On the subject of terminal care, perspectives on do-not-resuscitate, from a person of medical experiences, translated…
Many years ago, I was working at the offices of N.T.U. Hospital, I’d gotten a transferring patient. The family members told me, “the doctor said he didn’t know what he has, so told us to transfer to N.T.U. Hospital.”
I read through the referral sheet, it clearly stated, “Hepatoma metastasis to spine”. Could it be, that the last doctor didn’t DARE to tell the patient what he had? Or, did the doctor not explained it clearly enough, or even, the family members didn’t listen hard enough?
I’d started remembering a past case, a woman rushed her father who had terminal cancer into the E.R., the physicians in the E.R. told the families, “the patient is having difficulties breathing, we need to intubate immediately, if we don’t, he will die very quickly. Do we save him or not, you decide now!”
Although the daughter had persuaded the father to sign the “choosing a milder and more peaceful measures”, and had DNR registered to the man’s national health insurance card, but, as the E.R. doctor pressed, “Do we save him or not?”, she’d just felt, that “if I’d told the doctors not to save him, then, wouldn’t my father have died because of my choice?”, so, she’d told the doctors to save him.
And, two weeks after the intubations, his father, after being tortured, died. It’d made her regret her choice, and she couldn’t forgive herself to putting her father through the unneeded sufferings. Afterwards, she’d written a letter to me, complaining on how had the doctor spent an extra minute or two, to tell the families, “the patient is having respiratory failure, we’d need to intubate to save him, otherwise, he would be in life-threatening danger. But the patient has terminal cancer, intubation will only prolong his suffering. And, the patient already signed his own DNR, should we, respect the patient’s wishes, to not intubate, so he can pass away peacefully like he’d wanted to?”, I’m sure, that the families will make the right decisions, and accompanied by the patients’ sides, and with the help of the medical services provided, finishing up with life.
Revealing the Situations with the Patients, to Eliminate the False Hopes
The doctors should learn how to communicate with the patients and their families, especially in disclosing of the bad situations, to keep the families from feeling too distraught, but it shouldn’t keep the families on false hopes, so after the results didn’t work out, the family will be in deep regrets.
would you have this???
not my photograph…
As I worked as a resident of neurology my neurosurgeon professor, Cheng-De Lin made a very good example, for every patient he’d operated on, he’d placed the X-rays of the patients on the view box, and explained the situations until the families understood it, the pros and cons of surgery, possible outcomes, then, had the patient and the families make the decision on what should be done.
There was a family member who’d asked me, that their loved one is ill and the doctor said that surgery is needed, and wanted the members of the family to decide; he’d asked me if he should go ahead with the surgery for his loved one. I’m not sure of the patient’s condition, so I’d told the individual, ask your loved one’s doctor, “If s/he is your family, would you choose to operate? Why?”
The surgeons would often be asked to treat their patients like their next of kin, to use empathy with them. The surgeons should explain the outcomes of each of the options of treatment to the families and the patient, the possible outcomes of the decisions, so the families don’t have the false hopes. If it’s a very difficult decision, then, the doctor should think on behalf of the patient, if it were their loved ones, who would they choose for their loved ones. To help them make what’s the best decisions, or at least, the decision which the families will have the least regrets over.
There are a couple in their sixties, that came to my office right before the Chinese New Years, I’d found, that the wife had a brain tumor, that she had a very high intracranial pressure, she’d needed the surgery immediately. I’d suggested that she check into the hospital right now. But, it will soon be the New Years, and she’d refused to.
After I’d discussed with the family members, for the best interest of the patient, I’d told her, “You have a tumor in your brain, it’s a benign meningioma, there’s a high success rate. But, your intracranial pressure is very high right now, you are in imminent danger, you need the surgery now. If you don’t check into the hospital right now, you may not be around for next year too.” The patient cried for half an hour, then, checked into the hospital, and, by January 15th of the lunar calendar year, she’s already recovered completely, and left the hospital healthy.
or this???
not my photo still.
I’d often taught my students, to use empathy to tell the patients’ families, “If s/he is my kind, this would be the choice I would make on her/his behalf, and why.” I’d also often told the families of my patients, you can ask the doctors, “If s/he were your family, what, would you do, and why?”
Cared for in a Hospice, Living Longer & Better
If the disease is really hard, and caused the patients a lot of suffering, and even if they’d battled with it long-term, it’d spent a lot of medical resources and money, and the rates of success aren’t that high, the doctors should tell the patients and their loved ones truthfully. Don’t carry that attitude of let’s just try and get through it, and not tell the patient and the families about the pessimistic diagnoses, to mislead the family members, the patients, dying in suffering and pain, will make their loved ones regret for a long time! Actually, hospices is proven to help the terminally ill live longer and better too.
So, this, is from a professional angle, the man had seen so many cases, where the families refused to give up and causing the patients to suffer even longer, and afterwards, the families started regretting had we only, and so, the physical wrote this article, as a “warning” of sorts, to RESPECT the wishes of the terminally ill patient, so the families won’t have all the regrets after their loved ones are gone.
Life, the Obstacle Course 