But years of quiet and thoughtful reflection identifies some second order and often unspoken nuances of the transition to life support that are perhaps more important than the first order physical aspects. When the man dying of cancer deteriorates to the point that his oxygen saturation cannot be supported without life support or his respiratory distress is too severe, and I position myself behind that bed, propofol and an 8.0 (endotracheal tube) in hands, I know the oft unspoken truth - that this is the last time that this man will be indubitably conscious and coherent or will speak to anyone, most notably his family. Insomuch as life consists of an interaction with one's environment, with a central focus on social interactions, the patient dies the moment I induce with propofol and insert that tube between the vocal cords. He has traded his last words for a few more breaths. (He has also traded away his ability to enjoy food or drink.)
This is a blog about how lack of common sense leads to common nonsense in medical practice. The result is often Status Iatrogenicus, or a vicious cycle of complications, burdensome care, wasted resources, and missed opportunities. This blog aims a critical eye at various aspects of medical practice that just plain don't make sense - because the cure for common nonsense is uncommon sense.
Monday, October 28, 2013
Your Last Words for a Few More Breaths: Unspoken Trade-offs in End-of-Life Care
Subscribe to:
Posts (Atom)