* * Anonymous Doc

Tuesday, August 4, 2009

A patient left against medical advice early this morning. And died three hours later.

See, sometimes you should listen to your doctors.

Except I'm not sure that's really the lesson here. For the past week, every doctor who's seen this patient has had a different message. One attending talked to her husband about discharging her last week. The next attending said no, she wasn't stable. The next attending said sure, we're not really doing anything for her, she's just as good at home. She packed her bags... and then some blood work came back and, oh, no, she's staying. Leaving, staying, leaving, staying. The family got fed up. Every day we're changing our minds, what can we possibly know? We lost credibility. We waffled, and stopped seeming like experts. They started asking more and more questions, and we didn't have answers. Not that there are always answers-- we don't know how disease is going to progress, we don't know how much time someone has left with any great accuracy. She had a year, maybe. At best. Kept in a bubble. At home, apparently she had three hours. Stopped breathing, husband called 911, but it was too late, she was gone.

Now the husband surely blames himself for pulling her out of the hospital, and to some degree I guess he should, but, really, what was the alternative? She had no quality of life no matter whether she was here or at home, and at least at home she could eat real food and sleep in a real bed. She was dying, no matter what. We weren't doing a lot for her, except that we were here to react to an emergency. But the price of that was he couldn't have a life and neither could she. If you're never going to leave the hospital, what's the point? If we're keeping you alive for the sake of keeping you alive, what's the point? Never gonna recover, you're in this state of limbo between life and death... I understand why they wanted to leave... and I understand why they thought it would be okay to leave, since we didn't seem to feel all that strongly either way.

And of course the response here is relief the patient left against our advice, because otherwise would we be sued? Of all the things doctors could and should be sued for, hopefully telling terminal patients they can go home to die if they'd rather do it there than in the hospital isn't high on the list of malpractice infractions anyway. I'm sure there's a forceps stuck in someone's chest cavity that's better worth a lawyer's time.

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