Let me ask you.... what is the line between killing someone and withdrawal of care. I understand the idiom of respecting a patients wishes, but how do you know that the wishes remain the same until the end.
My experience is drawn from pt "K", an individual that did not want medical intervention for his terminal illness but was completely lucid and communicative at first. What transcribed was so depressing. First he becomes DNR (do not resuscitate), then we dope him up, stop blood draws, d/c the anti-biotic, and finally stop IV fluids and feeds. The moment he would groan the family would interpret this as a sign of agitation so we slosh him again by knocking him out with more fentanyl (stronger narcotic than morphine). Maybe his groans were wishes that he wants us to save his life or at least feed him. I will never know....he passed away this past Friday.
Since when is a "respecting a patient's (initial) wishes as noble as saving a life", as my attending tells the family. This is not what I signed up for.
2 comments:
On night shift, I was struggling on with a patient with multi-organ failure. He was a very depressed old man who repeatedly asked us to leave him alone as he wanted to die in peace, hopefully in his house, surrounded by his loved ones. As the treating team had expressly written and underlined "family wishes to pursue active treatment" on the previous day's notes, I wasn't in the position to change any treatment goals, especially not at 4am in the morning. But I did document my opinion on the issue. Next night on, I note that they have added an SSRI to his cocktail of medications, and are still pumping him with antibiotics which have added to his discomfort by causing noxious diarrhoea. He has also started PR bleeding. Went to see him, same thing-requesting to be left alone. Couple nights later, I got called to see him as he was on his way out. Called his family while he was still coherent so that they could rush in and talk to him for the last time. Guess what? They scolded me for calling them at 1am in the morning as they were already in bed. Said that they had already visited him last week.
According to the day intern, the family didn't even bother turning up when his death was certified at 9am in the morning.
Poor man.
Keep up the good work.
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