You don ’t know what your patient’s end-of-life wishes are

As I walked in the room, I noticed it immediately: Norman was worse. The recurrent invasive cancer in his neck was impairing the drainage of fluid from his face making it difficult for him to turn his head, and it had progressed overnight. Despite his alarming appearance, he seemed calm. There were no more cancer-specific treatment options: the surgeons had declined to operate again; he had received maximum dose radiation; and the risks of chemotherapy outweighed any potential benefits. His pain required doses of opioids high enough that he often fell asleep in the middle of conversations. Because of his tracheostomy, Norman communicated by writing. Sandra, his wife of 63 years, spent two hours each day traveling to and from the hospital to keep him company. As he worsened, I wondered why Norman had not chosen hospice or to forgo attempts at resuscitation. He was going to die from his cancer, but unless he changed his mind, I feared that one day he would develop pneumonia, transfer to the ICU or suffer the trauma of invasive catheters or CPR. I worried about the judgment of my colleagues who might feel I had neglected my duties and failed to “get a DNAR” or enroll him in hospice. 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: General Medicine Authors: Tags: Physician Hospital-Based Medicine Palliative Care Source Type: blogs