Sunday, June 8, 2008

Ice Floes on the River of Life

There's an old legend that the Inuit placed their elderly or infirm on ice floes and pushed them out to sea when times were especially lean. While this might have been a rare occurrence, some of the tribes carried out a form of assisted suicide wherein an elderly person who felt they were a burden on their tribe might asked to be killed. There was a belief that a person who was murdered had a more pleasant afterlife.

I think about this a lot when I go into work every day to face the same 3 or 4 patients I have been carrying for a while. Not that I am going to assist anyone into the next life or hasten their trip, just that sometimes the limbo created by indecision I think is much worse.

We, meaning my fellow ED residents, have made the comment, on occasion, about "our tax dollars at work" when faced with patients that are prime examples of what is wrong with the health care system and the welfare system in general: ie. the meth addict who uses his disability checks to support his habit, the "blinged" out moms with their giant gold hoop earrings, cell phones and fashion handbags who want a script for tylenol so that medicare can pay for it, and the mom who came in with her infant on her lap in an ambulance to the ED for a medication refill.

I have a couple of patients who should have been transferred to nursing homes several days ago, but their families can't, or won't, make a decision about their care. They are both in their mid 90's. They have both had strokes making swallowing difficult leading to the problem of aspiration pneumonia because their throat muscles aren't working properly, and they can't even swallow their own saliva properly. One has a feeding tube placed in through their nose and the other is on IV fluid because the family keeps insisting that they will pass their "swallow exam" even though they've failed the last 3 times.

As I was leaving yesterday, both families were leaning toward placing a feeding tube called a PEG (percutaneous edoscopic gastrostomy) into their stomach. This is a minor surgical procedure, and even if done by the least invasive means possible, is still a procedure requiring some kind of sedation and proper wound healing to limit breakdown. And, these patients are in their 90's, with strokes, not swallowing their own saliva properly, at high risk for aspiration pneumonia, etc.

And this is my world, every single day. Which is why I am not writing much during this rotation. I don't like rounding for 4 hours every day. I don't like non-decisive people and being asked day after day to sit around and do nothing for my patients. And, I don't want to bring this negative energy and sound like a whiner to this blog. So, I will write less for now and maybe jump in from time to time with some interesting events from some projects I am starting. It's only 3 more weeks... sigh... I am at my ADD 2 week, losing interest point and can't imagine 3 more weeks... major sigh.

1 comment:

lv2trnscrb said...

I'm so sorry, Veronica, this would be a tough rotation; I wonder if some of these decisions that have to be made would be easier if parents talk to their kids about their wishes for care as they advance in age and get Advanced Directives in place, etc. So sad.

hang in there; each day gets you closer to a new assignment; I do miss your entries, but I can understand why it would be hard to have much of interest to write about

betty