Who is the "crazy" one here?
I recently saw a case of a man who suffered a severe traumatic brain injury and spinal cord injury. He was rushed to a local hospital and placed on life support. The doctor told his wife that he had less than a 1% chance of living and suggested removal from life support. Amazingly, this suggestion came less than 12 hours after the injury. Anyway, the patient's wife held physicians in great regard and had the mindset that "the doctor must be right." She again asked if he was sure the chances of living were less than 1% and he reportedly said yes once again. At this point, the patient's wife elected to remove him from life support. But something happened -- he kept breathing. And a few hours later, something else happened -- he opened his eyes, gingerly removed the cold compress from his forehead, folded it again, and placed it back on his head. He then lapsed into unconsciousness again. Amazed, his wife ran into the hall and asked for another doctor's opinion. The second doctor reportedly stated that if the patient is still breathing by himself the next morning that they will transfer him to a level one trauma center.
The next morning came and the patient was still breathing. His wife decided to have him transferred immediately. It is at this point that the most distressing event occurred to the patient's wife. She stated he overheard one of the nurse's say that the wife was "crazy" for trying to keep him alive and transfer the patient. Well, seems to me that the wife was correct because now the patient has regained many of his cognitive faculties (although not at the level he was before the injury), can hold a perfectly normal conversation with people, and although still partly paralyzed, can enjoy watching and interacting with his children. This was an important story which highlighted that doctors are sometimes too quick to elect to pull patients off life support and that some patients can pull through and fight the odds. We owe these patients the chance to make that fight (at least give them more than 12 hours!). To not do so, well, that is what would be "crazy."
posted by MedFriendly | 11:11 PM
10 Comments:
Wow Dr Carone...this IS such an important post.
I have handed out the paperwork for advanced directives with explanations as needed and yet I have not done this for myself or family. I should have the talk with my 84 yr old mom...but that is difficult to do. I don't do it for probably because like many people somewhere in the recesses of my mind I feel as though it would be death producing. it's ridiculous to think that though because I believe when it is time it is time.
I have often said though that I would want life support for a period of time and keep feeding tubes even if support removed. of course it is what is in writing that counts. I DO believe in miracles or unexplained recoveries (miracles)and so would want the chance and would want to give others the chance.
I think TWELVE HOURS was way to short of a time period. Maybe he would have been right most of the time and he has seen so much that would support his decision but maybe it would be good to step back a bit and reevaluate and maybe this case will cause him and others to do that, not only professionally but they may have to make a personal decision as well.
BTW that is why this is an important post because you never know how you might impact someone for the better on the blogosphere.
I would want to thank them for helping and I would bring them something to eat. In my thank you letter i would be sure to include how well he is doing. not too much just tastefully so. I would want to be tactful and non accusatory but still get my point across that he is doing so well. again because perhaps they need a reminder for the next time.
About the nurse...medical employees need to be careful, what they say, how and where they say it. It is a basic universal law that negative comments will fly through the hospital whether intended or not. and particularly if patients could be around because even if you are not saying anything bad they could potentially misconstrue it.
Once a coworker had asked me when I came in how my husband's case was going and I quietly told her about the disturbing setback that had occurred the day before. I didn't realize anyone was around to hear me. She left and shortly after a man came up to me, introduced himself (he was on a supreme court - showed me ID)and said he couldn't help overhearing me. (I thought I was quiet) I am not sure where he came from but he had brought someone else to the ED that day. he asked me some questions and befriended me. He gave me his number so that I could reach him anywhere in the united states at anytime. He could not get involved legally but he was a major emotional support at the time. Sorry this is long and now off topic but we never know who is around. Oh and I consider that meeting a "divine coincidence" in that I think that there are definite times they we are meant to cross each other's paths.
I am a traumatic brain injury survivor. I was in a motorcycle accident and am lucky to be here.
My husband never left my side. He had to know everything about what they were doing before it was done. He stopped me from receiving the wrong meds one time because he heard the nurse call me the wrong name.
I was fortunate to have someone watch out for me intelligently while I was in my coma and then later when I awoke. I was still in a vegetative state that I have no memory of for 5 more weeks.
I can only hope most people would have someone in there corner like I did...you have too if you can.
For every doctor who takes a patient off life support too early, there are 50 doctors who leave them in a vegetative state in the ICU for far too long, costing us billions of dollars in wasted money.
The problem for our society is not too little ICU care, its too much.
Other nations in Europe are not nearly as aggressive as we are in the ICU setting. They give their patients maybe 48 hours to turn around, and after that its pull the plug. There's none of this stuff about letting people linger for a week or longer waiting for them to come around. Thats routine medical practice in the states.
Well, ok, but in this case, they didn't even give the poor guy 12 hours.
Well Ok....nothing. Anon brings a very good point up about the REALITY of ICU care. Just how much ICU care have you done Dr Carone? Any? The reality is that patients are often kept ventilated in the ICU long after any meaing hope of recovery (for a multitude of reasons, family and doctor related). This includes multiple invasive procedures which in the setting of no hope of meaninful recovery can be seen a torture. Very simply this level of futile care is not allowed to occur in Europe. Additionally, you did not state if you recieved your info from the chart (docs) or the wife ...big difference. Who told you the pt had a less than one 1% chance of living. The wife or was it documented in the chart. From this vantage it appears that you have very little understanding of what goes on in the ICU on a day to day basis.
Then I suggest you get a new vantage point and stop making excuses for substandard medical care. Also, I also suggest you stop assuming things you know next to nothing about. How does experience working in one on the most well-known and busy trauma ICUs and neurosurgical ICUs in the country suit you? Well, that would be my experience which I did at Jackson Memorial Hospital in Miami. Perhaps you've heard of it. Oh wait, maybe not, since I have no way of knowing you are even a health care professional since you continue to hide under the name "anonymous."
Anyway, it was documented in the medical records that I reviewed that the doctors determined in less than 12 hours that he should be taken off life support. As far as the less than 1% comment, that came from the wife, but I'm not surprised you would discount that, since people with your type of haughty attitude normally dismiss anyything patients and their family members say anyway.
PS. Thank you for continuing to visit my site, because every time you do, you put more money in my pocket from advertising revenue. :)
Oh come now Dr. Carone. You are a neuropsychologist. You are not a pulmonary ICU doctor. This may be hard for you to believe but training as a neuropsychologist in Miami still does not make you an ICU doctor. Obviously I don't know the specifics of this case, but
the reality of ICU care is that we are often way to aggressive in futile (or close to futile) circumstances. If you really had a close relationship with the ICU it would be patently obvious to you. Please, I don't want you to believe me, I want you to look up the evidence for itself and stop spewing personal anecdotes. You use almost no objective evidence on your blog. Just your personal opinion. That is fine but opinions are like a$$holes. Everybody has one. About my "haughty" attitude...I am not the one butchering residents, staff, and everybody else on my blog for whatever reason...you are. I mean really, wearing ID badges that don't flip around. Have you ever even worn scrubs before? Why don't you just complain about the color of the walls of the hospital. Is it really that hard to ask somebody who works in the OR all day to flip there badge around?
PS: If you get paid by medicare D providers when people visit your blog (or subcontractors paid by them)...good for you. It just means you are hypocritical when you rail about residents taking pens/lunches. Can't you see the similarity here guy?
Funny, I never recall claiming to be an ICU doctor. Now here is something you may find amazing, but we actually agree on something. That is, I agree that there are many instances of futile ICU care in which people are kept alive in vegetative states or comas and the family is left with unrealistic hopes of a miraculous recovery. That is one extreme. But there is another extreme, and that is the one I was trying to point out. That is, cutting someone off from life support after less than 12 hours is just not enough time. And if you sat down and talked with this patient like I did, was able to have a normal conversation with him, and understood how happy he is to be alive and watch his children grow up, you might understand why I feel so strongly about this.
I am a big believer in objective evidence and science. Go to my website and you will see the peer review article I have published in neurology, neuroradiology, psychology, and neuropsychology journals. But there is a time and place for everything. This is a blog and this is where I get to express anecdotes and subjective opinions. That's the whole point of the blog. And yes, you are free to agree or disagree as you see fit. I hold no monopoly on the truth, but I have strong views and I'm not scared to express them. I guess that is another thing we have in common.
Yes, I have worn scrubs plenty of times having been involved with more than my fair share of WADA procedures. I shouldn't need to ask people to turn their ID badge around like I am an FBI agent. It should be readily observable. I have nothing against residents and couldn't stop laughing when you said I have a superiority complex about them. It wasn't too long ago when I was a resident/fellow, so trust me, that's not it. I just have a problem with substandard medical care and I don't care who it involves. When I see it, I will point it out. And since you mention it, the hospital walls could go for a touch up.
Lastly, I don't get the analogy between me having a private blog that anyone is free to come to in which there is no quid pro quo versus medical professionals taking gifts from drugs companies which can later affect their clinical decision making. Hey, but that's just me.
Sorry medfriendly, not part of the thread but anon is right. If you are taking money from medical/pharma advertising then you really have very little to say to some poor overworked, sleep-deprived, resident looking for a meal or a writing instrument. My 2 cents
Sorry, but there is no conflict of interest in terms of what I write on my website and any of the advertisers.
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