Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

We were promised death panels

Physician on FIRE, MD
Physician
July 18, 2016
693 Shares
Share
Tweet
Share

The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there’s free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma or a particularly nasty infection. We’re prepared to handle them.

“Where is the patient?” I inquired.

“On the way down from ICU. The surgeon’s on his way in,” I was told.

Hmm … they usually come from the E.D. This may not be typical.

I look up the elderly woman’s medical record on the computer. Two days post-op. Ischemic bowel. Septic shock. Multi-system organ failure. Two pressors at maximum doses. This is not typical, at least not for our community hospital.

The patient rolls in with two nurses.

“We haven’t been able to get a blood pressure or pulse oximeter reading, but she was speaking a few minutes ago.”

She’s turning a bluer shade of pale despite 100 percent oxygen delivered via a non-rebreather mask.

We proceed swiftly to the operating room.

“Is she full code?” I ask.

“Yes. We’ve been trying to contact family all morning, but we haven’t gotten a hold of anyone.”

OK. Ketamine, succ, tube. We hang a third pressor.

Incision. We have a blood pressure, 56/29. More pressors. I place a 20 gauge catheter where the radial artery should be pulsating. Success. I take a few deep breaths.

The skilled surgeon discovers a belly full of dead bowel. We titrate our medications to obtain a blood pressure of 90/50. Most of the offending intestine is removed, leaving a short segment of dusky small bowel to allow any abdominal contents to escape via an ostomy.

The patient is returned to the ICU with a breathing tube in place, but with better numbers and better color than she had an hour earlier. With some serious teamwork, we did what was necessary. It was not easy, and I relied on our nurses, nurse anesthetist, surgeon, scrub tech, and others to contribute and help me keep her alive. We did a great job.

But did we?

Hours later, family convened, and the reality of the situation was presented. Her condition was more or less incompatible with life, and she wouldn’t have a heartbeat if not for earlier and ongoing Herculean efforts. The family chose to withdraw care, and she passed away shortly thereafter.

Scenarios like this are played out in hospitals across our nation every day. Too often, we neglect to think about what we want the end of our lives to look like. It’s easier not to think about it, and not to plan for it.

As a result, we health care providers frequently do “everything possible” to sustain life for patients with dismal odds of survival, let alone any sort of meaningful life if the patient does indeed survive.

Spending skyrockets in the final year of life. Analyses of Medicare patients show spending of $40,000 to $50,000 on medical costs in the last 12 months, a six to seven-fold increase over average years.

Enter the death panel

The term “death panel” is the opposite of a euphemism, a cacophemism used to portray a sane way of addressing end-of-life issues in a negative light. The term was coined in 2009 by Sarah Palin as a strategy to create public outcry against the Affordable Care Act (ACA).

The actual legislation targeted was HR 3200, a bipartisan bill cosponsored by a cardiovascular surgeon, Charles Boustany, MD, that would provide reimbursement for physicians to discuss advanced directives, living wills, and other end-of-life issues. The bill, supported by the AMA, AARP, and others, was inserted into the ACA, subsequently removed due to the “death panel” controversy, and eventually died an undignified death of its own.

While we may not need death panels, and we certainly don’t need care rationed by governmental bodies as the term suggests, we could certainly benefit from further discussion and consideration of what we want done to our bodies when we are facing near-certain mortality. As a society, we should recognize the importance of having a plan in place, and as physicians, we need to help our patients face these uncomfortable questions before the answers become necessary. Consult with your own physician; my wife and I have expressed our own wishes in a Five Wishes document.

If you haven’t read How Doctors Die, it’s a worthwhile read about how a handful of doctors choose to live their final months and days. In contrast, a new study highlighted in this recent Doximity article, shows that we die a lot like everyone else, despite our knowledge and best intentions.

When we fail to address end-of-life issues, we rob people of the ability to die with dignity. The woman we “saved” if only for a few hours, was speaking before she was rushed to the operating room.

I didn’t hear those words uttered to the nursing staff, but they should have been spoken to her loved ones. She should have been able to say goodbye and hear what her siblings and children had to say before drifting away to what comes next. If the appropriate discussions and decisions had taken place, she may have had that opportunity.

We did what we had to do for her; I wish we could have done less.

“Physician on FIRE” is an anesthesiologist and can be reached at his self-titled site, Physician On FIRE.  

Image credit: Shutterstock.com

Prev

The cost of taking the USMLE exams is staggering

July 18, 2016 Kevin 8
…
Next

5 questions to ask before applying to medical school

July 18, 2016 Kevin 2
…

Tagged as: Critical Care, Hospital-Based Medicine

Post navigation

< Previous Post
The cost of taking the USMLE exams is staggering
Next Post >
5 questions to ask before applying to medical school

More by Physician on FIRE, MD

  • Personal finance strategies to combat physician burnout

    Physician on FIRE, MD
  • A physician volunteered for his hospital’s board. He was sued for millions.

    Physician on FIRE, MD
  • If you are a practicing physician, you need rest

    Physician on FIRE, MD

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • A story of a good death

    Carol Ewig
  • I challenge you to discuss death

    Emily S. Hagen
  • My grandfather’s death: What I’ve learned about life

    Munera Ahmed
  • Death and Dvořák

    Daniel Song
  • Medical error is not the third leading cause of death

    Skeptical Scalpel, MD

More in Physician

  • Beyond pizza and pens: National Doctors’ Day should be about saving lives

    James Young, MD
  • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

    Asha Padmanabhan, MD
  • Physicians are a finite resource we need to protect

    Jack Resneck, Jr., MD
  • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

    Kevin Haselhorst, MD
  • The hidden truths of hospital life: What doctors wish you knew

    Emily Stanford, DO
  • The heart of a Desi doctor: Balancing emotions and resources in oncology

    Dr. Damane Zehra
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech
    • The beauty of a patient’s gratitude

      Dr. Damane Zehra | Conditions
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 15 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Moderna's Steep COVID Vaccine Price: Corporate Greed or Capitalism?
  • House Republican Argues Against FDA Budget Increase
  • Prescriptions for Stimulants Jumped During the Pandemic
  • Federal Judge Strikes Down ACA's Preventive Care Coverage Requirements
  • Pandemic Jump in ED Visits for Firearm Injuries Continued Into 2022

Meeting Coverage

  • VTE Risk in Recurrent Ovarian Cancer Increases With More Lines of Chemotherapy
  • Obesity's Impact on Uterine Cancer Risk Greater in Younger Age Groups
  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech
    • The beauty of a patient’s gratitude

      Dr. Damane Zehra | Conditions
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We were promised death panels
15 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...