Friday, November 09, 2007

Easier in than out?

My patients are like time bombs, I contemplate silently as I drove home post call this wet, winterlike drizzly morning along the TM-Machang road.

Many of them come relatively well yet at the slightest provocation or in some none at all, may trigger such an explosive chain of events that you as the doctor is simply blown away.

I've not had a, may I even call it dramatic, on call in a long long time. and I don't wish to have one similar to it in an equally if not longer time.

Referrals all day and two deaths upon arrival at HRPZ's casualty. Hmm, the MOs there are probably cursing me under their breaths.

Both deaths are octogenerians, but doesn't mean it is less painful to their beloved.

As I sit here watching my kittens being bullied by big fat Bubu, I wonder how the families are doing. Did they regret the decisions they made? Are they happy with the way I handled their cases?

The first difficult case in the morning initiated a disagreement among the family members. When she deteriorated, there was only one son and he told me specifically to go all out in managing her. When the rest of the clan turned up, it was a different story altogether. I was already being called to attend to an actively bleeding upper GI bleed case in the male ward so I left the case to my senior MO who, upon returning from escorting a case of a fully dilated transverse lie in labour, was called immediately to escort this one.

She told me later that the eldest son was unhappy that the decision to intubate and refer his mother was made without the whole family's agreement.

This is the dilemma; the decision to intubate or not is a very difficult one to be made by an MO, especially one who is oncall alone on a public holiday. When I am faced with an increasingly distressed patient, I can't just stand there and do nothing.

It was further complicated when during the resuscitation period, practically the whole kampung was watching us; most likely thinking the modern doctor is only torturing a soul who is ready to go. Yet, at the same time, we often get berated for denying them the chance to say goodbye.

I knew, practically, she was not the best candidate for active resuscitation yet till now I am still at loss for words when I try explaining this to the family. How do you tell family members to let go? Is letting go the same as giving up?

Furthermore, if I was faced with this, would I be rational enough to make the right decision?

3 comments:

Anonymous said...

doc yana,
nak tanya,
in the case mentioned above, siapa yang paling layak untuk bagi consent? first son? husband? the person admitting the patient to the hospital?

Sue Tiramisu said...

Actually, any first degree relative yg cukup umur bleh buat decision.
Org melayu nie usually will defer to yg lebih tua biasanya. So most of the time, husbands will have say lah, then followed by eldest son...

Anonymous said...

i have the same experience too....it's a life circle doc...