A 95 year-old man with Alzheimer's disease, a crappy heart, gangrene in both feet, and a DNR order, who's been goofy since you began giving him Morphine 3 FREAKING DAYS AGO, is NEVER EVER EVER, under ANY circumstances, a STAT neurology consult for confusion NO MATTER HOW MUCH MONEY HIS FAMILY HAS GIVEN THE HOSPITAL FOUNDATION!!!!!
Oh that poor, poor man. 95 is a good run, why can't his family let him go in peace?
ReplyDeleteSometimes letting go means get all the latest/greatest so that facts are checked and accounted for to hopefully stem the guilt one has for "letting go" ... sucks to be the physician who gets the call, but from the other side of the fence, I understand it.
ReplyDeleteKind of like why I just dropped $3k on an 8 year old great dane. In people years he is about 80 and yet, his quality of life never suffered before his *event*... I checked all my facts, had him to 3 different vets - regular vet, university research hospital, and then a great dane vet.
I'm very glad I did. He is not dying of kidney failure but overcoming the loss of hydration when his IV was pulled and anesthesia. I did not euthanize him as was hinted by regular vet.
If the 95 year old was my dad, I would double check things too... not rigorously, but check. Then I would prepare myself to let him go... into that good night.
It sounds to me like the family is letting go, in their own time, in their own way, and mourning the loss along the way.
But the important question is: Is the hospital foundation mentioned in his will? And is there any chance he'll change it now that he's confuzzed?
ReplyDeleteBut all of his kids are lawyers, what else could we do?
ReplyDeleteHe's rich. He's confused. Just make sure he brings his checkbook.
ReplyDelete>>Kind of like why I just dropped $3k on an 8 year old great dane. In people years he is about 80 and yet, his quality of life never suffered before his *event*...>>
ReplyDeleteThis poor gentleman had Alzheimer's and was DNR. Your dog had a reasonable quality of life until his "event". That's the distinction.
In veterinary medicine, we are fortunate to have the capacity to end suffering with euthanasia. That's not so in human medicine, but human medicine does offer the option of DNR/DNI. As a veterinarian, I don't always agree with a client's decision to euthanize, and I know physicians don't always agree with DNR/DNI orders. Physicians must also wrestle with family members' disregard for DNR/DNI orders, as in this case; veterinarians sometimes perform "economic" euthanasias. End-of-life issues are thus complex for both groups of professionals.
When I strongly disagree, I state my professional, medical opinion and remove myself from the case (just as Dr. Grumpy described in his 11/21/09 post "I Ain't Coming"). It's self preservation.
FYI, it's SOP for veterinarians to offer euthanasia as one viable option when a patient, especially an animal with other chronic problems, presents in serious condition with a potentially fatal and/or expensive problem. Many of us would much prefer to treat aggressively and not be the one holding the syringe of blue or pink juice. We must balance our clients' feelings about whether their animals are suffering, however, along with the knowledge that our clients are paying the bill out-of-pocket (also very different from human medicine).
When I see a patient with a life-threatening illness affecting quality of life, I discuss options (including euthanasia, if appropriate) and the cost of those options. On a few very rare occasions, I've refused to euthanize. On many more occasions, I've euthanized potentially viable patients, had the client been able to pay $3000-10,000+ for life-saving treatment.
I'm glad you made the right decision for you and your dog. I also hope the family of Dr. Grumpy's patient allows him to die with dignity.
Why is it that we're kinder to our pets than we our to our humans???
ReplyDeleteUnless they have a big, fat load of cash waiting for you and a KCL filled syringe in your hand.
ReplyDeleteOh, a patient with Alzheimers was BEGINNING to be confused. How on earth could they tell? I'm surprised he wasn't totally non responsive with all of the above on his plate.
ReplyDeleteAs a new nurse it makes me feel like my critical thinking skills are top notch compared to this!
Isn't that the first question doctors ask; whether it's a rash or vomiting - what changed around the time the symptoms started?
That kid of stupidity just makes me "worince" (word verification.
I once took a realtive's dog to be euthanized because the dog had heart failure do to heart worms. (which is stupid start living on the central east coast just above sea level with water every where!)
ReplyDeleteI digress.
I also chose to let my childhood dog live out the lung cancer she had on prednisone and pain killers. She passed away in what appeared to be a fairly peaceful way.
Now had euthanasia been an option for a human, I would have chosen that for my comatose, dying father instead of watching him wither away to nothing on a feeding tube and a bed pan.
I agree with the vet, every situation is different.
Dear Anonymous 11:30, the problem was the feeding tube. Without the artificial feeding your dad would have passed away much sooner and more comfortably. My heart goes out to you....
ReplyDeleteBut how many chickens did his family give, and where does the hospital foundation keep them?
ReplyDeletesince i work in an integrated system, a big donor consult would indeed be stat. gladly so. we need to survive to serve the community well, and the family needs to know we care about them. especially about them. thats ok.
ReplyDeleteDr. Grumpy,
ReplyDeleteDid you rush over to see this patient, stat-freakin-now?
I dunno. A few moments of lucidity due to your efforts may solve some future economic crises, such as raises for unecessary paper pushers, or new laptops for executives that can't even use a spell checker.
ReplyDelete