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Monday, January 13, 2014

What Do You Want Us To Do

We pulled up to the house to find a kid about 18 years old waiving emphatically. As we followed him into the house he told us his grandfather was having a hard time breathing.

Inside we found a near 90 year old man laying quietly in bed. He looked frail and sick. Really sick. Like dang near dead sick. His daughter was by his side tending to him. The man was breathing ok and had a weak radial pulse. I noticed he also had an IV in his arm.

I asked the daughter what was going on. She introduced herself as a nurse (which meant absolutely nothing to me) and said that her father had cancer of the colon which had metastasized all over his body. He had a valid DNR and the family's wishes were for my patient to be comfortable. They had made their peace with the fact that he was dying.

The daughter than informed me that she had just given a repeat dose of dilaudid and morphine to the dad. Now she was worried because her father was having a more difficult time breathing.

For those of you that don't know both of those drugs belong to the opiate family (like heroin) and both cause a decrease in the body's respiratory drive. While we do have drugs to reverse this process it also takes away any of the pain killing affects of the drugs.

By now we had the old man on some oxygen. He was still breathing adequately but he was tiring out. We asked if they wanted us to honor the DNR which they did. That begged the question, what do you want us to do?

She just kind of stared blankly in response to that question. While the daughter had realized that her father was going to die it hadn't dawned on her that in would be that day.

We explained all the options to the family taking time to make sure they understood the possible and probably outcomes of each. They then decided to have their father/grandfather transported to the hospital with the caveat that he would be kept as comfortable as possible.

The next day I ran a call with the same medic from AMR. He said that the patient had made it all the way to the hospital but not much further. When they entered the ER the doc asked if the patient was still breathing. The MD and the medic looked down at the patient and watched him take his last breath.

At least he's is comfortable now.
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