When working in the neurosurgical ICU at Tygerberg Hospital, most patients I saw there were due to acute traumatic injury, for example those involved in motor vehicle accident or community abuse. The devastating part being that not all of them recover and thus become classified as terminal by the Doctors. This was the case of one of my patients whom, after a week of being ventilated and showing no improvements was pronounced as being “beyond the turning point” by the doctors. This is not unusual as one journal article dealing with neurosurgical mortality rates states that a nonstatistically significant trend toward increasing mortality rates were seen in hospitals with a lower percentage of elective neurosurgical cases, in Level 1 trauma centers, and in hospitals that were not certified stroke centers. (Hammers, Anzalone, Sinacore & Origitano, 2010).
None the less, death always comes as an unexpected shock and even more so when you are dealing with someone such as the above who is about to face death, out of his and everyones control. When I was told to continue with treatment, although I tried my best to keep hope, I still felt useless and even a measure of disregard for what I was doing as it all seemed pointless. Ethically there should have remained a good level of support and comfort even though the patient was unconscious. My stand on life and death is firmed by my religious beliefs as most peoples moral standards are.
The bible has a balanced view on the matter though. Although it is not permitted to end life, the prolonging of life with regards to the terminally ill is not required. (“What Does the Bible Say About Euthanasia (Mercy Killing)?”, 2018). Death came about due to sin which Romans 5:12 brings out. However, the focus is not to prolong the dying process but rather the hope that is extended to us in John 36:9,10 which tells us about the resurrection. Thus, what was said by the doctor was not necessarily out of place but I feel he should have told me to rather withdraw further treatment than continue.
In conclusion, because this patient was classified as terminally ill the treatment in my opinion should have come to an end. Furthering treatment having known there was nothing I could have done to help the patient improve anymore is disheartening as a physiotherapist. Our jobs as physiotherapists are to aid patients to reach recovery and a satisfied rehabilitation; therefore unnecessary time on a patient I could not help was spent. This should not be taken out of context, however, as someone with cancer who although terminally ill and not in the end stage of death should still try and preserve their life as life is precious to God for he after all created it. (Acts 17:28) In future practice I will voice my beliefs, however, I will do so through showing respect to the doctor and patient. The other side being that maybe the doctor was not honest with regards to the actual state of the patient and further treatment could possibly have helped. This particular patient died two days later.
References:
Hammers, R., Anzalone, S., Sinacore, J., & Origitano, T. (2010). Neurosurgical mortality rates: what variables affect mortality within a single institution and within a national database?. Journal Of Neurosurgery, 112(2), 257-264. doi: 10.3171/2009.6.jns081235
What Does the Bible Say About Euthanasia (Mercy Killing)?. (2018). Retrieved from https://www.jw.org/en/bible-teachings/questions/euthanasia/
New World translation of the Holy Scriptures, rendered from the original languages. (2015).
3 thoughts on “Without Recovery:”
Hi Kai. Thank you for sharing your experience with us to read, relate to and learn from.
I really enjoyed reading your piece and the fact that you openly expressed your emotions towards the experience you had. I can derive from your writing that you truly had empathy with your patient, which is an essential skill to have as a physician. I also like that you clearly state and stand by your beliefs and moral standards, which is something I, as a reader, can strongly relate to.
With regards to improving your piece, I feel like a different opening sentence, paragraph or even adding a video at the top will make your piece much stronger rather than directly jumping into your experience. After reading the first few sentences of a piece, I would like to have a clear idea as to what the piece is about and what I can expect to follow. I also feel like you could add in more research and references on what literature says about treatment withdrawal and end-stage of life treatment/rehab to compare different studies and opinions. That would certainly also aid in strengthening your piece.
Then I would like to disagree with you on one matter which is that you felt like treatment should have ended once they found out he was terminally ill. And please correct me if I understood wrong, but in my opinion I feel like treatment should continue, although it would no longer be aimed at active recovery but rather making the patient comfortable and preventing secondary complications and pain. Our jobs as physicians is not only to treat, but also to prevent and by doing so you are improving a patient’s quality of life even if it’s his last few days on earth.
Overall a very interesting and easy piece to read. You gave me the opportunity to think about how I feel about the matter you discussed, what is my views compared to yours? and it certainly got my wheels turning. If you have any questions regarding my feedback I would love to hear from you.
Cara Uys
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Hi Kai
Your piece was very intense and I am sure a lot of us can relate to it and the siutation you were put in.
I agree with you that the doctor should not have told to continue with treatment as it was not going to benefit the patient. It was interesting and I had not have thought of the fact that the time you used treating this patient that was terminally ill was taking important time from other patients that could have benefited a lot more from your treatment.
I really enjoyed the fact that your beliefs come through so strong and that it shows the type of person and physiotherapist you are. It made the piece so personal and I appreciate that.
I think at the end you were speaking of a possible other side from the doctor. I think further elaborate on that, could possibly make us think a little more.
I agree that we should all voice our opinions, even though we are students and it is intimidating but we are also part of the interdisciplinary team.
Thank you for your piece. Just be aware of not making the sentences too long. Eg, the last sentence of the first paragraph.
Hey Kai
Your piece was actually rather emotional to read and I personally, as im sure many other phsyiotherapy students, can relate to the situation.
I had a similar experience in that i also told to continue with treatment on a pateint that was terminally ill with no hopes of recovery and it too took a toll on me emotionally and physically. It took time away from me being able to see other pateints who could in fact benefit from more rehabiiation as well as making me emotionally depressed when having to treat the pateint.
As i have exprience such a situation i can strongly agree with you in saying that the doctor should not have told you to continue with treatment as it was not going tobe of any furthur benefit the patient.However just a though…. maybe the doctor was being overly empathetic towards the pateint and prehaps asked you to conitue with rehabilitation from a palitive care point of view just so it did not seem like every one had given up on the patient completely?
I did really enjoyed the fact that you added in your own beliefs as it made the pieve more personal as well as trying to understand the doctors possible reasons for wanting the rehabilitation to continue
Just watch your setnance structure..you could have prehaps broken up your last paragraph and possibly added a small onliner introduction to catch the readers attention.
Overall your piece was very clear, conscise and well written.