Introduction: With over 16 million veterans comprising 6% of the adult US population, and a quarter of all US deaths, the end-of-life experience for veterans is complex. Given that 96% of veteran deaths occur outside of US Veteran Affairs (VA) facilities, there is a significant gap in specialized end of life care for this population. By fostering open communication, providing comprehensive support, and respecting patient and family preferences, ICUs can transform into spaces of hope and dignity. Leveraging the power of ritual and tradition, such as the Final Salute, can provide profound meaning and closure for veteran patients and their families. However, the underutilization of these ceremonies in civilian healthcare settings highlights the need for innovative approaches to support veterans at the end of life.
Description: A veteran who was admitted to a civilian ICU a complex surgical history, including bowel obstruction and multiple revisions that was complicated by septic shock. The patient was treated for his infections and eventually extubated and being prepped for yet another operation when the patient's condition deteriorated rapidly. The patient’s daughter was 9 months pregnant requested a dignified end-of-life, contrasting with her mother’s traumatic ICU death, which involved terminal chest compressions. During the initial counseling about the various comfort care measures, the medical team learned that the patient’s military service was a major part of his identity. Upon the patient’s death, nurses and residents draped the body with a US flag. The patient was wheeled through a hallway lined with staff, residents, and fellow veterans for a formal salute. Once the patient left the unit, The flag was folded and presented to the daughter, who expressed how meaningful this whole event was to her and her family, and that it's exactly what her father would have wanted.
Discussion: This case demonstrates the ease and impact of the integration of military traditions and the creation of supportive environments for patients and their families during end-of-life care for veterans in civilian healthcare settings.
