I say Americans because I’ve never worked elsewhere so I don’t know if this is a global thing or a cultural thing….
I went on service today and one of my pts was a guy with cancer with mets to the everywhere who was signed out as “discharged to GIP, will need hospice H&P”. *Great!* I thought. Hospice H&Ps are pretty easy, I have a dot phrase, and usually I only have to really explain why giving MeeMaw a bunch of narcotics isn’t actually going to harm her.
I walk in and there’s my patient laying in bed, a skeleton with skin, classic Q sign, eyes won’t blink. RR 10 and he appears reasonably comfortable, aside from the weird not blinking thing. His son walks up to me as I badge into the computer and stands nary a humerus’s length away from me, and starts talking about how he felt pressured to agree to hospice, he’s thinking to revoke it. He wants my second opinion if hospice was appropriate or if it was just pushed “cuz they’ve written dad off and don’t want to care for him anymore”.
Now, a month ago this pt failed his 4th line treatment. This onc group is amazing and have been priming the pump about hospice ever since the 2nd line failure. “No” he says, “dad told me 10 days ago he wants to fight. I want to take him for experimental immunotherapy. I want you to consult PT/OT/SLP. If he can’t swallow I want you to call GI and have them place a PEG tube.”
During this encounter the pt goes from comfortable breathing to agonal breathing. Son asks me “what percentage of sure are you that Dad is never gonna swallow again?” I say, as respectfully as possible, “about as sure of anything in medicine as I’ve ever been.” He asks me what we can do about it. I say we are past the point of no return and at this time the only thing to do is to gather friends and family around, keep him comfortable, and say goodbye. I say “your dad is dying”. He scoffs and says “we’re all dying, but I seem to be the only one who gives a shit.” I finally say (after an hour of being in the room) “no, I don’t mean he’s dying in the existential sense. I mean your dad is unlikely to survive the weekend.” Luckily at this moment the hospice RN walked in and I was able to gently extricate myself.
But seriously, what gives? Is this because we don’t have socialized healthcare? Is it because we think True American Grit can overpower Death itself?
I’m so sick of patients dying while waiting for their families to do the hospice meeting. I’m so sick of feeling like a callous cunt for having the audacity to point out that death is not something any of us can outrun, no matter how much of a fighter GrandPap is.
It was a rough day.