Hopeless Cases October 30, 2007
Posted by keepbreathing in Coming to an ER near you, HCotW, code blue, ethics, medical ethics, respiratory therapy.trackback
Some time ago I promised you new features: the hopeless case of the week and the success of the week. These features were part of an effort to create interesting content and explore some of the dichotomies of medicine. But me being me, I forgot all about them until today. Today, working in the ER, I got a new Hopeless Case Of The Week!
The hopeless case came in this morning via ambulance. I was sitting in our RT cave in the ER when my “spectralink” phone rang.
“Respiratory.” I drew a deep breath and sighed. In this ER, they either need me for something critical or something asinine. Middle ground is hard to come by.
A tinny voice leapt from the earpiece. “Intubated patient coming to Intensive One. Six minutes.”I got to my feet.
“Right!” Hanging the phone up, I grabbed my stethoscope and strode out into the ER, walking past The Hallway Patients and The Security Guards and eventually winding up in Intensive One. I turned on the ventilator and waited. Moments later EMS lurched into view, tugging a stretcher with a pile of blankets on it.
On closer inspection, the pile of blankets was a cachectic middle-aged individual. Their blue eyes were open and staring off into space; their wasted limbs were splayed lifelessly across the stretcher. The paramedic began to rattle off report: the patient was a middle-aged man from a local nursing home, with a history of IV drug use, drug-resistant pseudomonas, C-Diff, MRSA, various chronic failures, enormous amounts of thick yellow secretions indicating a fulminant pneumonia—and full-blown AIDS.
He had been found unresponsive in his room at the home, probably when the one aide for 100 patients poked him with a stick and he didn’t move. He had no DNR. He had no family. He was unable to decide for himself what to do…so now he sits in an ICU bed, intubated and ventilated, being pumped full of drugs while microorganisms eat him alive from the inside. His mere presence in the ICU puts healthcare workers of all stripes at risk. His quality of life is minimal. He is not aware of his surroundings, and he…is…going…to…die.
Despite all this, he sits in a 3,000-dollar-a-day plus intensive care bed. We are keeping his body alive as long as we possibly can, but for what? This case is 100% hopeless. If we cure him, he will return to the nursing home and then either die or come back to the ER again. If we don’t “cure” him but simply prolong his life for a long time, he will linger in our ICU, acquiring rare and exotic infections until the day that he dies in a high-risk ID-nightmare code blue.
I am at a loss to explain why we are doing this to this man. The compassionate thing to do would be to make him comfortable until his inevitable demise. But the promise of modern medicine is immortality at the expense of quality, and so…until he has the audacity to defeat our machinations, he will remain alive.
This is a perfect example of why we have the best healthcare system in the world. We even give good healthcare to people who don’t deserve it.
I’d recommend an ethics consult, if those weren’t often more painful than taking care of the patients.
[...] there are the stories that stir pain within us, because we feel for each other. KeepBreathing at Respiratory101 paints for us the ultimate hopeless case that all too frequently comes to the hospital, and how [...]
Poor guy. And if he managed to come around he might even realize how big a unsolvable pain he is to the staff….thereby causing even more pain and despair on his part. Where are his friends, his family? Long gone perhaps and now he is in the company of strangers, attempting to be as kindly as possible and trying to cover up the fact that they know he is going to die.