By Allison Bond
I could tell my patient was dying. In the final stage of liver failure, she lay listlessly in her hospital bed, her skin ashen and her eyes dull. Intractable intestinal bleeding, likely related to her underlying disease, had landed her in the intensive care unit. Although all patients in intensive care are tenuous, it was clear she was worse off than most.
Her daughter and granddaughter hovered worriedly near her bedside. “What is going to happen to her?” her daughter asked me, her voice wavering.
I proposed a family meeting in a small room nearby to discuss the next steps in her care. As her loved ones and I sat around the table, I explained that our team and the consultants had concluded that one option was to insert a tube to briefly stop the bleeding. The tube was merely a temporary fix, however; for a number of reasons, there was no way to permanently stanch the flow of blood. Alternatively, we could focus on making her as comfortable as possible. Given her underlying liver disease, even if the bleeding stopped, she would live a few days at most.
“She would never want any of this,” her daughter said softly, dabbing her wet eyes with a tissue. “She’s been saying for months that she knew her time was coming. She was at peace with it.”
Her mother would not want to undergo the procedure – her daughter was sure of that. She would want simply to die peacefully, without pain and surrounded by family.
Yet when we returned to her room, we found that another team had already inserted the tube. I was shocked and livid. Such a critical miscommunication between doctors taking care of the same patient horrified me.
