Last week a man was rolled in to the ER, although I hesitate to call him a man. He looked more like a mummy; lips shriveled, eyes sunken, arms and legs even wrapped in gauze to cover his numerous decubitus ulcers. He had suffered complete and total anoxic brain injury months earlier; there was nothing left of him but a physical husk. Every single physician and nurse dropped what they were doing to stare incredulously as he was wheeled by. He was death incarnate.
The medics, with a wry smile, handed me his chart from the nursing home. Handwritten, on a single blank sheet on top of the chart was a family member's scrawl, underlined three times and followed by a plethora of exclamations.
It became quickly apparent that he was much sicker than his chronic state of nearly-dead. Heart rate was up, blood pressure was down. We sat around for a moment, twiddling our thumbs. He was clearly going to die no matter what we did. The "right" thing to do from a legal standpoint was to rush him up to the ICU, flood his system with antibiotics, take him to the operating room to slice out all of the decaying flesh, and pound him with fluids.
The "right" thing to do from a medical and humane perspective, however, was to let him go. I would add "peacefully", but that opportunity was lost months before when we stabbed a breathing tube through his neck, shoved a foley up his urethra, a catheter up his rectum, and a feeding tube through his stomach in the name of Good Medicine. So, instead, I pulled the family aside to talk about end-of-life care. I wish I could say it went well.
"I'm sorry to tell you this, but there are two ways he can die tonight," I said quietly, "peacefully, with morphine to make it painless and comfortable, or with the ICU physicians cracking ribs during CPR, pushing painful medications through his veins, and shoving you out of the way during his last moments so he can't be with his family."
The daughter looked at me with a distasteful look. "Well, we goin' home, so it's between him and God now," she scoffed, "so y'all better do everything for him. I got faith he'll pull through. Here's my phone number in case anything happens. If it's busy jest call back later."
And so, he went to the ICU. Predictably, his heart stopped beating, ribs were broken during CPR, needles were stabbed into any remaining veins, and no loved ones were with him when he died. The phone was busy. They stopped by the hospital late the next morning with a bag of Dunkin Donuts to sign the paperwork.
Is there a moral here? I'm not really sure. I suppose I can only speak for myself when I say - vehemently - that I would never want to go that way.
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