Kissing Cousins

I'm going to get back on the soapbox, yet again, to talk about the importance of having advance directives, living wills, etc.  I have a patient this week who suffered a massive stroke.  So massive that they will never have a "meaningful recovery."  Essentially, my patient is brain dead.

Somehow, they managed to tell their children that they didn't want a tracheostomy (breathing tube in the neck) but not much else.  Now, I have had many discussions with families about their loved ones' health and final wishes.  I am, as some of you know, a strong proponent of "letting nature take its course."  Sometimes in medicine I think we forget that just because we can doesn't mean we should.  And, this is moreso in the critical care setting where letting go is sometimes the best medicine we can practice for our patients.

Anyway, unfortunately, this patient's family is, shall we say, mentally challenged.  Rumors abound regarding in-breeding and first cousin marriage, but regardless, my patient's children don't understand the meaning of brain death.  They still think their parent has a chance of recovery.  I spent 2 hours, and a priest and social worker spent another 2 hours trying to explain to them that their parent is dead.  They may be on a ventilator, but that doesn't mean that their parent is going to wake up.  I knew they didn't quite get it when one son kept asking if a blood transfusion or feeding the patient would help.  I don't know that I have ever been so coarse or so graphic with a patient's family, but they just didn't understand.

I plan to talk to them again on Monday and see if anything we talked about sank in.  I told them they could be at the bedside when they were ready to say good-bye to their parent, but even then, I think they thought if they didn't do anything their parent would recover.  It's a difficult situation, and very frustrating.  Again, all of this would be a moot point if my patient had a living will, advanced directive, tattoo across the chest (as I've heard rumored someone actually does) which states "Do Not Resuscitate."

So, as we go into the next year, maybe a New Year's resolution should be to talk to our families and loved ones.  Get out the box of tissues and bottle of wine, because this isn't an easy discussion.  Sit down and make a plan.  Write it down.  Come to an agreement.  And, because I am an organ donor, I always encourage parents to think about their children in these discussions.  Considering the death of your child is a horrible thought, but when you comes to terms with the possibility and make a decision regarding organ donation, you know a part of your loved one carries on.

During the week I met an 8 year old heart transplant patient who was visiting the hospital promoting blood and organ donation.  She was born with a heart defect that required multiple surgeries as an infant.  A couple of years ago, she developed a fatal complication and would have died without a transplant.  Luckily, someone else's family made the decision to donate their child's organs, and this young girl received their heart.  Now she's involved in promoting organ donations across the country.

Since I'm getting married in a few months, it's the perfect time to talk about final wishes.  My fiance knows I want to be an organ donor.  Take anything needed.  I'm not, after all, going to take it with me.  My mother and I have had the discussion.  I know her wishes should she become unable to vocalize them.  Sad, yes.  But a few moments of sadness will lead to a great relief of burden should the time come when I ever have to make a decision regarding her care.  I'll know what she would have wanted, and I will be able to carry out her wishes.

OK, off the soapbox.  The countdown continues, and we're into the final week... woohoo and boo because the painful attending is coming back... BUT, it is the final week...CCU Countdown:
Days until the end of the rotation:  8
Actual number of days I will be working during that time: 7
Days left until the painful attending returns:  1
Number of days until my next 24 hours off:  7 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 1
Number of long call shifts remaining: 1
Number of patients: 2 1/2 - I have a multisystem organ failure that has to count as an extra 1/2 pt due to all the work needed
Number of super nurses in the unit:  4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)

Tags: organ donation, advanced directives, living wills

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