"Our challenge as a medical profession is to ensure communication and cooperation with the hospital clinicians who do not know our patients but who care for them when they're hospitalized – patients we know well, with whom we have shared experiences and built trusting relationships like the one I have with Mr. M," writes this family physician in today's
By H. Andrew Selinger, M.D.
As a family doctor, I had the privilege of sitting down at the hospital recently with Mr. M, a longstanding patient of mine, and his family. Mr. M is a college-educated engineer, struggling near the end of his life with end-stage kidney disease, dialysis, severe congestive heart failure and crippling COPD. And he was pretty down about it.
In the hospital, a critical care physician, a pulmonologist, a nephrologist (kidney specialist), and a cardiologist were caring for Mr. M. Recently his heart stopped and was restarted while he was in intensive care. He and his family then decided that if that happens again, he would like to be left alone with no resuscitation or artificial life support. That’s when Mr. M’s daughter, a registered nurse, asked me to come up to the ICU to talk with them about end-of-life issues
. I no longer make rounds at the hospital, so I called ahead to let his ICU nurse and his medical staff know I was coming. I drove up after my office hours, so we could spend some uninterrupted time together. Mr. M is still sharp as a tack and was visibly shaken by his brush with death and exhausted by his frequent coughing and inability to easily clear phlegm from his lungs. We sat together in his room with the curtain drawn for privacy, his wife, his two daughters and one son-in-law by his side.