Wednesday, November 16, 2011

View from the other side of the curtian

I got a call last night that my grandma was being taken to the hospital.  She had an acute change in mental status which prompted a blood draw from the visiting nurse which lead to a realization that she's significantly hyponatrimic (low sodium). 

When I went to bed last night, she was still being evaluated and stabilized in the ED.  Soon after I woke up, my mom called to ask how invasive central lines and arterial lines are.  She informed me that she's in the ICU, still lethargic, low serum sodium & high WBCs, and the doctors think this is all from a UTI.  She's maintaining her pressure relatively well on just simple fluids. 

While my 94 year old grandma has been DNR for a long time, there is no clear delineation on what falls into the resuscitate category.  There wasn't going to be any gastric tubes 5 years ago when a stroke meant she could no longer eat without aspirating, but then she was deemed confident enough to make that decision on her own and somehow that tube has kept her alive all this time.  So, the G-tube stays put.  My mom & uncle have decided that there is to be no intubation, no CPR, no trips to the OR.  But what about the gray area?  IV fluids, antibiotics, pressors, medication to stop an arrhythmia, etc...

So many times throughout 3rd year, I've heard physicians tell family members "if it was my mother/grandmother/sister/daughter I wouldn't want them to go through this, to suffer..." From the outsider's perspective, those conversations always seem relatively straight forward with a clinical decision based on the laws of probability.  From this perspective, it is much less straight forward.  She has already proven that she can overcome the impossible as she has been at death's door too many times to even count.  She's completely content with a dependent life, even if it one that I would never want for my self.  I'm realizing that making these decisions based on emotion and knowledge of the person is much more complex than making them clinically. 

Being the person the MY family turns to for medical advice is much more difficult than playing that role for others.  I'd like back to the other side of the looking glass now.

No comments: