Three "family members" call yesterday for an update on one of my patients.
First one: "His wife's on the phone." Great, I give her an update.
Second one: "His girlfriend's on the phone." Uh, what? "His girlfriend. She says she's his girlfriend." I ask the patient what's going on, he says, yeah, she's his girlfriend, the wife knows about her, it's fine. Great, whatever.
Third one: "The woman he lives with is on the phone."
Not to make this about me, but, come on, this guy has three women clamoring for his affection, and I can't even find one?
I'm kidding, sort of, but it's actually sort of amazing to see the variety of family structures and relationships that patients have. The dynamics in so many families seem so completely messed up, no doubt in part because of whatever medical issue is in play, but even besides that, I can't imagine some of these relationships are functional even outside the hospital context. People who cannot say two sentences to each other without screaming and fighting about it. People who don't even seem to like each other, yet who will show up day after day to visit. And people who've been together for years who won't visit at all.
On a practical level, what I've seen over this past year has made me realize how important it is for people to have the conversation with their families about what they want as far as treatment. It's not surprising that most people don't-- it's a terrible conversation to have-- but "he would never want to live this way" and "he would never want us to just let him die" as two sides of the DNR continuum-- it's helpful to know where someone falls, and more often than not, family members don't know, and can't simply divine the answer.
The running joke all day yesterday-- you have to have something to keep you going when you're working on a holiday-- was whether we'd get to see red, white, and blue. And of course we did. One patient bleeding out, one patient losing blood flow to one of his extremities, and one patient who couldn't breathe. Happy 4th of July.