The swastika-donning patient who refused his lactulose

As a third-year medical student rotating on the internal medicine service at the VA Hospital, I took care of an elderly patient who was suffering from decompensated alcoholic cirrhosis.  His condition was complicated by hepatorenal syndrome, multiple electrolyte imbalances, and hepatic encephalopathy. It was most complicated however by various ethical challenges and by the social and familial factors surrounding this patient’s course of treatment during his one-month stay on our service — and further by his dispositional affect that made me regularly question whether we were offering this patient the care which he truly would have desired, if he were able to more clearly communicate his wishes, or rather offering excessive life-prolonging therapies amidst a virtually futile prognosis. This patient was memorable because he was the sickest on our floor and because of how involved his adult children were in his care.  He was also particularly memorable, because in a hospital where veterans have a reputation for being friendly and grateful patients, this patient donned a swastika tattoo on his wrist amongst various other illustrations scattered around his body, reflecting a time in this patient’s life when he must have been vocal about his general hate toward others. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Education Hospital Medical school Source Type: blogs