Will you pull the plug?

morning sniffles — Tue, 25 May 2010 12:39:41 +0000

Mrs. M is an 86 year-old retired public school teacher who admitted due to sepsis secondary to coronary artery disease, type 2 Diabetes Mellitus, Chronic Kindey Disease (CKD)
She has necrotic non healing wounds on bilateral legs down to heels of her feet. She also has grade 2 bedsores at the sacral area that are about 8 cm in diameter.
She was on dopamine, dobutamine and furosemide drips when she was transferred to our ward from the suite room.
When her blood pressure has stabilized, the dopamine and dobutamine drips were taken out accordingly. And when the edema has subsided, furosemide drip was shifted to oral. She was then ordered to get out of bed and sit on bedside chair which she did but during her activity, she bled to much forcing her to stay in bed.
Within the week, her appetite has decreased resulting in decreased oral food intake. Nasogastric insertion was made to give way to osterized feeding to meet her daily caloric requirements.
Her oxygen saturation through arterial blood gas has deteriorated requiring her to be hooked to mechanical ventilator. Her increased mucus sections required frequent suctioning but being traumatic as it is, it was hard to introduce the oral airway as she bites it.
The family requested for DNR, no intubation, no suctioning, no chest compression no IV insertion attempts and what not. A couple of days passed and she was weaned off the ventilator. She was on oxygen per nasal cannula. Her vitals were stable but despite oral diuretics, she continuously retains water advancing to anasarca and deterioration in her level of consciousness was noticeable. Despite that, the family has decided to take her home with NGT and oxygen support on. It was not clear to me if she has brought home against medical advice but one thing is for sure, they will just wait for her to flatline at home which is equivalent to pulling a plug of a patient who is on life support machine.
I understand that they would not want to add more pain to patient by declining all invasive measures that could save or prolong her life, but still, is it right to just let her suffer until her last breath?

A tiring,edematous yet fulfilling task

morning sniffles — Wed, 15 Jul 2009 13:35:31 +0000

My rotation in the ward for my BST at the LCP has started last Monday and although sleep has been elusive, I still feel the adrenalin rush through my vein.

It is like I am an energizer bunny.

My feet are still swollen and although this signals me to follow the red light, I have no intentions of taking leave of absence. Although we are allowed to have 6 absences for the entire training period, I feel that it is just proper to maximize my training fee by taking the opportunity to be in the ward and learn new things about bedside care.

Aside from the bedside care, we are expected to perform admission and discharge procedures and to carry out doctor’s orders. If you want to excel in something you must not stop at just learning the 411 but you have to progressively learn the craft.

While I feel so pumped up in my training days, there are instances that sadness sucks the joy in my highly cholesteroled heart.

After every endorsement and rounds, I usually review the patient’s chart to check on the diagnosis, doctor’s progress notes, medications and everything I could wrap my mind around.

Last night, I managed only two patients. One has so many medications needed to be given at certain intervals. The other has just prn (pro re nata) or as needed medications. It was for pain.

The doctors made their rounds so I was not able to scan the charts of my patients.

At past 6:00 pm, I was asked by the charge nurse to assist the attending – an oncologist in medicating my patient (who only has prn med). He was given Etoposide – a chemotherapy drug.

After regulating the drug, I looked for the patient’s chart and found out that he has bronchogenic cancer with non small cancer cells. The cancer has metastatized in his brain.

He is undergoing 6-cycle chemotherapy. I was really surprised because he looked healthy, not experiencing alopecia and he kept on playing tricks on me every time I entered his room.

I am imagining, If were in his bed, would I still be the same bubbly person that I used to be? Chemo is a very scary and horrible experience based on people who have undergone it.

I know that as a medical practitioner, emotion should not get in the way of my profession. I was supposed to handle three patients that day but my third patient who had a DNR order expired. It is sad when you are in the room with the relatives to witness the doctor to pronounce the patient dead.

Every training day is a tiring and edematous day but at the end of the day, I do not feel exhausted.

This is what I wanted to do. Screw the odds, Death is not an option.

All I need now is my Trodat so that my hands will be spared from scribbling my complete name and license number on each page of the patient’s chart.

Morning Sniffles » edema

Will you pull the plug?

A tiring,edematous yet fulfilling task