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Addressing these issues takes a team that includes nursing, social work, and other staff members who interact with a patient.
We had met recently with Charlie and his wife to talk about his deterioration and the declining quality of his life. He was no longer able to do the simple things he had relished in the past, including 6-mile walks around the lake and his favorite food (Korean). Things weren’t working for him anymore: he wanted to know not only his prognosis but also his options.
In our discussion with Charlie, we reviewed the medical options, but we also made clear that he had choices, including the choice to say “no.” As always, Charlie’s was clear in his own (coherent) mind as to where things were going. He decided that there would be no further hospitalization, surgery, or dialysis for him. Enough was enough.
The physician needs to be engaged and willing to enter into this end-of-life discussion. Sometimes it takes a house call.
We helped make Hospice arrangements so that he could be home with his wife and spend his remaining days with friends and family.
These events and choices all happened 3 weeks before the “miffed” phone call. I called him. On the phone, all Charlie wanted to know was, “if it’s supposed to take less than two weeks to die, then why haven’t I died yet?”
We agreed to have lunch at a place on the lakeside near his home. He was more unnerved than angry because “he expected to be dead already.” I think that his modest residual kidney function put him on the long end of the bell-shaped curve for that 8 + 2-day average time to death after stopping dialysis. This was something we hadn’t really considered during our previous discus- sions. When I explained this to him, he accepted my explanation with his usual grace and practicality. He said he was not in pain, that he had good nursing support through Hospice; that his wife was sad and would be lonely when he died, but would have her children for support. We parted. I said good-bye with a hug, and I offered that it wouldn’t be much longer. Indeed, he died 3 days later, quietly at home.
The physician needs to be engaged and willing to enter into this•end-of-life discussion. Sometimes it takes a house call.
Volume 73 • Number 4 Washtenaw County Medical Society BULLETIN 25
Health & Fitness