Mrs. Zelnick’s lips were blue, her eyes glazed over, and her oxygen saturation at 70%. But her nails had been done earlier that week and were a lovely shade of crimson. Her hair, although slightly mussed from the pillows, had not lost its set. Even in her dazed state, she possessed dignity and grace.
I stood at the door reading her chart. This woman was dying of pneumonia. As the palliative care attending physician, I’d been called in to help midwife her death. According to the team, she had refused to be put on a breathing machine. The best we could offer was aggressive treatment of her shortness of breath.
I began my career years earlier as a gung-ho saver of lives in the ICU. But I soon realized that the high-tech tools we used there often harmed, rather than helped, my patients with serious illnesses or frailty. Many were resuscitated long enough to remain on the machines that had saved their lives. But they would never return to life.
With this growing discomfort, I sought training in the new field of palliative care, which aims to treat the patient as a whole being instead of a collection of organs. The goal is to honor an individual’s preferences and values instead of focusing solely on physiology. And now I was on my third day as a palliative care consultant, eager to practice my new set of skills.
I approached the patient. We would need to manage her shortness of breath. She also seemed to be suffering from delirium. I would start a low dose of morphine to relax her breathing. Some Haldol would help to reorient her. The nurses in the comfort suite would direct a gentle fan toward her face to help with the breathlessness. They’d clean her mouth, change her bed and provide a comfortable place for her to rest until she died. (…) Read Full Article Here