Respiratory Therapy 101: Just Keep Breathing

First: I saw the best patient ever today. She was a young lady who needed a blood gas, and not only was she cheerful and cooperative, she was absolutely charming even with a needle stuck in her artery. I was totally impressed with her as a patient and left her room smiling and feeling satisfied, an unusual occurrence. Another patient of mine had a very curious family member who was considering a career in RT, and I spoke with him for a while and hopefully was able to sway him in the direction that’s best for him. Those are two really positive, awesome things that happened today that offset the sad case of Mr. Crusty.

Mr. Crusty was encrusted in weeks worth of filth. His disgustingly large omentum was covered in fungus and dried liquids, and his toenails appeared to require the services of a professional arborist. He was, in short, totally incapable of caring for himself in any meaningful way. This had not prevented him from living alone in his own filth, where he had apparently slipped on something abominable and landed on his head on a floor covered in effluvium.

Mr. Crusty was officially a DNR patient, until the physician called his family (Crusty Junior, a few towns over) and asked them if they were OK with Crusty Senior’s DNR status. Crusty Junior was in direct violation of Geraghty’s Law of Grieving (thanks PJ), which states that there is an inverse relationship between the volume and duration of grief and the amount of love and care demonstrated for relatives in the past. Needless to say, we intubated Crusty Senior and dragged his mostly-dead, filth-encrusted butt up to the ICU.

This is a perfect example of the Hopeless Case of the Week.

What we did was to take an 80-some year old man, who stated that he did not want life prolonging measures, and perform some of the most aggressive procedures we have on him to placate his yokel family. We spent a great deal of time, money and resources to “save” the life of a man who (a) has stated that he does not want to be saved in the presence of his physician, and who (b) has absolutely no quality of life outside of the hospital. We violated his wishes to make his family happy. Not only is this a really bad use of critical care resources, it’s a violation of the implied contract between patients and caregivers, and that disheartens me.  Why did we do this? What did we achieve? If nothing else we can ask these questions and maybe think a little bit about what it is that we sometimes do to people.

Mr. Crusty is this week’s best candidate for the Hopeless Case of the Week so far.