In the AST, a book doctor of emergency medicine Paul Seward “Angels of Rescue”. “Pravmir” publishes an excerpt from the book.
- Help? Salvation? Legalized euthanasia?
- Euthanasia: right to die or a cry for help?
- Refusal of resuscitation is not euthanasia
- Against the wishes of the patient called an ambulance, she died in the intensive care unit alone
- Family decided to turn off – and what to do doctors
I took the envelope, drew from him a statement on three typewritten sheets and quickly looked at her.
The guy wasn’t always disabled. To nineteen years of age he led a normal life, if you count the usual problems at school, experiments with drugs and a friendship with bad guys. He had the girl he was definitely concerned when she got pregnant, they got married, but continued to live together, and our patient took multiple jobs to support her and her son.
Unfortunately, he got involved in the drug trade.
And one day, about two years ago, was in trouble. There was a fight — whether for money, whether for drugs, in the securities is not explained. Said only that in a fight the young man was hit in the head with a piece of pipe, which fractured the skull, which caused a serious concussion of the brain. Ambulance took him to the neurosurgery, where he immediately had surgery to take away excess blood. Doctors temporarily removed the cap of the skull due to swelling pressure on the brain is not increased. Put him on an anticonvulsant, to check the level of glucose and oxygen in the blood and loaded into a medically induced coma to give the body a break and start the recovery process. In other words, your surgery the neurosurgeons saved a patient’s life.
That’s just to Wake him up then they never could.
Ever since the guy was in the nursing home. Through the abdomen into the stomach he introduced a tube through which the food was received. He was regularly turned and as necessary, changed the diaper. He from time to time opened his eyes, but individuals are not distinguished; he didn’t react to it and he didn’t say anything. The mother, who often visited him, thought that sometimes he knows it. The sisters are doubted.
During these two years he has been in our hospital. Once he popped the tube leading to the stomach, and it was necessary to insert a new one. There were also respiratory disease and inflammation of the urinary tract. But in such serious condition he was admitted for the first time.
I once again flipped through the map. Then he looked at the patient. And looked at the nurse.
“Look,” I said. — Take all the tests, but the samples leave here — will not send. Then when you put the catheter, begin to pour saline at 20 CC per hour and come with me. I have to call. Let’s stop for a moment.
In fact, at that moment I realized that the young man in the ward — not just sick with a infection.
I had to decide how to take care of him from a human point of view. Given his position, what he actually wanted from us? And how could we understand what he wants?
Of course, his case presented a serious medical problem: infection, and recognition and prevention of early septic shock, and maintenance of respiration in a patient with severe injuries of the nervous system, and difficulty with blood pressure.
But a human being — not just a set of medical problems. It is also the ethics. And quality of life. And religion — or spirituality. Someone needs to ask these questions and answer them, if the patient can no longer?
We should not forget that for him I am not a pastor for the parishioner and not the teacher for the student. He’s my patient and I the doctor is obliged to provide him with medical care. We met under such circumstances where I need to provide it with highly qualified, expert medical services, to do everything possible to save him, to cure him. Such is my role. But at the same time I am a person dealing with another person, and can’t help but ask yourself, will it be sufficient just to perform this role, or have yet to go beyond it?
I want to say that even now, after thirty years of practice, I do not pretend to know all the answers. But then I realized that not knowing the answers does not exempt me from having to ask questions.
I want to take you, but my knowledge and make me the authority to act on behalf of the patient. Everything I do — or not do — for it will fall on my conscience. I chose my job; for many years he studied and worked hard to be here. The hospital hired me and pays me a lot of money to do their job, i.e. take the right decisions.
So, what decision I made?
I sat at the table, from which rose a few minutes ago, picked up the phone and dialed the number listed on the cover of the card. The woman on the other end answered after the first call. I introduced myself and asked who I was talking to. Then they said that the call from the hospital that I was a doctor of emergency aid and now nurse her son.
I can’t remember all the details of our conversation. In short, she said she had a call from the nursing homes and she was expecting my call. She asked me how she feels her son. I explained that he is seriously ill, probably with a serious infection — judging by the condition of the lungs, pneumonia, — which, given his other problems, he can quickly die. I also said that we gave him saline solution and we’ve managed to stabilize him, but if we’re going to save his life, we must take much more decisive steps, and as soon as possible. I asked what she thinks about it.
The woman replied that will be in the hospital a few minutes; may I wait for her arrival? I said that nothing is going to do without her, and hung up. Then he asked the nurse to invite the liaison officer with the family (it’s a special person hires the hospital that he was in contact with relatives of the patients, buying magazines, brought coffee and generally provide a comfortable environment for patients and members of their families) and the hospital chaplain and returned to the house to the boy to check how things are going.
Less than a quarter of an hour, how came his mother. Communications officer waited for her met at reception and escorted to son. I was still in the house, so saw her immediately walked over to the bed, took the boy’s hand and looked him in the face. She spoke to him: said that is always there and he loves it. Then looked up at me.
I told the nurse to watch the patient a few moments. We liaison officer took the mother into the next room intended for relatives of seriously ill patients, where we could be alone. On the floor there was a carpet, and the walls were sofas and chairs; side tables with lamps were laid out magazines.
Our conversation took very little. She asked about the status of my son. I replied that at the moment due to intravenous infusion of his heart rate and blood pressure stabilized a bit. We gave him a tylenol suppository, gently ease the heat, so probably he felt a little better, although he was not able to tell us about it.
Then she asked what will happen to him next. I said that, on the one hand, if you give him strong antibiotics and transfer to the intensive care unit for intensive care, it may last some more time in the nursing home.
On the other hand, without antibiotics, he likely would die within a few hours. I also mentioned that, as far as we can judge, no pain he does not feel.
I admitted that I can’t say whether it is necessary to try to save his life, knowing that this episode will follow exactly the same or it is better to give to move with the world. Such a decision could only accept it.
The moment his mother was silent. Then said, “I Think we need to let him go”. I nodded and stood up to escort her back to her room…