Something Missing

Ashlin Mountjoy, MS4 at UCSD SOM, PRIME-Health Equity

There’s something missing.

Neuro
CV
Resp
FEN/GI
GU
Heme
ID
Endo
MSK/Vasc
PPx

It seems like a pretty comprehensive list. At least it’s a familiar list – the way the ICU attendings want us to present the information.

Neuro: she is minimally responsive.
CV: Her heart is stable.
Resp: Her breathing is apneic and agonal. But it’s more comfortable today than yesterday. Will start a morphine drip.
FEN/GI: She’s not eating much anymore. Do we need a feeding tube?
GU: Minimal urine output. Foley in place for urinary retention. Check.

Dispo:
Multiple calls placed to SNFs around the county. Can’t find a bed there, will check with another. Is the son ok with this plan? Is the monthly cost ok? Can she go to a SNF? Plan to discharge today.

Currently stable.

There’s something missing.

Does anyone put the pieces together? Where in the progress note is the big picture? The whole person? The person with multiple organ systems failing.

pssst…she’s dying. She’s not stable. She’s dying. She’s 102 years old. She’s comfortably dying. Dare I say she’s appropriately dying? We can let her die in peace.

No morphine drip. No feeding tube. No foley.

Something’s missing.
Perspective?
Humanism?
Compassion?

Something’s missing.

Can I fill in the gap?

I wrote this while on a Palliative Medicine rotation. I was struck reading through charts of my dying patients how little attention the broader medical field gave to the ultimate direction our patients were headed, how rarely the word death was mentioned. Sometimes we need to take a step back and look at the whole picture and accept it.

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