On Being Fired

I knew this was going to be diffucult from the onset. The family brought in this 70 year old male with end stage prostate cancer for fevers and fatigue. The gentleman could hardly keep himself up in his wheel chair. The exam was otherwise normal. Based on his general dability and high fever I suspected pneumonia....or a uti...or a viral ilness. Either way he couldn't go home. I argued with the family who felt he was just being "overly dramatic". I finally convinced them to take him to the hospital.

He had pneumonia.....he had widely metatstatic prostate cancer....he had been so weak for the last few months that he couldn't walk, or get out of bed, or doing anything meaningful to take care of himself. Antibiotics helped the pneumonia but the rest is what we struggled with. Based on his rising PSA, failure to respond to a sophistacated regimen, and overall disability I advised the family on hospice and the unlikely possibility of recovery.

And there so to speak is where the shit hit the fan. The family had been told by a radiation oncologist that the patient had 6-10 years to live based on the literature. Not based on the patient condition, not based on the rising psa, not based on the fact that the urologist suggested hospice. Based on the literature.

So clearly I must be wrong. They decided that their family member was just not working hard enough. So they pushed him to do more physical therapy even when he was so exhausted he couldn't lift his head (the social workers called me and thought that they should report them for elder abuse). The family lashed out at the nursing staff when they tried to give him pain medication for his bone mets becuase they didn't want him to "get addicted". And once I had him stabilized and transferred to a nursing home for physical therapy they called the director to complain and to fire me.

So I called the family and assured them that I wanted the best for their loved one. That ofcourse if they were unhappy with my care they had the right and responsibility to have another physician. That it was my hope that their family member would recieve the best care whether it was given by me or one of my colleagues.

And the family relented and decided they wanted to keep me as his physician. And the nurse called to say that the white count is up. So I ordered cultures, ua, cdiff and a repeat chest xray. And, ofcourse, the nurse called back to say that the family was refusing the xray.

Apparently they were concerned that the radiation from the chest xray would be to harmful