* * Anonymous Doc: So are we rooting for him to die?

Wednesday, May 2, 2012

So are we rooting for him to die?

There's a patient on my service who has been nearing the end for a couple of weeks now.  His family has been very involved, last week it seemed like things might have been getting slightly better, but in the past day or two they've taken a turn for the worse.

Last week, the patient's daughter mentioned to me that she had an important business trip coming up, and wanted to know if I thought she needed to make plans to reschedule.  I said it's hard to predict these things, but at that moment he seemed stable, so there was reason to think that things might not be happening immediately, and there was a decent chance the trip would be OK.

Of course, she left on Monday and almost immediately, things became much less stable.  She had said I should call if anything changes.

So I called.  And I said, again, it's hard to predict these things, but it's possible that he only has another day or so at this point, and if she wanted to make sure to see him before he dies, she may need to cut her trip short.

"You really think I have to?"

"I don't want to pretend I know more than I do.  It's possible he will rally again and make it through the week, but it's also quite possible he won't."

"You're not telling me enough to make this decision."

"If it were me, I'd come back as soon as I could."

"But he might not die."

"That's right."

"Okay, I'm coming back.  But my boss is going to throw a fit if my father's still alive on Friday."

"Sounds like a great boss."

"You think you could write me a note saying he died even if he doesn't?"

I'm seriously contemplating writing the note.


  1. kinda funny, kinda WTF, kinda totally understandable all at once. Is the guy at least DNR or is the family responsible for prolonging this as long as possible?

  2. As a professional, I completely understand her predicament, although I'd probably lean on the side of not going on the trip to begin with. That's a hard call, and for now I'm glad I'm not in those shoes!

  3. Not really a hard call at all, if you've got your priorities straight. Sure, I could imagine scenarios where this trip is "mission critical" for her work and she is an irreplaceable part of the mission, but THIS IS HER FATHER! That she is asking how close he is to the end suggests a relationship close enough to have warranted a "I'm sorry, but I just can't go on the trip because my father might go at any time" line to her boss. There will be other trips, possibly other jobs (assuming the worst), but there is only one death of a loved one. Period.

  4. Do NOT write that note! You've been completely candid with her, rightly telling her "I don't want to pretend I know more than I do." She must take responsibility for her own decisions and accept their consequences. If her boss behaves as badly as she fears, that's something she has to face, too. You are not obliged to shield her from life's vicissitudes, but you are obliged to be an honest person. You owe that to yourself, above all.