Monday, October 31, 2011

Agents of Torture

I don't know when I became the angel of death. It was never my plan to be the patron saint of hospice. In fact, I started my career dealing with much less terminal illness. But as I spend more and more time in nursing homes, end of life discussions are a large portion of what I do.


I had multiple admissions to the facility this weekend. Of course, there were the occasional rehab patients recovering from hip and knee replacements. I was shocked, however, to see how many people rolled through our doors with end stage illnesses. The expectation was that they were coming for rehab.

There were metastatic cancers, devastating cerebrovascular accidents, and centenarians newly started on dialysis. As I sorted through the admissions paperwork, I started to see familiar patterns.

Peg tube placed for malnutrition. Dialysis initiated for failing kidneys. Chemotherapy scheduled for lung cancer with diffuse metastases.

Since there was no documentation of detailed end of life discussions, I made a point of asking each patient and family member a few questions:

How do you think treatment is going?
Has anyone told you about prognosis?
What are your goals?

Surprisingly, many of these questions had never been asked or answered. I found my patients and families to be largely oblivious. Many of their responses were shockingly uninformed.


I don't know how we got to this place. I understand that we as a profession need to make money. That gastroenterologists need to place peg tubes, that oncologists need to give chemo, that internists need to rack up visits.

I accept these facts. But when did it become okay to practice futile medicine and batter our patients?

How did we become agents of torture?


rose said...

Hi there.. I stumbled upon your blog this sleepy Monday morning, as I began to work through the fog in my brain, and once again start-jump it, to move in the right direction.
I feel fortunate to have come upon your blog. As I read through some of your notes, it gave me hope that we do indeed have good grounded physicians still alive on this planet. Many days I go home jaded from the dealings of healthcare.
I am a bone marrow transplant coordinator, here in the midwest, that has been blessed to have worked with compassionate, and good 'ole kind physicians. Physicians who go out of their way for their patients... who aren't afraid to go the proverbial 'extra step'.. and expect it from their staff and people with whom they come in contact.
But then there is the 'other side' of the coin... those that make us lose our hope that the compassion will continue with the 'exintsion' (if that is a word) with our old 'work horse' docs.
You gave me hope on a chilly sleepy Monday morning, and I ask you, please please-never lose your compassions and your caring. Our cold world of healthcare needs more of 'you'...
And as the funeral director said.. 'slow down, boy'... slow down and enjoy those little things with your wife and kids.. you will find that those little things are the important things in life... God bless you, your family, and your work.
sincerely, Monday morning ramblings from an 'old chick' who found a bright spot in her morning, in your blog. Thank you!

Unknown said...

Such an honest caring commentary on "health care"
that is not healthy and not care in America.