Thursday, Sep. 3rd 2015

The unplanned journey

When I set up this website a couple of years ago I envisioned that I might be blogging with some regularity, not daily, but at least more often than once a year!   I’m going to give it a go again with a post here and there and I hope my partners will also occasionally post.   There is so much going on in the world of pain management and palliative care that it begs for some thoughts from physicians who practice in the arena daily.     Like many blogs, these will be editorial thoughts for what they are worth.   If nothing else, I hope they will spur thought, conversation and perhaps controversy!

As we took off on rounds this morning we were discussing the man we were about to see. He is clearly at the end of his life, but not actively dying. It is here where palliative care seems to be most important.     Heart disease. Lung disease, diffuse spinal degerative disease, morbid obesity. He is immobile and now has a potentially lethal spinal injury with infection that cannot be “fixed” or even stabilized by surgery. He’s an older man, in his late 70s close to the average for life expectancy in the USA. He has been slowly declining and really is suffering despite everything we can throw his way to help with physical pain.    Without a DNR and with family members resistant to the concept he is facing a rough end.   It’s been presented but family is not ready to discuss it.

This is a little like someone who decides to take a trip, and has booked an airline flight.  They have no other plans.   They aren’t even sure which country their plane will land in.   No planned place to stay, no travel itinerary, they’re not sure how to get back or how long they’ll be there.   No one would take that trip yet we see this thinking in the hospital often.   People seem willing to accept medical care without even spending time to discuss thoroughly what that trip will look like.   This gentleman has a good chance of ending his life on a ventilator with a feeding tube in a facility, bedfast, if he survives a code blue and makes it through the ICU.    It’s his choice but he and his family deserve the right to have more than one travel itinerary presented to them before his plane takes off and lands.

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