and you with her. My mom, once she entered "active dying" would not let me touch her hand or her arms, she would push me away, but I could rub her forehead and give her kisses. Hospice allowed both my parents to have a "good death" (for lack of a better term but it is so fitting). My biggest regret is we didn't bring them in sooner and when I come across families on the cusp of the decision I always share my belief to bring hospice in sooner rather than later.

...action from someone who has the authority [to give such a directive] is needed IMMEDIATELY!

As long as it doesn't get cofused with the TV remote!

Spouse picks up remote, trys to turn on the TV, on off, on off, on off! Turns and says, "Honey, I can't get the TV to turn on and will you stop all that thrashing around!

Chochabalua, you won't think it's so funny if it's you doing the "thrashing". But, then again, maybe watching you spinning round on the bed and doing 360's would be a chuckle for some of your friends to watch!

Pacemaker companies and physicians are the ones to approach. Your request alone should make a huge difference. They want to please the public and the patients. Ultimately they will honor the "buyer". You may want to bring that issue up when the device is being implanted....and make sure you are happy with the answers before you agree with the implant. The patient and family are in control at that time....and it is competitive. You can always find another cardiologist who uses a different company....and go to another hospital as well. If you are limited by your insurance, you can still control the game.

RBTatt

But, then again, maybe watching you spinning round on the bed and doing 360's would be a chuckle for some of your friends to watch

Hey RB, would that be the "Exorcist" model pacemaker?

chochabala, that was NOT funny.

Oh! I beg to differ, Blue!

It was very funny!

Put me on the list for it was very, very funny!! LOL And I have way too much experience in this type of thing.

For me, the decision would be simple. When I reached the condition where a DNR (Do Not Resuscitate Order) is appropriate, I would have the defibrillator turned off. Defibrillation is resuscitation - quite different from simple pacemaking. If you have reached the time when it is undesirable to have medics shock you from the outside to restart normal heart rythm, then it would also be undesirable for an implanted device to do that.

i agree with mailman

These things are easy to turn off. Its really not something that even needs to be discussed ahead of time

Eric, you would think it would be very simple, but they don't make them that way, unfortunately (and I'm sure on purpose). I do know from the two surgeries my dad has had since his defibrilator was implanted-in order to turn them off, they have had to call the company & have someone sent to the hospital with some machine they use to actually turn it off. It should not be this complicated-the doctors and the hospices should all have access to the machines so that they can just take care of it if a patient requests it.

Death with dignity isn't a moneymaker for medical professionals.

these things save lives. 1 out of every 4 implanted.

Come on...be reasonable

They're easy to turn off too. Don't let the media herd you like sheep.

I agree. I am 28 but most of my family is dead and I don't really have a relationship with who's left. I am single (although with a baby on the way and possibly marriage soon) and I have taken no chances. I have a will, living will, and financial/medical POA's in place and did so as soon as my mother died. I am also looking into funerals but mostly because I was assured that the prepayments are transferrable to wherever I happen to live when I die. I know I'll have to change the will around when the baby comes and if I re-marry, but just having it there gives me such peace of mind.

My significant other is a police officer and is 35. He hasn't gotten any of that done yet and it drives me nuts.

I am sorry for your loss, though, and I hope that the POA issue soon gets resolved.

A magnet did not stop my mothers defibrillator from going off. Apparently they do not always work.

literally, mary, you need a bigger magnet.

magnets always work.

Have cared for a number of patients who, after tiring of being "kicked by a mule" they demand the cursed devices be removed.

nothing is perfect. But at the end of the day, they save lives

VERY short indeed...

"chessy": The information may not have been to prevent "explosions in the furnace". Funeral homes and cremation facilities have been known to recover expensive implanted devices and recycle them in whole or in parts into unsuspecting patients. Patients are charged thousands of dollars for these implants and there's a healthy black market for "used" discounted devices. Who is going to suspect this?

If these devices "exploded in the furnace" as claimed, then there would be printed notes on all funeral home contracts to this effect, requestiing notification and permission for removal of all such devices before processing.

This is a neat little explanation for those who view the body and question a fresh incision before it is processed or buried. It allows removal of the devices over a period of time instead of just as the body is being placed in the furnace. Any family member asking about the new incision would be given this explanation.

Interesting, thanks jessix!

Pacemakers operate on batteries. If you throw a battery into a fire or expose it to extreme heat, it will explode. Even if a family does not volunteer information about a pacemaker in their loved one, it is standard procedure for morgue/hospital staff as well as funeral home staff AND crematorium staff to check for pacemakers before the cremation takes place. Multiple people check and sign off to verify there is no pacemaker/the pacemaker has been removed before proceeding with cremation. Any implanted device running on battery power will explode in the retort and can cause enough damage to the retort to render the unit unusable until repaired. If that happens, each person who signed off on the body (hospital/nursing home, funeral home staff, receiving staff at crematorium) is held liable for the damage to the retort, which is part of the reason why paper trails follow a body.

If the body is to be buried, there's no reason to remove the pacemaker so it will be left intact.

Already told my relatives to pull my gold crowns out or the guy at the crematorium would. I am 100% serious.

I had both of my parents cremated and both times they asked about pacemakers. It was the same funeral home, though, but maybe it is becoming more common practice to ask about it. Both times, especially with my mother because her death was sudden, it would never have occurred to me to bring up a pacemaker had either of them had one.

jessix, do you have any links or other data to support your claims about funeral homes recycling pacemakers into 'unsuspecting persons'? because it is illegal in the USA to implant ANY used pacer or other implant into a(n American) person. the funeral home we dealt with for my parents, however, told us that recovered pacemakers could be donated with our permission to a program that recycles them for needy people in Africa and South America, where this technology is available only to the very rich few who can buy it. we signed a release for them to do exactly that

Roxie; I understand completely. see my entry-sounds very similar. Dad and I never regretted his decisions. Technology can be helpful but it can also devastate lives in ways unthoughtof. I am 58 and I will never have an ICD implant-I will let God control my life and death, not man and his faulty logic.

While it's not about people whining about their depleted 401-Ks, it is newsworthy simply because it is an important topic that isn't discussed in the venue in which it should be -- the doctor's office. Now, more readers know to ask the questions and get answers about an issue they unfortunately learn about at the worst possible moment. And no, my family did not consider suing anyone. Not all people dealing with terminal relatives think along those lines.

It's a news story because there are hundreds of thousands of people with these devices that should be aware of this. It seems the only one that has legal action as a first thought is you.

And there are hundreds of thousands more facing the decision or with reason to believe they may have to decide on this in the future.

Sorry about your loss!I recieved my first defibulater in 1999,after a sudden death epasode.Have had three replacements.The first thing thay told me was to Put a good size magnet over it to turn it off,Thay even gave me one .My children use to chace me around with it.

Sorry for your loss, missing. I empathize with all the questions you have. I became a widow at a very young age and all I have to offer is the hope that you will not agonize over the questions you have and that you are able to find answers to the questions you cannot let go. As the years have passed for me, I have finally gotten old enough to realize not every question has an answer. I am sure you did everything you could. I wish you peace of mind and lots of love in your life.

Apparently, not much of one. However, I found the following article, which may be helpful to those of us considering end-of-life care for ourselves or loved ones.

It seems that the use of a magnet in close proximity to the device, will turn it off. Still this wouldn't be my preferred method of choice--I would want my heart specialist to come with the machine, and turn it off, if that is my choice.

Never be afraid to speak to a loved one about end-of-life care. It's a decision and a conversation we all must have.

magnets deactivate ICD's, not pacemakers though

alitasara, the device in this article is different than a regular pacemaker. although many of these devices also have pacemakers in them, they essentially have the capability to give a similar, (though somewhat weaker), kind of strong jolt that you would see with rescuers using 'paddles' to defibrillate (shock) someone as part of CPR. a regular pacemaker does not do this