Tuesday, October 13, 2009

going to hell

My last call was particularly difficult. I know I've semi discussed ethics in previous posts but I honestly didn't think it would be such a huge part of my life as a resident. I am quickly learning that this isn't the case.

Around 130am I got a page about a pt on the floor who was not doing well. He was a 90 year old man who has recently been in and out of the hospital for pneumonia. He was actually getting better when that evening he aspirated an entire bottle of ensure. He then started breathing really fast (tachypnea) and required more and more oxygen (hypoxic)and started running a fever. So we transferred him up to the ICU and started to get ready to intubate.

But then we all paused.

He was a full code. He wanted CPR, intubation, cardiac life saving drugs.

And yet we paused. He was 90 years old. The likelihood he will be able to come of the ventilator is small. We tried to explain that to him and he responded with "I dont want to talk about that right now. I dont know what to do." Thats when everything changed.

To go up the chain of command in terms of power of attorney (POA) it usually starts with the patients spouse (but only if they are straight---dont even get me started with that), then their kids, then their parents/family, and then maybe friends? It all gets muddled.

So we called his son because that was the only number we had in the books. He comes into the hospital and we have a 2 hour conversation about to intubate or not to intubate. Meanwhile Mr. H's respiratory rate is slowly declining. After this discussion we realize its his wife who has the medical POA. So then we call her, who says to do everything.

So we set up the intubation again. And I start tearing up. If this man was 20 years or even 50 years old I wouldn't think twice. But with all his other diseases there is a very high chance he will not survive this. I am about to intubate someone who probably will never come of the vent. I am supposed to be doing this to save people. I am exhausted because it is now 4 am. So I start tearing up but try to hide it by pretending I am excited to "do a procedure".

When my pulmonary fellow comes in that morning I start with "I may be going to hell because of this one....."


Grumpy, M.D. said...

You did the right thing.

It's tough, and I agree this is an example of futility. But when the family is demanding this your hands are tied.

We all see these situations, and they suck. And almost never have a happy ending.

So you ARE NOT going to hell. You only followed the family's wishes. Whatever happens now is a result of their actions. Not yours.

You can't beat yourself up over this. If you sell a car to a guy who then crashes it, the accident is his fault. NOT YOURS.

Good luck and hang in there.

K said...

I'm surprised the issue didnt come up until he went into respiratory distress.

Old MD Girl said...

Nope, you're not going to hell. The family might be.... but it did seem like everyone was following the patient's wishes.