October 20, 2010

• Good Cop, Bad Cop

  On R service, I find myself playing a lot more good cop, bad cop than I ever did as an intern.

  A 22 year old girl whose mother was a patient that had suffered a heart attack and stroke with anoxic brain injury and was in a vegetative state. The intern had [correctly] convinced the daughter to make her mother’s code status CMO, or comfort measures only, meaning withdraw all life prolonging treatments and measures except for pain control to ease any suffering while the patient passed away. All was well and good, with the mother on hospice awaiting placement. A bed was found, but because the daughter would not be able to afford the $6000 for a month of custodial care, I decided to play good cop and allow the mother to stay in the hospital for another day while our financial assistance worked to help the daughter.  

  At which point the daughter decided she wanted to restart tube feeding on her mother. The intern decided to allow it. No good deed goes unpunished.

  At which point I come back in as bad cop.

  I basically came in and explained to the daughter I would do no such thing as restarting tube feeds would disqualify her mother for hospice care and hold up placement. The daughter explained that she didnt want her mother to suffer by starving. I explained to the daughter that food does not relieve pain, is not a medically indicated treatment for anything, and would only prolong her mother’s suffering by keeping her alive as essentially a root vegetable. The daughter continued to insist on restarting tube feeds. 

  At which point I had to ask her point blank, “I know this is a hard situation and difficult choices, but what is your endpoint here? What do you think feeding her is going to accomplish? She will never return to the way she was, and you are simply keeping her locked into this body because you feel guilty. Which you shouldnt. what happened is not your fault, but there comes a time to let go and let nature take it’s course.” I then told her I was stopping the tube feeds and that was my final decision.

  Not a nice thing to do to a 22 year old. But part of the art of medicine is managing not only diseases, but expectations, and if people dont have realistic ones, they will not be satisfied with hospital outcomes ever.

  Did I make her cry? Probably, but I never got to find out, because I still had 13 other patients to take care of, and I left the intern in the room for her to complain about the horrible doctor trying to kill her mother.

  • 10:15 pm
  • 3 Comments