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Wednesday, October 10, 2007

How do you decide??

Life as a doctor is pretty mundane...Day in day out you will do almost the same thing, rounds at 8am, clinic at 10...blah..blah..blah But there are occasions like this past week where it has been an adrenaline rush. It is meant not in a good way. As I mentioned earlier, there has been an exodus of patients to the ER over this week... and this is not yet Raya. But what I am rambling about is not on how busy it will be etc etc etc....

I have been practicing medicine for the past 8 years.... but one thing I have never gotten the hang off is how make the decision whether to go for active resuscitation of a patient or not. Tonight I have been ask to make that call. A new admission who is elderly and has multiple medical problems was admitted with gas gangrane (a potentially fatal infection) of the leg. She has been bedridden for months and is taken care of by the daughter. Anyway, her pressure crashed tonight as she was in sepsis. My medical officer after resuscitating her called me to make the decision for active resuscitation or not.

Ah, I was in two minds. First and foremost I have no idea of the patient and her social support and thus can I make the decision there and then. I asked for active resuscitation but went myself to asses the situation. There lie a frail looking lady gasping for air.

Ah...shit.... next running through my mind is her quality of life.... can I ever improve it? Should I prolong her life in this current vegetative state? But then who am I to make the decision? Is the family accepting her very ill condition? Things like cost and quality of life is something hard for me to quantitate. 8 years never got me comfortable in making that decision. If I know the patient longer perhaps I wouldn't hesitate but this lady is 'new' to me.

We sent her to ICU. There I met her daughter who was crying away. I saw the old lady in the ICU.... we intubated her. Now I feel guilty, I should have the guts to say NO. I am making her miserable, but how can I let go. Ah I don't know, I don't know, I don't know...

And now at 1.30 I cannot sleep... I have done her wrong. If I was in her shoes I would want people to let me go and die in peace.... Ah......Life is depressing...

3 comments:

Spena said...

Bakawali-its not your fault. You are just doing your job. Tapi mesti you tak boleh tidur kan?

ardy said...

It is never our decision, never, to decide on ending someone's life. We suffer in this world, so that in the afterlife, it will ease our punishment and sufferings. God works in a mysterious way.

Maybe you feel you should have let her go. Maybe you made the right decision.

John F SeaDemon said...

When I had to end someone's life, I did not think twice. It was my job. The only mistake I did was to see his eyes.

Those eyes haunt me still.