November 19, 2010


WARNING: my post today is morbid but necessary.

All to often in health care I see patients who are kept alive by extreme means. ie- ventilators, feeding tubes, pressers (drugs) and other medications. Some of these patients will make a recovery, some will not. Usually its apparent early on who will have a chance to return to normal functioning and who will not. The main predictors of this are age, co morbidities and present diagnosis.

Most of the time the stresses of making decisions regarding plan of care for these patients relies on the next of kin; husbands, wives, children, parents etc. This can be a very stressful situation and often I see the families are torn with their decisions. What if I decide to withdraw care and he/she would have been better? What would he/she want? What if I continue to let them do everything and he/she never gets better?

I had a patient this week, for example, who has been with us for over a month. I wont get into the details of his diagnosis and everything that has happened but his prognosis is poor and he is clearly suffering. He has no quality of life, he is basically a vegetable and there really is very little hope he will ever be functional again. It makes me so sad to see him, it really breaks my heart to see people like that. If that were me I would say extubate me, put me on a morphine gtt and let nature take it's course. I think thats what most people would want. However, your vision is clouded sometimes as a family member, we selfishly want to keep them alive by all means because we feel that if we dont we are signing there death certificate.

So what am I getting at? There are these great things called "living wills" What they are ultimately is your voice of what you want done for you and what you dont. It takes the stress off your loved ones to know what you want. It's not an easy thing to talk about, especially when we are young but we are all going to die at some point and we dont know when, that's just a fact of life. I urge everyone to have a look at this legal document and to have the conversation with your next of kin so they know what you want and what you dont. It wont be a pleasant conversation but a necessary one.

No comments:

Post a Comment