Dying with dignity

I have recently moved into the new neighbourhood and started my practice. First of my experience to be a doctor in the community I am living like the old fashioned family doctors. I should say I am liking this experience.

I got call from the neighbouring block, they had a special request for home visit as she was very old and can't be brought to the clinic.

Sunday evening home consultation is not a very exciting event. Nevertheless I literally dragged my feet. The family was eagerly waiting for me.

She was 85 years old very frail and completely bed ridden. The family said she had a major fall followed by a surgery 6 months back has been bedridden for most part since then. They said she has not been eating for few days now, less responsive and has developed a bed sore too.

If same patient were to be brought to the hospital, my line of approach would have been to order various tests to check her electrolytes, infection and so on. We doctors are taught to fix things and to find things which we can fix. Lately some experiences and a most influential book "Being Mortal" by the author Atul Gawande has changed the way I look at these kind of  geriatric problems.

I told the family it could be the infection from the bed sore and I put her on antibiotic medications and some supportive medications, and told them we will see the response.

There was a dramatic improvement, they called me the very next day saying her appetite was better and was more responsive. I was surprised with the response and happy too.

2 weeks from the first consultation, they called in again. Her intake was less again, bed sore had healed completely but she was less responsive they said. Family was worried they asked whether she needs to be hospitalised and what will the likely steps be further on.

For the first time I heard myself talk about dying with dignity, how important it was to understand what the patient really wants and what can be done. Is hospitalisation really the answer??

I understand from all my previous experiences in dealing with the critically or terminally ill patients .It is not that the family doesn't understand the situation but it is the guilt that they haven't done enough for the loved ones pushes them to take decisions which may not improve either the life span or the quality of life. I addressed that particular concern, the family were extremely loving and taking great care of her.

With exchange of notes with patient herself, she said she wanted to be at home.
Family respected that.

Next few weeks went by meeting children, grand children.

On New year's eve I was called into see her, she had stopped breathing a few minutes ago. I checked on her and pronounced her dead. Her room was filled with children, grand children and loved ones around her.

Family thanked me for the clarity I gave them and not the false hopes.

As Doctors we have an enormous responsibility to communicate things clearly and in an utmost humane way. No medical school ever teaches you that.

Dying with dignity is as important as living with one.