Tuesday, August 03, 2010

running on empty

the current average life expectancy in malaysia is 74. (71 for men & 76 for women) (read here)

so any day lived in health beyond that can be considered a bonus. some call this having a long life; as an avid fan of Air Crash Investigation on Nat Geo channel, i cynically call it Running On Empty.

this 86 year-old woman was brought back to Casualty by her family, just 3 days after she had been discharged. she has heart disease, a previous stroke, was bedridden & had just recovered from pneumonia, having spent 3 weeks in hospital, 1 week of which in ICU.

in Casualty, she was gasping & was barely conscious. i explained to the family that she was very ill & recovery would be very unlikely, given her current & past medical problems. however, the family was firm that i should do the necessary for the her.

i wished they had never said that.

because unfortunately, "do the necessary" here means putting in a breathing tube into her windpipe, attempting many times to insert a cannula into a vein but succeeding only once because she had dainty blood vessels. in the end, we had to proceed with CPR because her heart had stopped. in the process, we used over 20 ampoules of medicine & broke a couple of ribs from the vigourous compression on her frail chest.

all in vain.

i wished they had never given the instruction "do the necessary" because i knew she was already running on empty but i was duty-bound to provide a service i had been trained to do.

i wished they had said 3 other words instead, like maybe "make her comfortable" or "make it painless". masterly inactivity would have provided a more dignified end to a long life.

may her soul rest in peace.

18 comments:

reanaclaire said...

when you mentioned that a couple of ribs were fractured due to cpr, it reminded me of my FIL's case.. the doctors were trying hard to revive him in the ICU and his ribs were also broken during the process... he was 81..
so nowadays our livespan is 74 plus minus.. it is considered great..

Hello Kitty said...

Doc, I nearly cried when I read this post. I certainly don't want my loved ones to go through this. And I don't want myself to be subject to all those pain and suffering at that age! I tried to put myself in the shoes of those who said "do the necessary" - maybe they really loved her so much and genuinely believe God will pull her through?

When I am about to reach the end of the road, I'd make sure I tell my loved ones to let me go when the time comes (eg when advised by the good doc!).

Hello Kitty

doc said...

Claire,

breaking a few ribs is a common occurence especially in elderly patients but there is usually no further complication from this injury; the ribs heal themselves.

doc said...

Kitty,

the family does not realise the full impact of their request probably because they think the patient can be treated & then discharged from hospital.

it's also commendable that they believe in giving the best till the very end.

it's the very fact that the patient is their mother & grandmother that i don't interfere with their decision to proceed with treatment. i just present to them the medical facts & my professional opinion of the likely outcome.

as they are paying customers, private doctors often accede to their requests, even though sometimes we personally disagree with the decision.

**doc gives kitty a pack of kleenex**

ilene said...

In my mum's case, we gave her quality life and towards the end, we took the doctor's advice and brought her home as we didn't want her to be subjected to the agony of having tubes all over her. Besides, that was her dying wish too. Letting go of a loved one is extremely painful.

missyc said...

not a nice way to go in peace with broken ribs & heavily drugged !

doc, can I ask is there any truth (heard from grapevine) that one can try "pin prick test fingers" besides CPR to check if can jumpstart the heart to beat again?

Adino said...

At least the family members could live with the fact that they didn't deprive their mother of any help when she needed it.

And at least you tried your best to the end.

But just curious if doctors ever get used to people dying, since it is part of their job?

doc said...

Ilene,

letting go is indeed painful & that's probably why it's equally difficult to make that decision.

doc said...

MissyC,

it's not even considered going in peace!!

i'm not aware of the pinprick tests you mentioned but there is an acupuncture point called GV26 that has been tried out in conjunction with CPR but is not successful all the time. read here:

http://csuvets.colostate.edu/pain/Articlespdf/GV26Acupuncture.pdf

doc said...

Adino,

i can only speak for myself. i face dying patients maybe 5-10 times a year & i still can't get used to it, as each affects me in a different way.

seriously, if i'm not affected by death, then i think i've lost compassion for my job & for the patients i manage.

Michelle Mak said...

makes me think back about my late grandfather..
instead of trying to drag on his life.. we allow him to leave because of the three word "quality of life"
1st- we've done our best to wat we can do
2nd- he is old and we doesnt wanna see him suffer any longer
3rd- we have been treating him well all this while and spent time with him with the time we have.. so no regrets even if he leaves..but he will still be missed deeply..

hence, treasure the time and whatever you have.. love those who loves and hates you.. cause u never know when a person will leave..! :)

good job doc!

Unicorn Girl said...

Doc , u should not take it too hard on yourself just because you could not save her . I guess any doctor in your shoes would have felt the same way too.

doc said...

Mich,

i guess the really difficult part is to determine when enough is enough, & it takes a lot of courage to make that sort of decision.

for the decision-maker, he/she should not be blamed for his/her choice. maybe that's why (ie. being blamed) no one likes to make this sort of decision.

doc said...

UG,

actually, i wasn't taking it hard at all. i just felt it was a real pity a lot of unnecessary things were done, esp. expenditure at the hospital, when she could have passed on peacefully at home.

Bengbeng said...

the family does not realise the full impact of their request probably because they think the patient can be treated & then discharged from hospital-> the whole family had agreed to let my MIL go but the eldest son came home n insisted to exhaust all avenues... she is suffering and the whole family is suffering n it is now tearing the family apart n the guy has more or less left it to others to shoulder the responsibilty.. it is so common nowadays.. this inability to deal with a situation like this and at the same time pin much upon hope n prayers

doc said...

Beng,

actually, what you described is common. just last week, we had a patient whose daughter gave everyone in ICU a difficult time. she wanted this & that, then refused this & that.

even after the patient passed away, she insisted a meeting with all the doctors involved to explain why & how her mother died, as if all the info conveyed to her all that time had fallen on deaf ears!!

Michelle Mak said...

few days prior to the comment i leave.. my grandpa(dad's side) left us..

it was a shocking one indeed..was sorta blaming myself.. cause if i was back home i could have done something for him..
but again i let him go with a open heart knowing we will meet again one day..

:)

doc said...

Mich,

may your grandpa's soul rest in peace.