Recently, I had a middle-aged woman with gastric cancer to tend to in the ICU (Intensive Care Unit). She was operated a few months ago, and discharged from hospital. Very soon, the aggressive cancer recurred, spreading to distant organs.
She was readmitted. Her prognosis looked bleak, and death, inevitable. Soon she was shifted to the ICU as she required drugs to normalise her blood pressure. She developed renal failure. Her consciousness waxed and waned. The advanced cancer seemed determined to kill her.A patient like her with advanced and incurable cancer must ideally be allowed to spend her last days in the hospital room or home, in the midst of her family, not ‘treated’ in the secluded, cold and lonely environs of an ICU, amidst the alarms and bleeps of monitors.
The family, which was being briefed daily by me about the patient’s deterioration, demanded ‘everything be done for her’, including the prohibitively expensive bedside dialysis. This, despite being conveyed about the futility of treating her aggressively: One, aggressive treatment would only prolong her suffering; two, precious money was being spent on a lost cause. However, her family paid no heed to the suggestions of the doctors. Briefing patients’ families, one among my many responsibilities, is painful—both to me and the families, when the patient isn’t doing well.
Her teenaged son’s father was no more and he wanted his mother to be ventilated if need be. The doctors had no option but to treat her, though hesitantly, despite her steady deterioration. He ‘wanted his mother back somehow’. So the doctors were left with no choice but to treat a patient with advanced malignancy and renal failure, using expensive treatment modalities.
The patient lingered in the ICU, but her health was not improving. Ultimately, the family, which was in financial doldrums, decided to have her transferred to a cheaper hospital nearer home for palliative care.
Doctors, especially those in ICUs, these days often face a catch-22 situation. They are unfairly charged with treating patients ‘unnecessarily’, and even ‘treating patients already dead by ventilating them to make money’. The other side of the coin is that they are also required to meet the sky-high expectations of patients’ families and their unreasonable demands, even if the disease is terminal. Demands to treat patients who shouldn’t be treated are increasing by the day. Due to the glaring lack of a credible legal euthanasia policy in the country, attempts by doctors to play God in the ICU aren’t easy, and may even be often misunderstood.
Email: earaly@hotmail.com