Monday, January 31, 2011

o-dubs: on the other hand...

I've been really lucky to get such positive feedback from readers, and even luckier to get contributions from some of them. o-dubs wrote this in response to "my empire of dirt". Lightly edited. Thanks, o-dubs!

Patient had already completed round one of chemotherapy, with no discernible progress; she was admitted for respiratory distress. She and her incredibly supportive family were trying to decipher all of the information presented to them by the pulmonary team, the oncology team, the nephrologists, the medical ICU team. She was pleading with me through her tired eyes as I replaced the biPAP mask that she had worn for the last three days; this was the only way for her avoid intubation. I would explain to her again and again why it was necessary for her lungs at this point; she would just politely say, "Do what you need to do, sweetheart. You all know best."

I brought the attending into her room following rounds. He made direct eye contact with each of the expectant faces looking toward him and said this: "Look, here's where we're at. Right now, you are alert, you are aware of what's happening around you, you are able to talk to your family and enjoy the company that they bring. At any moment, all of that may change. Our medical technology will not be able to cure your condition. Yes, we will be able to keep you alive---possibly longer than if we stop aggressive treatment at this point---but your mental status will decline, you will be supported by machines, and some of those machines require sedation that would dull what capacity you have left. If it is more important to maintain the quality that you have right now, to be able to see and speak to your family and enjoy them...get the hell out. Now. Today. Don't stay here one hour longer than you have to. You don't have much time left either way, but right now you have the opportunity to choose to spend that time in a comfortable place, surrounded by these people who love you, not worrying about any more tests, procedures, or results. If that's what you want, now is the time to get out of here. We can help you do that, too."

I don't have any words to describe the relief, the happiness on Patient's face. Her cheeks had color for the first time in the three days I'd taken care of her. She smiled. As her family looked shocked and dismayed at this "failure" of medicine, this woman emanated a peace that was almost palpable. the family discussed this "new development" in the room for quite some time, but the woman's ultimate decision was delivered as a quiet, "Yes, please."

I removed her biPAP mask and traded it for a simple face mask. She was able to speak again. I could finally give her ice chips to moisten her dry, cracked mouth. No more lab draws. No more consults. Later that day, I sent her off to spend the rest of her life in a hospice house surrounded by gardens and art and a family who now had the freedom to focus on enjoying this woman as a mother, a wife, a sister, a grandma. A person.

Not a patient.

1 comment:

  1. I want this doctor. I don't know why most doctors consider lieing therapeutic. When I go to the pharmacy to fill a script and they give me my own personal rep from Pfizer I get suspicious. After all, I was told I would be fine and to come back in six months.
    I have one doc I trust, my nephrologist. I was totally screwed 2 years ago. Coming out of coma I found myself attached to more tubes than Frankenstein, including this spiderweb hanging out of my neck for dialysis. I asked him about the odds of getting off dialysis and he gave me 10,000:1. I got the 1. At my first office visit he told me that I was prepositioned for a transplant but my age and other factors would be hard to overcome. He made it quite clear that if my kidneys go south I'm probably screwed. Then he showed me pictures of his new baby and we sat around and bullshit for a while.
    I could have used this man on my team in the army.
    Of course this is from a patients perspective.