Tuesday, April 12, 2005

'Comfort care only. Morphine 5 mg IV q 30 mins prn, titrate as necessary'
That was the last order I wrote in Mr. T's order book when I left the unit.
Elderly guy with his lung ravished by emphysema, who popped a couple of blebs a month ago and developed a huge pneumothorax. Still persistent despite the chest tube, probably has a broncho-pleural fistula.
Anyway, today he told me (and his family) that he's had enough. That he's fought a good flight, and he wants to stop. Probably the reasonable thing to do; the thoracic surgeons didn't think the pneumothorax would resolve.
He'll probably pass on tonight. Not in any pain or suffering, I hope. I told his nurse to give him as much morphine as he needs to be comfortable. Everyone understood what that meant. Even if it means that that stops his breathing.
In endstage cases such as this, comfort measures are not uncommon, and unlike euthanasia, is not illegal or unethical. Although the line can become very blurred at times. The aim is not to hasten death, but to minimize suffering.
If only I could show the next smart-ass I meet who tells me smoking isn't harmful to Mr. T. And show him his chest tubes that were trying to keep his lungs inflated. And how he laid there, gasping for something we take for granted: air.


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