The Jordan River
It is a relaxed Saturday, but I can’t stop thinking about our patient who will come off the ventilator and die on Monday.
The family requested Texas Hospice to assist with the extubation, sedation and spiritual counseling. Before proceeding, I will meet with the family and patient, who apparently is cognizant and fully aware of what is going on. I spent some time today reviewing anesthesia medications. The patient is hospitalized so I will have my choice of medicines and delivery routes (IV vs oral).
I’m wondering:
- Does the patient want me to knock him out completely or partially?
- Is the patient frightened, excited, or both? Is he exhausted from his illness and ready to be through?
- Will the nurse be able to titrate meds according to my orders and the patient’s sensorium? Do I need to attend the entire process?
- Will we be able to find the balance between adequate and inadequate sedation?
- How long will the patient live after extubation?
- What is the spiritual state of the patient and family?
- What end-of-life documents are in place?
- Who has the medical power of attorney?
Attending as the physician in charge of this of scenario will be a first for me. I think my subconscious knows there are a lot of pitfalls and, therefore, I am restless.
I will prepare well for my role. I pray for this man who is preparing for something much bigger.
