Comfort Care

The last patient I admitted was a gentleman with multiple acute medical problems without a diagnosis. However, looking at the clinical picture, laboratory data, and imaging, his prognosis is likely very poor. Without aggressive intervention, he is unlikely to survive. However, he and his family members have expressed a long-standing wish not to have a prolonged technological death. Time and time again, while healthy and while sick, he has told his family that he does not want to be on a machine, does not want interventions to extend life, and he wants to pass when that time comes. As a result, even without a diagnosis and even with the possibility of a reversible problem, we decided to transition him to comfort care. We felt that whatever disease he had, an invasive procedure would be necessary and since that was not consistent with his goals of care, it is time for us to relinquish our control and let nature take its course.

While I have had patients die in the past, this is the first time that I've decided to let a patient without a firm diagnosis and with potential reversibility go. It's tough. But I'm completely convinced that this is the right thing to do. The family is completely unified in supporting this decision and his values seem to persist over a long period of time. Most likely, he has a terminal illness and palliative care is on board with this course of action. I guess the lesson I learned here was reinforcement of end of life decision making and the fact that the right course of action may not be the most medically satisfying.