* * Anonymous Doc

Sunday, May 2, 2010

Just getting home after my very last 27-hour shift (until the summer, when I'm on this rotation again as a second-year). For the next month, my long call nights are going to seem pretty terrific when I get to leave at 10PM instead of having to stay overnight until the morning.

I told one patient it was my last day, and he smiled and thanked me for helping to take care of him.

I told the attending it was my last day, and he grunted and walked away.

Why are the patients nicer than the doctors? The patients are the sick ones.

The final night was not without some drama. One of the patients, a tiny 86-year-old man, actually in relatively good shape for the ICU, but suffering from some pretty obvious dementia. Not entirely sure he knows where he is, he certainly doesn't know what year it is or the name of the President-- the standard questions we use to see how oriented the patients are.

But he's a lovely man, just wants us to be nice to him-- he gets scared when there's a commotion or someone raises their voice, but he responds so well when we talk calmly to him, make him feel like he's safe and being taken care of.

Two specialists come into the call room at 9:00 last night looking for me. "We have a big problem. Your patient won't consent to the [painful but fairly necessary procedure]."

"He's not able to give consent. He's demented."

"Well, he won't let us touch him."

"Just calmly reassure him. He's not denying consent. He doesn't know what's going on."

"He should consider himself lucky that Dr. [Jones] is the one doing this procedure," the young specialist said, referencing the older specialist next to him. He's a world-class expert in this."

"I'm sure he is. But the patient doesn't even know where he is."

"Well we have a problem."

"I'll calm him down."

"You sure you don't want to get your attending to explain the procedure to the patient?"

"It doesn't need to be explained. He can't withhold consent. He's not mentally competent."

"Well, if he doesn't consent, we're going to have a big problem."

So I go into the patient's room, and I calmly explain to him that he needs to let these nice doctors do this procedure, and everything's going to be okay.

"Oh, this isn't the place for that," the patient says.

"No, it is," I calmly tell him. "You're in the hospital."

"No, this isn't the hospital. I don't think I want to go to the hospital. I'll just stay here."

"Okay, you can stay here, but it's important that you let these people do what they need to do."

And then the younger specialist interrupts, screaming--

"You are very lucky Dr. Jones is willing to do this for you. He is a world-renowned expert. Very lucky!"

The patient turns to me-- "Is he talking to me?"

"No. Just relax. Is it okay if they do what they need to do to make you better?"

"If it's okay with you, it's okay with me."

"Yes, we should let them do this."

"Okay then."

"Okay, great."

The specialist turns to me-- "Oh, that was great. Thank you so much for getting him to consent."

"He didn't consent! He's demented!"

"Well, he's very lucky to have Dr. Jones doing this for him. I hope he realizes that."

"He doesn't realize that!"

The procedure went fine. Jeez.

4 comments:

  1. jesus poor man lucky you were there

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  2. This post brings up a very good point about consent, and this patient obviously was not able to consent. But it is interesting that the physician's did the "procedure" anyway. If it is a procedure that truly requires informed consent, than a family member should have been consulted. I hate it when physician's think they always know best and just do what they want, especially in a teaching hospital.

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