Family Meeting

This past week I had the opportunity to conduct a family meeting regarding a patient whose prognosis was extremely poor. The patient was a 71 year old woman with advanced breast cancer who was in hospice at home doing fairly well. She comes from a large and very close family. One night she woke up, felt dizzy, vomited and passed out. When EMS arrived, she was in asystole - her heart had stopped beating. No one knows for how long. They shocked her, did chest compressions, put a tube down her throat and started mechanical ventilation. Generally speaking, the recovery rate from "coding" someone (doing all those things I just mentioned) is pretty poor. Technically the patient was dead, and the EMS team brought her back. Unfortunately, her brain suffered extensive damage during the time her heart wasn't beating. By the time she arrived at the hospital, it was evident that she was severely compromised. At first the family wanted to do everything possible for her in the hopes that she would recover.

The purpose of the family meeting was to help the family understand the patient's condition and make decisions about how aggressively to treat her. It was a pretty emotional meeting. There were about 10 family members present, mostly the patient's children. Most of them understood that the patient was not going to get better. They knew she did not want to be kept alive on a ventilator and they did not want her to suffer unnecessarily. After many tears, honest answers and prayers (on my part), the family decided they would take the patient off the ventilator. We stopped all of the medications and IV fluids and wrote orders to keep the patient comfortable (medications for pain and anxiety). The family all gathered at the patient's bedside and later, when they were ready, they had the patient extubated (pulled out the tube that was helping her breathe). She passed shortly after that. It was one of the hardest things I've ever done, but also beautiful in a way - helping a patient die with dignity surrounded by their loved ones and helping the family through a very difficult time.

New House

Here are some pics of my new house. I moved at the end of June and have gradually been settling in with my new roommate Alexis. I don't have any pictures of her yet but I'll try to update soon.

It's a townhouse/duplex - pretty cute and comfy. Trying to fit two people's stuff in is a challenge, but we're managing to downsize bit by bit and get organized.

Started a new year and had a great first month as a second year resident on adult medicine. I'm on pediatrics now, so totally the other end of the spectrum. Life is still ridiculously busy, but I guess that's just the way it's going to be for another two years.