In-Reply-To: <[log in to unmask]>
I think that is a completely different scenario. If someone has died of
their terminal illness at home I regard it as an assault on the dignity of
the dead to attempt resuscitation. The issue with this patient is more one
of communication and acceptance. John Diamond wrote a very interesting
column in the Times about 3 weeks ago describing his throat malignancy -
which now appears untreatable - and describing his own utter inability to
come to terms with his impending demise. He called it incomprehensible
deniability, or something similar - he knew he was likely to die and maybe
soon but was unable to believe it.
Many patients who the medical team know to be untreatable do not feel
particularly unwell. If that lady had suffered a massive PE in hospital or
a huge haemoptysis it may well have been entirely appropriate that she was
not resuscitated from it. However, she got to see her notes and read
something she didn't want to see. It seems to me patients want it both
ways - they want access to their notes and then are upset when they read
something they do not like. How can medical notes be a reasonably true
record if this happens? Are we going to end up in a farcical situation
where notes exist in two forms, one fit to be shown to the patient and a
second hidden one?
It is fortunately still rare that a patient comes in to A&E as a result of
their terminal event and the partner dialling 999 in panic, but if it does
I still believe the humane thing all round is not to resuscitate. We had a
case a while ago of this with a man with end stage motor neurone disease
who choked. His wife dialled 999 and then did not inform the crew of the
diagnosis. He was resuscitated fairly readily back to ROSC and brought in.
It was not until his old notes appeared that it was realised what had
happened. He was by then intubated and recovering consciousness, and went
to ITU where he later succumbed to a chest infection.
Best wishes,
Rowley Cottingham
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