One of the hardest moments of my internship was being intellectually and emotionally invested in the care of an ICU patient. She was an 86-year-old woman who presented with significant altered mentation that went undiagnosed even after numerous imaging studies, electroencephalograms, dialysis and broad-spectrum antibiotics. Her husband would spend countless hours at her bedside and I was amazed at his commitment and faith that she would recover. From a physician’s standpoint, it was both humbling and challenging that we could not deliver the answers he so desperately wanted.
Even after an exhaustive medical workup, the family wanted to aggressively pursue treatment options. While there is always an intrinsic desire to root for patient recovery and ultimate survival, I struggled immensely with the decision to pursue invasive measures for her. Below is a poem that helped depict my feelings for this patient encounter:
Day 13 of intubation status post aspiration
I watch Mr. S hold her hand in anticipation
Since she is failing her SBT on the reg
Today is the day she gets a trach and PEG
I question her quality of life and wish she were DNR-CC
Because if it were me, I would much rather go peacefully
Image credit: The Last Straw by Kevin Rheese licensed under CC BY 2.0.
Resident Physician Contributing Writer
Ohio State University Werner Medical Center
Rohan M. Modi, MD is a resident physician at the Ohio State University Wexner Medical Center. Inspired by the writings of Atul Gawande, Rohan is interested in understanding the illness experience from the patient's perspective and centering medical care around the patient's values and priorities. He plans to incorporate these sentiments in his future career in Gastroenterology and clinical research.