I was almost run over by a gurney being pushed by a fast-moving Emergency Medical Technician. He thrust the patient’s chart at me. “Doc, you’ll want to check this lady out quick. She’s not looking good.”

The first thing I noticed was the color of her skin. Its greyish green hue signaled death’s approach. She had a nasal trumpet stuffed in her tiny nose and the quietest gurgle rattled around deep inside the tube. The only movement I could discern was a flaring of the tube-filled nostril, as if she were trying to expand it away from the large plastic invader.

She was 95, a tiny withered woman with leathery skin stretched loosely over her face. She was delirious and every few minutes mumbled incomprehensibly. She breathed fast and then slow, then fast again, as if she couldn’t remember how to choreograph basic physiologic functions. Her vital signs were dismal.

As the ICU attending, I wondered if I should prepare to intubate her. I asked the nurse to collect the required equipment and medications. Then I saw it — in the back of the chart, behind the EKGs, lab reports, and recent hospital discharge summary —the bright pink of a POLST form. (…) Read Full Article Here

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