Circling the Drain

I have an elderly patient right now who I don't know if they will be alive when I return on Monday. Friday morning, I arrive to the hospital to nurses buzzing around my patients room. Turned out my patient's oxygen dropped not too long ago and she was having lots of problems breathing. The nurses called the respiratory therapist to come in. The RT is a professional at managing airways and people in respiratory distress, but my patient has a "no code" status (=DNR=do not recuscitate) and refuses to have any invasive procedures done. I.E. she doesn't want to be put on a machine to help her breathe.

I examined her and ordered more STAT xrays and blood work and found she has pneumonia. So we began treating her for that. When I left yesterday, she was stable and on high flow oxygen.

After I had the chance to reflect on my patient, I kept thinking that I didn't know how I was going to feel if she passed away today (or any other day). On the one hand, I would feel like I did something wrong or didn't do enough to keep her alive. But on the other hand, maybe this is her time and nothing I do will keep her alive and we should just keep her comfortable and let her go. This goes against anything we've been taught in medical school...to NOT do the prescribed protocol for any given illness. Yes, I believe in a patient's autonomy and thier right to chose what happens to them, but it's hard to accept doing nothing when your job is to make people better or cure them.

As a medical culture, we don't do death well. Sometimes I wonder given all our technological advances, new medications, and research we can allow people to live longer. But at what quality of life? At what point do you take a step back and say "enough"? This very issue is something my own family is struggling with.

I think it would be good for me to do a rotation in palliative care next year. It would be a difficult rotation, but would allow me to get a different perspective on things. Until then, I'm not sure to hope my patient is alive or to hope she has passed peacefully when I get back Monday. In the words of Doris Day (one of my grandmother's faves): que serra, serra (whatever will be, will be).