Death, Dissonance and the Doctrine of Double Effect. 

This post was first published on Doximity’s Op-(M)ed “First Stab” Collection on 5/2/18 under the title: Should I Heal or Comfort?

Chicago, in February, was dark and cold. Even more so at 5:00 AM, when scraping ice and snow from my windshield before heading to the hospital. It was my first month as an intern in the ICU and my first day without my senior resident present. Working as a team, getting our patients through the day was challenging. Working alone, I felt overwhelmed. Knowing we planned to remove Mr. Thomas’s breathing tube only added to my angst.

A few days earlier, Mr. Thomas came to the emergency room by ambulance, in severe respiratory distress. In those chaotic first few minutes, the ER doctor intubated Mr. Thomas and put him on a ventilator. As the dust settled, and additional information was Read more

What do you do when you disagree medically on matters on life and death?

“This was published first in the Washington Post electronically on 7/29/2017 and will come out in print this Tuesday.  Click here for the link.  The comments so far in the paper have overall been quite emotional and angry in their response.  I am happy to discuss in more detail here on the blog and welcome any input or thoughts.  But the responses in the Washington Post highlight to me why we need to not only have more questions with our families on issues of end of life but to have more depth to them as well.”

The dilemma for the critical care team was not uncommon. An elderly patient in the midst of a life threatening illness and in severe pain, not understanding the critical nature of their current situation. A decision needing to be made about how aggressive to be. A doctor trying to convince the patient to pursue a rational approach, one based on understanding the limits and capabilities of life supporting interventions. This situation plays out in ERs and ICUs across the country hundreds of times a day. But two key factors made this situation unique. First, this elderly patient struggling to breathe, battling low blood pressure and in a tremendous pain was my wife’s grandfather. Second, the doctor recommending aggressive life supporting measures, contrary to the limits set by his advanced directives, was me.

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Walk with me…

Walk with me, why don’t you? It’s about time, don’t you think? We have been avoiding this for quite a while. But it is best to bring this out from the shadows and into the light. Let’s take a walk… Thru a part of my day. But be careful. You won’t like what you see. I don’t like this path very much. It’s why I have not looked lately. I just keep moving forward, one foot in front of the other. Don’t stop. Can’t stop. Movement keeps things blurry. And blurry is less defined. And less defined is fuzzy. And who gets hurt by fuzzy? Fuzzy is soft and safe. Fuzzy can’t hurt. Fuzzy can’t reach into my heart and soul and hurt me from the inside out.

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