tag:blogger.com,1999:blog-7423880838207203660.post7114298820539522924..comments2008-05-19T13:55:14.959-04:00Freadomhttp://www.blogger.com/profile/01132949384071592216noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-7423880838207203660.post-39370086266925410812008-05-19T12:26:00.000-04:002008-05-19T12:26:00.000-04:00The ethical dilemma is always more apparent in retrospect than in real time. Putting myself in your shoes, and in the family's shoes, I do not think that anyone made irresponsible decisions. You all opted for a chance at saving your patient, which was possible, given what you knew at the time you had to make the decisions. Yes, it was a long shot, but it was not unreasonable. Tragically, it turned out badly. That does not mean that you did less than your best for your patient.<BR/><BR/>It would be interesting to read a post from an attorney in your state as to whether the patient can be terminally extubated on the basis of her DNR request.<BR/><BR/>These are always difficult judgment calls with fuzzy boundaries. They seem clear after the fact, but they are not at the time one has to make them. You served your patient skillfully and contentiously. You did the best anyone could in a world of unpredictable outcomes. Be gentle with yourself.CountyRathttp://www.blogger.com/profile/10228262536418983673noreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-1232847243797894932008-05-17T21:07:00.000-04:002008-05-17T21:07:00.000-04:00I hate this kind of situation and I see it all the time. Tonight, for example. What the ER doc told my little lady's husband was that "you could always withdraw". That way the blame isn't felt by the doc anymore it is felt by the family. Way to pass the buck!Sarahhttp://www.blogger.com/profile/14593377383716715848noreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-49127197739923044452008-05-17T14:49:00.000-04:002008-05-17T14:49:00.000-04:00I do have an update on this case. As soon as this discussion phase has worn down I'll post it.Freadomhttp://www.blogger.com/profile/01132949384071592216noreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-1874300615029938832008-05-17T11:47:00.000-04:002008-05-17T11:47:00.000-04:00I guess it doesn't really matter what you or I think at this point. It's all up to the family and possibly your hospitals ethics people. This woman is certainly not going to attend any wedding. <BR/>In my experience so far, it seems like MD's do not always tell the family the cold hard truth about what is going on untill it is too late. We terminally extubate people all the time. I think that with the DNR from earlier you could extubate after 48 hours or whatever the clause is that she agreed to before surgery that took away her DNR.<BR/>I personally do not feel that the bronch was warranted from what you've told me. Old people die from pneumonia all the time, she had a long life many people would be jealous of. To let her go now should not make anyone feel bad.Mikehttp://www.blogger.com/profile/09288607465127714719noreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-68914872868055295722008-05-16T06:33:00.000-04:002008-05-16T06:33:00.000-04:00I agree totally with you. There are times when you just need to let go, Really if I live to be over 90, don't you dare do anything to me, just leave me at home with my family.Djanvkhttp://www.blogger.com/profile/01763856556153355491noreply@blogger.comtag:blogger.com,1999:blog-7423880838207203660.post-61432358779930945262008-05-16T02:00:00.000-04:002008-05-16T02:00:00.000-04:00This is one of the main reasons I want to work in pediatrics. I don't see it as saving a life, I see it as avoiding the inevitable.sometimesibreathehttp://www.blogger.com/profile/12752372891698524653noreply@blogger.com