Medical Anecdotal Report
Indexing Title: LBBERSAMIN’S MAR [15-01]
MAR Title: Being a Doctor, A Friend, and Family
Date of Medical Observation: December 2014
Tag: Understanding the role of a physician to a crisis situation of a close patient in critical condition
Category: Psychosocial– Reinforcement
It was a night of merry making for me and my friends owing to the time I had away from the hospital. I was able to catch up with them enjoy the evening. During that time, I was hailed by my friend to accompany him back to their house to attend to her ailing mother who was said to have difficulty of breathing. She was a 64-year-old female diagnosed with lung carcinoma stage III, post-coronary artery bypass graft, with hypertensive cardiovascular disease and diabetes mellitus type 2. I have known her since my childhood because I was very close to their family, and even having her as our godmother to me and my wife’s marriage. She was like a second mother to me. It has been more than a month already since she was diagnosed with this illness. All throughout this course, she often had symptoms of breathlessness and weakness. Although news of her illness came as a shock in their family, they were able to adapt to this problem by preparing the things needed for care. As I travelled to her house and entered her room, I found her in severe respiratory distress. She was already confused, with cold and clammy skin, and a faint pulse on her extremities. She was calling on the name of my friend while I had her lean on me, and tried pacifying her. “Ninang, ninang, I am here to see you”. We will bring you to the hospital”. We immediately transferred her to the car, after which I noted she had gone into cardio-respiratory arrest. Within minutes, we had brought her to the emergency department. In transit, with one hand holding on to her and the other hand clasping on the other, trying to compress my hands between her chest and the seat of the car as I sat at the back seat. When we arrived, I knew one of the doctors there and explained to him what had happened and the medical history of the patient. Resuscitation was initiated, but despite the measure of revival, no response was yet present. The emergency room physician had explained to my friends the futility of their efforts and the response they may get from these actions. I tried to explain everything we learned from the physician and relayed these messages to my friend because I knew he was overwhelmed by the situation. The ER physician also asked my friend if her mother had advanced directives towards her illness. My friend then told me that he recalled her mother saying that she does not want to be intubated and put on mechanical ventilator support when her time comes that she had this difficulty and the chances became bleak for her. I told him to notify his doctor cousin, who also knew of her mother’s illness and dilemma so that other than him and his siblings, their actual family doctor would know the case and give his comments of the situation. After a series of resuscitative efforts and no minimum amount of response can be elicited, we all agreed that it was time to let her rest, finally.
(Physical, Professional/Ethical, Psychosocial) (Discovery, Stimulus, Reinforcement)
Even in the light of our private time, resting and relaxing, we cannot deny the fact of our duty being a doctor. We can go to places on our own time, with family or friends, but even on these times we get a private consultation about their complaints and illnesses. The education and training we had, helps us handle light consultations and medical/surgical emergencies. Being pulled into that unexpected situation, I can only equip myself with what I knew about a patient in cardio-respiratory distress and what I can provide her at that time. Commanding the moment to decide what to do in a situation where the factors that play in dealing with a person in distress, a person close to us can be overwhelming. We may lose our edge in decision making and be overtly emotional. In issues critical to life prolonging measures, to halt or aggressively continue, the relatives of patients in these situations may find themselves entrenched in inaction because of their fear of blame. A moment like this, attending physicians lay upon them facts where they can base their decisions. Asking a patient or relatives in moments where a patient is incapacitated, advanced directives serves as a conduit to an all important decision based upon the wishes of a patient in this sensitive issue. Into this event of a known patient, a close patient, although asked upon by their relatives; a difficulty in providing a decision exists. When we know a patient, and a high density of familiarity is present, decisions that matter in the family, as in life or death, a doctor’s decision is often hard to provide. I did not want to bear the decision alone for my second family knowing that others, doctors of close relations and family, not present, to be out of the stream of information leading to a definitive pronouncement of certainty. In a moment like this, we can only provide facts. We can comfort and explain medical jargons a person in high emotional stress be resistant to understanding. We can be there to strengthen and guide them. We can provide emotional support and spiritual escort. In times when our patient and their family is in a crisis situation, we are there as their doctor. But in times of a family predicament, in the propinquity of our patients, our role as a friend or family should be concurrent with being a doctor.