I got to do a hospital consult on Mr. A today. He is a 70 year old man admitted to the intensive care for yet another episode of CHF exacerbation. He was also sick and tired of his automated implantable defibrillator going off. He also has diabetes for which I had been managing as an outpatient.
However by the time I got to him, he had already made up his mind. He was going to have the defibrillator inactivated, and just receive comfort care.
I had a long visit with him, his wife and numerous kids and grandkids. Clearly, he was aware of the implications of his decision. He was adamant that he not be 'coded' should he go into arrest; he knew if he was intubated he probably would never go off the ventilator.
And so, at his request I wrote to discontinue his diabetic medications. It was in many ways a strange meeting- everyone was composed, serious and perhaps a bit saddened, but yet relief was apparent even in his eyes.
And maybe this was a strange word to use, but it really did feel like it was truly a privilege for me, to have been able to share with this patient his experiences in what is probably the last few days of his life. To be able to talk to him, to hear his stories (and, true to his nature, some of his not-so-subtle jokes about the cute nurses and their tight butts)(but I think the nurses and his wife let him get away with that one), to have shared those minutes with him. I was glad it wasn't a busy call day, and I could take my time, not to cure him, but perhaps to aid in the healing of him, and his family. I think on busy days I'm often guilty of not spending enough time with the people I treat, to actually put myself in their shoes, to experience the things the do. So to have had the time today, was nice.
I imagine he'll hang around for another few days. He'll probably even make it till when I sign off the oncall pager to my colleague later this week.
But truly, it is a privilege. Take care, Mr. A.