Wednesday, March 17, 2010

Here's How Easily We Move From Consent to Burden

This is a very interesting read from a doctor's point of view, and it also shows how easily people can die because family, not the patient, thinks it's time. The family is obviously weary, and when offered at least a few good weeks for their loved one, they give up and elect to let him die
A patient's death prompts a doctor to assess 'Do Not Resuscitate' orders
The emergency department is always noisy, but sudden screams from a staffer still get attention. The triage nurse is yelling, "Not breathing, had vitals at triage and just croaked," as she runs toward us pushing a wheelchair. In it, a pale, thin man is slumped over and looking gray. I'm the attending physician in charge. Amid the usual strokes, heart attacks and bleeding ulcers, my day just became interesting.
"Anyone know of a DNR on him?" I ask. If there's a Do Not Resuscitate order, we won't prevent his impending death, which means no chest compressions or electric shock for a dangerous heart rhythm. If there's also a DNI (Do Not Intubate) order, we won't insert a tube to help him breathe.
Blank stares all around. "His daughter dropped him off with a chief complaint of weakness and went to park the car. I think he has cancer and is on chemo," the triage nurse says. Without concrete proof of a DNR or DNI, there's no hesitation. We resuscitate; we intubate. Click, klang, the laryngoscope snaps open and the patient has a tube down his throat within seconds. On the monitor, he is flat-lining -- no heartbeat -- and he has no pulse. I ask the nurse to start cardiopulmonary resuscitation, or CPR. The nurse has good technique, but even harder chest compressions would be better. more

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