My 89 yr old grandpa, with a history of type 2 diabetes, very well controlled, spiked a blood sugar in the 500s (normal is in the 100s) on a Monday in February. He was a little more fatigued than usual, and my mom called me for advice. I was concerned about any infections. His primary care doctor ordered 2 doses of insulin that day.
Day 2, he appeared sicker and sugars remained high. I talked to his doctor’s office asking very nicely for an infectious workup which includes blood work and cultures, chest xray, and urine studies. The nurse on the phone sounded younger than my sister, and did not know what hyperglycemia meant. The doctor ordered only one part of the labs that evening – a blood culture, and told his nursing home there was no need for a chest xray to assess for pneumonia.
Day 3, the results have returned and the nursing home said they were unable to reach the doctor.
Day 4 AM, my grandpa was in septic shock from aspiration pneumonia, and was admitted to the ICU. He never fully regained consciousness.
My mom called me, and I drove home to LA. The doctor’s excuse for 4 days of delay in care was “he’s old…I don’t want to be aggressive.” He offered no apologies. For the first time in my life, I cried because I was furious. I kept thinking of what my neurosurgery chief once told me “one day, you will know that your job as a good doctor is to protect your patients against the morons in the hospital” and his other advice “the worst prognosis is a nice patient with a nice family.”
I spent my time in the ICU since Valentine’s day. He became vent dependent meaning he needed a machine to breathe, he got tuberculosis (when he tested negative all his life), he got a feeding tube and then had a massive stomach bleed, and finally DIC, a condition indicating severe illness. He also assumed decerebrate posturing, indicating possible stroke, a likely complication of his severe shock. In between all these episodes were his doctors telling us to take him off of life support, a conversation they never fail to deliver when they somehow forget to discuss any other test results or procedures conducted.
My grandpa is on comfort care now, meaning there is no more treatments or blood draws. He gets a morphine drip and some IV. He is dying, paralyzed, and semi-conscious due to gross medical negligence.
I thought of how much medical school failed to prepare and discuss with me:
-How our treatment can hurt as much as it can save a life.
-How machines and medications and procedures can prolong not the living, but the dying process.
-How the consequences of our inaction and negligence, ignorance and fatigue is real.
-How not to sue another physician, a doctor who’s negligent at the end of his career at 65yrs old, who makes a very humble living as a primary care doctor in a country in gross shortage of primary care physicians.
-How to act as a family consult with medical knowledge, and objectively decide to terminate treatment for someone I love deeply.
-How to deal with my mistrust and anger toward members of healthcare when I myself am a physician.
-How to advocate firmly for the correct course of care when it’s in disagreement with another physician.
-How important it is to encourage patients and their families to be vocal, and strong advocates irregardless of how stupid it sounds.
-How important it is for physicians to apologize in times of error, not because of policy or fear of lawsuits, but because the patient and their family deserves it.
In 2 months, I will become a full time internal medicine doctor. I thought of all the families who have yet to come under my care, and all the things that can go wrong. I didn’t know…4 years ago…when I first began medical school, what tremendous responsibilities this lifetime was going to entail.