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No good deed goes unpunished.....
Mar. 23rd, 2007 04:58 pmSlept in this morning. Was rather tired and actually fell back to sleep after hitting the alarm. Then the phone rang at 9. The hospital for a patient I did not realize I'd be covering for who was doing very poorly I needed to be up. Just wish it hadn't been that way.
One of my call partners went out of town and asked which of us in the group could cover his practice while he was away. I said I'd take Friday. One of the others in our group, who just got back from having surgery herself, and hence didn't know our call partner was out of town, admitted this man last night and left word at our partner's office, so he could go in to see this man himself. Generally, if one of us admits a patient at night, the primary care provider picks their own patient back up in the morning, or if it's the weekend, on Monday. However, if the person is away on vacation, the person who admitted the patient keeps them, till their MD returns. At least that's how it usually works. However, given that the admitting call partner just came back to work, I certainly wouldn't expect her to continue, given that I'm on call for all of us this weekend.
I arrived this morning to find an elderly man, a diabetic who'd had a heart attack just last month, who apparently had a pretty major stroke yesterday, AND who prior to the stroke had pretty advanced Alzheimer's. He was also in pretty florid congestive heart failure and was requiring an enormous amount of O2 to keep him oxygenated. For some reason, his primary MD had not addressed his code status with the family. When I arrived at the hospital, this man was still on tap to be resuscitated, should he become un-responsive. This man is now so ill, he likely will not survive the weekend, and I for one think trying to resuscitate this man is:
a) likely to be futile,
b) painful for the patient,
c) cruel to his family, and
d) senseless, given his severe dementia prior to having his stroke.
So I, a complete stranger, wound up having to sit with his son, who was very obviously struggling with his own emotions on figuring out what was in his father's best interest. What quality of life is he likely to be revived to, if any at all? Fortunately, the cardiologist I called to come 'chime in' on his care is very familiar with this man and his family, and was there to back me up in my suggestion that this man be made DNR (do not resuscitate). When I brought this up to his son, asking if he was clear on what his father, pre-Alzheimer's would have wanted in this situation, he agreed that his father would not want to be revived. Now that is clear, we can go ahead to focus on making him comfortable and evaluating all our interventions in that light. Treat his heart failure, his shortness of breath, watch for infection, keep him out of pain, but if he's destined to go gently into that dark good night, not stop him from doing so.
So this is what took up my morning and a good part of my afternoon, instead of getting my own paperwork done, something I desperately need to do. Perhaps more will get done this weekend.
One of my call partners went out of town and asked which of us in the group could cover his practice while he was away. I said I'd take Friday. One of the others in our group, who just got back from having surgery herself, and hence didn't know our call partner was out of town, admitted this man last night and left word at our partner's office, so he could go in to see this man himself. Generally, if one of us admits a patient at night, the primary care provider picks their own patient back up in the morning, or if it's the weekend, on Monday. However, if the person is away on vacation, the person who admitted the patient keeps them, till their MD returns. At least that's how it usually works. However, given that the admitting call partner just came back to work, I certainly wouldn't expect her to continue, given that I'm on call for all of us this weekend.
I arrived this morning to find an elderly man, a diabetic who'd had a heart attack just last month, who apparently had a pretty major stroke yesterday, AND who prior to the stroke had pretty advanced Alzheimer's. He was also in pretty florid congestive heart failure and was requiring an enormous amount of O2 to keep him oxygenated. For some reason, his primary MD had not addressed his code status with the family. When I arrived at the hospital, this man was still on tap to be resuscitated, should he become un-responsive. This man is now so ill, he likely will not survive the weekend, and I for one think trying to resuscitate this man is:
a) likely to be futile,
b) painful for the patient,
c) cruel to his family, and
d) senseless, given his severe dementia prior to having his stroke.
So I, a complete stranger, wound up having to sit with his son, who was very obviously struggling with his own emotions on figuring out what was in his father's best interest. What quality of life is he likely to be revived to, if any at all? Fortunately, the cardiologist I called to come 'chime in' on his care is very familiar with this man and his family, and was there to back me up in my suggestion that this man be made DNR (do not resuscitate). When I brought this up to his son, asking if he was clear on what his father, pre-Alzheimer's would have wanted in this situation, he agreed that his father would not want to be revived. Now that is clear, we can go ahead to focus on making him comfortable and evaluating all our interventions in that light. Treat his heart failure, his shortness of breath, watch for infection, keep him out of pain, but if he's destined to go gently into that dark good night, not stop him from doing so.
So this is what took up my morning and a good part of my afternoon, instead of getting my own paperwork done, something I desperately need to do. Perhaps more will get done this weekend.
