Change brings about a lot of emotions. It evoke passion that makes us uncomfortable, make us move beyond the realm of what we know and challenges us. It leads us open to fear. The right wing sought that out and play that to the weak, the frail and the paranoid right in the use of "Death Panels".
This week I promised myself that I would not discuss Advanced directives with my patients after the right wings claim to have won the battle in "removing the death panels" from the house bill.
More of my thoughts below the fold.
My thinking may have been wrong. I've been a Nurse for 25 years. I've owned my own Assisted living facilities for 8 years, been a Hospice Nurse, work ICU, ER, Open Heart and dealt with literally thousands of deaths. Many of these were without Advanced Directives, they had no living wills, no Health care surrogates, left no instructions as to what their last wishes were should their lives hand in a critical balance.
I deal with this balance every day, where seconds count. Presently and for the past 4 years I work in a Cardiac Cath Lab. A stable patient can arrest with a balloon or stent inflated in the LAD at any time. A living will or DNR is usually revoked during these procedures and treatment for Ventricular fibrillation is immediate and usually (as it is witnessed) converted quickly. But the STEMI patient poses a different challenge, as does the elder pacemaker implant or peripheral runoff/aortagram.
A STEMI is a heart attack with ST elevation. Many patient do have advance directives and occasionally there is confusion. In todays medicine the likelihood of survival from heart attack is much higher that when I first got into critical care 25 years ago but the occasion arises when we find a patient ventilated and left suffering from a hypoxic event. It is time to make a decision to "pull the plug on Grand mom" As Sen Grassly put it.
While Texas and Virgina has Medical Futility laws, in many States it's up to the Physician to make the decision to remove life support, even if brain activity exist. I have watched it in disbelief as viable people died. There is not always the standard to met "clinical death". This is why the "conversation" is important between the medical provider and the patient. Laws are not consistent from State to State and Physician / Client privilege can become a smoke screen for both nefarious behavior or extreme waste in health care cost.
The decision belong to the patient as to how they want to end their life, in what conditions, leaving what debt or expenses or memories to their families. My own father refused treatment for lung cancer as it would only create debt, make his last 6 months sicker and not give the family any better memories of him. He went into hospice and from 6 week of diagnosis - death he faced his life and his choice without debt. Public option removes the pressure of this "debt" question. Public option gives patient faster access to health care so cancer isn't stage 4 because of cost concerns over which insurance plan I can afford or denial of referral. But I'm getting off track.
So, having made up my mind Friday morning that I wasn't going to talk to any patient about DNR's or living wills I went to work overtime in the open heart unit (my wife is out of work with an infection on her spine from dental work that she had and it infected her heart.... settled to her spine as osteomylitis). Low and behold I spent 1.5 hours dealing with a patient and her daughter talking about her DNR order and getting back to hospice.
While the right is debating "death panels" and killing the public option, Nurses and Physicians are dealing with real scenarios that are costly, private, heartbreaking and we can't get reimbursed for our time?
Public option must stay on the table.