Bringing Out the Worst

On most days I love my job. I honestly get to feel like I have made a difference in the lives of my patients. Sometimes that can mean the I am there when the code is called, and actively participate in life-saving measures. Sometimes this can mean I help them breathe easier with treatment. And sometimes this means I am there to help them be as comfortable as possible as they slip from this world, while other times, it is too late for them and I get to bring my experience of losing my mom to lung disease to help their loved ones through loss.

But there is one thing I cannot stand about this career I have chosen for myself. Quite honestly, if you want to see the bottled-up dysfunction in a family emerge, put them in an ICU when their loved one is critically ill. This is where you see it all. This is when the dirt comes to the surface. This is when it gets ugly.

Brothers and sisters fight over medical bills. Nobody can agree on end-of-life issues. I have even seen relatives attempting to take pictures of the patient on life support, to which I have to be the Patient Rights Police and insist that they could possibly be violating the patient's right to privacy at a time when they cannot give consent.

I can understand the concept of someone wanting us to do all we can. I really do. But what happens when the point of medical futility is reached? Shouldn't there be someone in the family who is able to listen to reason? To see that the medical treatment has reached the point of torture?

So what prompted this? I have resuscitated people for some reasons you would not believe. I think the worst was a 99-year-old man. He had survived cancer. He had lived with lung disease. He was getting dialysis several times per weak to overcome kidneys that had long since failed him. He had had 4 open heart procedures. He collapsed at home and the family called an ambulance. They wanted everything done. He was brought to us on a high amount of oxygen and in the end stages of heart failure. And he coded. And the family made us do everything. I felt his frail 99-year-old ribs crack under my hands as I compressed his chest. It was pitiful. But we got him back, though we all knew it wouldn't be long before we were doing it all again. So we approached the family about signing a do not resuscitate order. And they refused. The reason? (Which I cannot believed they confessed.) They had a huge celebration planned for his 100th birthday in just 3 months and he couldn't be permitted to die before then.

Well, though the situation was not as bad, this weekend I found myself taking care of Mrs. X. Mrs. X is not there. Neurologically, she is gone, which is the result of anoxic brain injury from a stroke that was not treated in a timely manner. She is unable to cough, and so we have to suction her almost every 2 hours to clear her secretions. She does not respond at all. Not even a gag as I threaded the tube through her nose and down her throat. Her tongue and pharynx are so swollen that I predict airway compromise any second, which will require intubation. Her team of doctors has tried and tried to explain to the family, only to have the family adamantly refuse to sign any advance directives. Yet I have not seen anyone come and visit her in the past 3 days. And it pisses me off. I am forced to torture this woman, most likely because someone is still cashing her social security checks. It is almost criminal. This is what I hate about my job.