Monday, September 21, 2009
I recently spent some time in another country that has socialized medicine and thought I would share a story that illustrates the differences b/w our system and socialized medicine:
72 yo deaf and demented male from a nursing home arrived looking pale, diaphoretic, and not responding to voice commands. The gentleman looked very critical, and my instincts were to get ready to intubate him. However, my attending on duty looked at the patient and realized his quality of life was very low considering that he was deaf, at the end of his life, and living in a nursing home. He told me to not intubate the patient(even though no family members were present). I then got an EKG illustrating a very wide complex tachycardia with high t-waves suggestive of hyperkalemia (high potassium). I drew a state venous blood gas which confirmed a high potassium level of 7.0 (normal is less than 5).
When the potassium gets very high, it can cause the heart to stop beating if is not corrected. I brought the EKG to the attending with the lab result of the high potassium and asked him if he wanted me to push calcium gluconate with IV glucose/insulin (the treatments for a high potassium). He said, "No. His condition is already very critical because he is in urinary retention and has an acute abdomen. We need to just let him die peacefully."
It was quite shocking b/c in America we would have intubated him and performed heroic measures, but it begs the question- "Why do we save everyone and not take into account individuals quality of life? Would I want to be treated if I was demented and lived in a nursing home? Is it more humane to just allow people to die peacefully?"
Rather then giving him calcium and glucose/insulin, I gave him Morphine for comfort. He died peacefully about an hour later.
Posted by SerenityNow at 12:25 PM