Wednesday, October 07, 2009

Giving up.

One of the biggest challenges of medicine is knowing when to quit.

We take care of lots of sick patients and sometimes we push and push and push. Sometimes we don't. I don't know if I'll ever learn enough to know how to decide what to do. We were taking care of a patient yesterday who was very, very sick. We basically were doing the absolute maximum medical therapy. Chances of recover seemed miniscule. Part of me was ready to keep pushing. You never can tell how people will respond and she had made a very, very slight improvement.

Most often in this situation, I am the one who is ready to stop. I am the one who has to tell the family, over and over, that there is no hope. That continuing is pointless. To try to get them to understand. Her family, though, hated seeing her intubated, with essentially no neurologic activity, being kept alive by machines. She had discussed with her family her wishes, and had said numerous times she didn't want to be in this situation. They were pushing me to quit.

And so we did. We turned off the medicines. Took out the breathing tube.

She died 7 minutes later.

Did we do the right thing? I think so. I really do not think she would have made any meaningful recovery. She was able to die peacefully, according to her wishes. Her family was able to say goodbye. But deep down, I always wonder what if.....

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