Mr. Grainger is going to die.
Not now, but the time for him is more imminently on the horizon that it is for me or you. He has cancer throughout his body, spreading into his brain. And as with any seriously ill patient, when we brought him into the hospital, we talked with his family about his "code status."
Code status refers to how aggressive the patient wants his caretakers to be in resuscitation. "Full Code" means that if his heart stops, we'll do CPR, and defibrillation as necessary, if his breathing stops we'll put a tube down his throat, etc. A "full code" on a patient is a violent occasion. CPR, if done properly, can break ribs, especially 80 year-old osteoporotic ones. A 30 year old might survive a code. An 80 year old almost certainly won't.
Which is what we tried to convey to Mr Grainger's family. But they were incensed that we would even ask about this and insisted he be "Full Code." So that was entered into the chart, though we didn't agree with the decision.
So this morning, my attending gave us a long talk about the ethics involved, insisting that in a patient like this, where a code has zero apparent chance of success, it is within our power as physicians to simply refuse to perform the code. His exact words were "if they want to sue, let them. There is no way a court can hold you liable for not performing a procedure that is against your medical judgment."
Leaving aside for the moment the fact that he turned, without thinking, an ethical debate into a legal one, the point is that we are to do the best for our patients, and sometimes that means doing nothing. I think I'm on board with that.
What bothered me about the way he defended it was by turning the discussion into a legal one. I'm concerned that so many derive their morality, at least in ambiguous situations, from the law. The reverse should be true, no?
I've also noticed, throughout my time at this hospital, that my concern for my patients has been somewhat lower than previously. My team, and indeed, most of the residents at this place seem to hate their jobs, hate the program, and hate their patients. I know that's not true completely, but the contrast with other hospitals, including my Number One Choice, is stark. I'll be ranking this one pretty far down my list when it comes to the match.
What this means for my blog is that I've realized my tiredness more, I've had a harder time finding touching stories and fun patients to write about, though I've been reluctant to join in the cynicism of my team. So I'm going to try to swim against this tide of negativism.