* * Anonymous Doc

Tuesday, September 13, 2011

"Doctor, aren't you worried about my mother's low urine output?"

"Your mother has no brain activity. Her last set of labs were incompatible with life. I'm not specifically worried about her urine output. She is not doing well."

"But don't you think she'd be doing better if we figured out why she's having so much trouble producing urine?"

"No. I'm sorry. Your mother is not doing well. She probably doesn't have more than a couple of hours. I'm sorry."

"But I want to get to the bottom of the urine thing. Are there any tests we can run?"

"She's on a ventilator. She's not able to breathe on her own. She is not doing well. There is no reason to subject her to more tests without any plan to use those results to improve her condition. There's nothing we can do at this point. I'm sorry."

"...and I didn't like the color of the urine she did pass."

"The urine is the least of her problems. I think you should spend this time with her, unfortunately it is not looking promising right now."

"I want to run the tests."

"There's no indication to run any tests. Unfortunately, she's septic, there's nothing we can do at this point."

"Should we try dialysis?"

"There's unfortunately no benefit to anything we can do right now. We're just trying to make her comfortable and minimize suffering at this point."

"She'd be suffering less if she could urinate."

"This is not the acute problem. I'm sorry. There's a bigger picture I want to do my best to make sure you're seeing."

"She needs to urinate."

"You need to go be with her. I will check on her a little later, but I need you to know, things aren't looking good."

"I also want to make sure she's getting the diabetic meal."

6 comments:

  1. OMG....I had a daughter just like this. Except it was vitamins. Everything would be better if mom were just getting some vitamins.

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  2. Are these your friends from last Tuesday, by any chance?

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  3. denial is a damn powerful thing.

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  4. I wonder if the euphemisms you used ("she's not doing well," "she doesn't have much time,") were confusing the relative in this case. What do you think would have happened if you had put your hand on the person's shoulder, looked him in the eye, and said, "Your mother is going to die very soon, probably within a couple of hours, so whether or not she is passing urine doesn't matter now. You should go spend these last moments with her, while you can."

    Sometimes I think it's a kindness to be that direct. Especially when the person you're speaking with is likely to be in denial about what you're saying - then it's even more important to state it in a way that leaves no question as to what you mean.

    I know it's hard, but we lay-people rely on you doctors to tell us the hard truths.

    I'm sorry your patient died.

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  5. (Even "incompatible with life," doesn't mean much to non-medical people. Sorry, forgot to include that above. I know that sounds really clear to you, as a doctor, but it's not clear to your average person. Really.)

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  6. Amy - You make an excellent point. I once had a doctor tell the family of a patient who was imminently dying that the patient "didn't have a long-term prognosis". When they looked at me quizzically, I said "She's dying right now." In medicine, we seem to be very afraid of being direct and using hard words like dying, but I think it's a very important thing for us to learn how to do.

    To shamelessly plug my own blog, I wrote a post about this a while back: http://solitarydiner.blogspot.com/2011/08/if-you-cant-say-something-nice.html

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