on death and dying.

Well, first I'd like to start out with a link: http://www.youtube.com/user/rockyandballs#p/u/0/WO1QM2rH3KE

Today was another bang-up day on neuro. Consult #1 was a gentleman in the ICU who had already been in the hospital for 6 days. We were consulted for recurrent altered mental status. At the moment, however, his mental status has resolved. So .... there is nothing but a normal guy to evaluate.

*break* for some excellent noon didactics including a great trauma resuscitation lecture and a delightful M&M

Return in the afternoon for a consult on a lady in the ED who has aphasia, gaze preference, R sided paralysis, R facial weakness & decreased sensation. Fuck. Only thing - it started yesterday, in Florida, at 7:30pm, when their flight was on the tarmac. Then - dude brings his wife to a hotel and thinks she's just tired and *finally* brings her to the ED @ about noon today. During the exam, his biggest concern is how he's going to get his luggage which is on its way to San Diego. Let alone that his wife has a massive L MCA stroke (as it turns out - hemorrhagic).

I also thought about death a little bit today. That last patient there - she had a 5x6cm bleed in her head and was on warfarin and had probably been oozing for .... 17 hours. She had a very bad prognosis. So, on admission, we discuss with him whether his previously healthy wife (who is in her late 70s) would want to have an ET tube. "NO". What about compressions, medications, or cardioversion? "NO". So, this is a woman who was previously functional, who will likely be dead by the time I return to the hospital in the morning. It makes me feel a little dirty to say, but it was refreshing to see an appropriate DNR order - one that I felt I might make myself. She and her husband had talked about it before. They'd been happy and had led full lives. Neither wanted to burden the other, so they didn't.

It made me think of my Grandpa; he's 95 now. He'd been healthy, living more-or-less on his own until about 90 when my Grandma died. He was quickly moved from Florida up to NJ to be near my aunt. Since then, nearly any time I talk to him, he tells me how he's ready to die, "What's up Grandpa, how was your day?" "Just another day to wake-up." Serious depression. He watches all of the people in his nursing home die. He's now been hospitalized 3-4 times in the last year, bilateral hip fractures, sepsis secondary to UTI, and pemphigus. He just keeps ticking. He seems fixated on death when I talk to him, but he still seems terrified of it. I sometimes think things like, "he might be happier if he didn't have to continue this" and then finding myself feeling like a complete ass for thinking that. And then I argue with myself about it.

We can keep people alive forever - but should we?