* * Anonymous Doc

Friday, August 27, 2010

"We should really talk about how your mother is doing. You know, she's 88, and the progression of disease has been really rapid over the past few weeks, she's had all of these complications, I just want to talk about how we might transition to some kind of comfort care, so she can get out of the hospital and spend the time she has left back at home."

"Doctor, I know what you're saying, but I see her looking at me. I know she's still in there, and I know she'd still want treatment."

"I'm not saying we don't want to treat her. I'm just saying there's not much left that we can do."

"She looks better today than she did yesterday."

"Yesterday we thought we were losing her, that's true. But if it comes to a point where she has to have a breathing tube, or chest compressions-- I want to talk about whether we think that's actually in her best interests at this point."

"I want everything done that can be done. Even if we can squeeze one more minute of life for her, that's what we want."

"I understand. I just want to make sure you're thinking about what she would want, and whether she'd want to be kept alive artificially at this point."

"But she could get better."

"It's very hard to imagine that scenario. You've seen the progression of disease, and the other issues she has going on."

"But it's possible."

"It's not something that we would expect, medically."

I feel like I've been having these conversations all too often, and they're very difficult. Because as much as we want to pretend that we're trying to give patients an informed choice about end-of-life care, and the options they have, I'm absolutely sent in there with an agenda. "Get them to make her DNR [do not resuscitate]," the attending says, and I go in there and see if I can make the family come around. It's not out of a desire to do harm, or to stop treating-- it's out of a desire to be humane, and do what's right for the patient-- she's dying, there's no way to avoid it, and she's not going to have any more moments of what we see as meaningful life. Of course, what we see as meaningful life may be different from what the family sees as meaningful life, and it's hard to know where the line is. No brain activity is not meaningful life, I don't think. Not being able to respond or communicate is not meaningful life, I don't think. But it's impossibly hard for families to make the decision to give up, and to accept that it's the end. And I feel like the Grim Reaper when I go in and have to convince them to make her DNR.

"I think maybe we should postpone this discussion until tomorrow."

"Yes, she'll be better by then, I feel it."

"I hope she will be."

1 comment:

  1. You're doing the right thing. People aren't acting rationally in those circumstances and can't let go, but we don't have infinite resources. All the money our health care system wastes keeping people alive long past their due could be used to treat younger people with a future ahead of them.