I was trying to quickly wrap up my patients for the afternoon, since I had someplace to be at 6pm (a bike race to be specific), when the nurse taking care of the woman in room F told me that her son had some questions for me.
I sighed. I always want patients and family to understand what is happening, but sometimes I feel like i explain the same thing over & over again (because I do, most of the time). But this time the questions were different.
“I need you to be frank with me,” her son stated solemnly, but peacefully at the same time. I actually felt soothed by being in the room with the woman whose blood pressure was 88 systolic and her pulse ox was 85%. “Is my mother in imminent danger of dying?” he asked.
I wasn’t quite sure how to answer his question, so I probed further in to why he was asking.
She was a “no code”, “Do Not Intubate”, “Do Not Resucitate”, etc. Generally, I know what that means, but far more important than what boxes are checked on the “DNR” form is what the patient wants from their quality of life. I feel that it is the onus of the physician and healthcare team to determine what “boxes” to check, based on the patient’s and family’s stated wishes for end of life.
After discussing his mother’s quality of life, I gave him my recommendations. I didn’t feel comfortable withdrawing all care until he had the opportunity to talk to his sister in North Carolina, and to talk to his mother’s physician. While I was flattered that he asked for my opinion, I explained to him, “I’ve only known you and your mother for less than two hours. I don’t feel comfortable telling you stop all treatment right now, but I will give you my advice about what you should do tonight.”
I suggested that we continue fluids, antibiotics and humidified oxygen through the night to maintain her present state of health, and possibly improve it. This evening he could discuss the case with his sister and in the morning talk about it with his mothers physician. I told him that there was nothing that we were doing tonight that could not easily be stopped in the morning and this would give him and his sister time to discuss her care.
Was it a cop out on my part? I don’t think so. I’ve recommended to families that they stop all treatment in the past, especially when it’s clear what the patient’s wishes are. I wasn’t certain that this lady would die tonight if all treatment were stopped…I was pretty sure she would linger for days to weeks, getting progressively worse every day. I wanted him to at least enjoy her company for one more night.
She said to her son just as I was leaving, “Matthew…I’m not very good company right now. Why don’t you go home.” Matthew didn’t seem to mind just sitting there in his mother’s room. Enjoying her quiet serenity one last time.
Matthew didn’t mind it at all, and neither did I. It was better than the bike race would have been.