Compassionate care in 2017

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A 90-year-old mother is in the hospital for a stroke.  Her son gave me the following details:

Two months ago, mom was admitted to the hospital for dehydration.  At baseline she had mild dementia and chronic atrial fibrillation.

She recovered well.  Before discharge, the primary care physician convinced the family to change her status to “hospice,” arguing that she would get better, more appropriate, and more comfortable care.  Her blood thinner Eliquis was discontinued for being “too risky.”

She went back to her home where she lived with her family and had a care giver attend to her needs also.

She was ambulatory (using a walker), but her family bought a wheelchair for extra assistance.  She was able to feed herself, was conversant, and enjoyed life (she sang to herself frequently).

Off the blood thinner, she had an ischemic stroke last week.  The hospice service initially diagnosed it as an aspiration pneumonia and advised the family to put her on “comfort care.”

The family went against that advice, took her off hospice status, and got her admitted to the hospital.  She is now mostly somnolent, aphasic, and hemiplegic.  She is kept on intravenous hydration only and has not had any food for a week.

The hospital service is telling the family that there is nothing to be done, and that they should consider discharge to a nursing home for comfort care.  Anticoagulation has not been resumed.

She is, however, making urine, and not showing sign of any imminent death.  Instead, this woman is being condemned to death by starvation and/or another stroke.

This is what passes for compassionate care in 2017.

5 thoughts on “Compassionate care in 2017

  1. Hospice marketing people (usually attractive younger females) bring me pens and sticky notes, like pharmaceuticals used to before the feds shut them down. Big pharma drug pens didn’t bother me, but the cheery hospice promoters do, and their trinkets do too.

    Reminds me of a cheery female life insurance salesperson telling my wife and me the astronomical sums my wife would get if I died sooner or later. No cheer for me.

  2. Should it not be determined medically if her being taken off blood thinner might have caused complication?

    • There is no way to be absolutely sure but it certainly seems to be the case, given the timing.

  3. She & her family should be doing cartwheels for the 10 bonus years she received (most people die in their early 80’s, IIRC).

    If her family wants to pony up the funds from their own piggy bank to keep her going, by all means, splurge. But if there are public or pooled (insurance) dollars that have to be spent to do this, the science of scarcity (economics) has to ask whether such money would be better spent on a younger patient with bigger problems.

    The reality is that there are no solutions, only trade-offs. And “compassion” is a useless tool for making those decisions, since it can be applied to every sick person that any pot of money could be spent on.

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