Sorry for suddenly being MIA. Friday was a rough day, and I needed to gather my thoughts before I figured out what to write on here. Thursday, I was assigned to the male ward for my first week of my 2 week hospital rotation. Our team is responsible for 30 beds which is about 35-50 patients since often two patients are placed in one bed. 3 patients died on Friday. Typically, 10 % of patients die on the wards here, but according to our resident this was the first time that so many died during the day while he has been here.
The first patient was a 45 year old HIV+ male who had sepsis from an unknown origin. When we came to his bedside during rounds he was barely breathing, with no audible heart beat nor a palpable pulse. In the states, we would have called a code, however, his chance of survival was low so we left him to die peacefully surrounded by his family.
The second patient was a 50 something year old male with metastatic hepatocellular carcinoma. On palpation, you could actually feel the large tumors throughout his abdomen. We also found him unresponsive and barely breathing during our afternoon rounds. We talked to the family - no intervention was requested and they stayed by his side until the end.
As frustrating and emotionally draining this situation was for me (and would be for anyone who has provided or received medical care in the Western world), I realized that I could learn a difficult lesson from the Kenyans - stop care when care is futile. In the U.S, it seems that we focus much more on quantity of life rather than quality of life these days. In rare instances, we have created miracles with our advanced technology. And, as a result, many patients and their family members opt for every last intervention and grasp onto any remaining glimmer of hope that exists. I know that this is a controversial topic, and I do not want to imply that I think we are at fault for thinking this way. However, being in this environment simply makes me wonder if we could reach a middle ground, and perhaps think twice before we place 98 year old granny on a ventilator for the remaining days of her life.
I'll try to have some lighter and less morbid posts this week :) I'll also make sure to include some more pictures of my new home and the downtown area of Eldoret (hopefully this will be possible with the slow internet connection).
Finally, I would love to hear your comments on the above topic so please feel free to share your thoughts on the blog comment section or via email!
Hey Dach,
ReplyDeleteI have to take this econ class this week, which I am not so excited about, but we were talking about the fact that a huge reason for the ever increasing federal debt in the US is from medicare paying for the last 2 weeks of people's lives. I am sure you know but each day in the ICU is $10,000, which medicare has to cover. I think you bring up a really important point, one that most politicians don't have the balls to raise in the US - is it really worth it to keep someone alive for an extra few days or weeks when there is no chance they are going to get better? To me this extra financial burden for generations to come, not to mention the enormous strain it puts on families dealing with losing a loved one is not worth it.