WhiteCoat

The Boxer

He used to be a boxer.

Those days were long-gone, though.

Now he was a shell of his former self.

The hands that formerly knocked opponents to the mat were now contracted and full of arthritis. Dementia had taken away his ability to tell the stories about his career. Metastatic lung cancer ravaged his body. Multiple bed sores ate away at his sacrum and his heels. Repeated courses of treatment for his MRSA and other drug-resistant infections had caused him to get clostridium difficile colitis. The diarrhea made the bed sore on his sacrum even worse.

Now he was in respiratory distress.

Paramedics tried to intubate him, but his contractures prevented them from being able to properly position him.

He wasn’t moving enough air to sustain life.

The old man’s friend wasn’t quick enough to save him.

His son, the power of attorney, demanded that we “do everything.”

The nursing home staff said that his son hadn’t visited the patient in over 6 months. One time a doctor was able to have the patient declared as a DNR. The son became upset and fired the doctor, then rescinded the DNR order.

So we revived this shell of a man.

We got the breathing tube in place. Tan-colored mucous bubbled up as we Ambu-bagged him.

We looked through the chart to start him on antibiotics to which he had not developed a resistance … yet.

We changed the dressings on his wounds. Of course as one of the nurses was pulling off a dressing, it flung pus across the bed and into the respiratory tech’s face.

With some fluids and a lot of suctioning, the patient was ready to go to the intensive care unit.

The patient’s nursing home doctor didn’t take care of inpatients any longer. In an odd twist of fate, the doctor on call for the hospital happened to be the same doctor that the son fired after he obtained a DNR order on the patient. The doctor accepted the patient, but made it clear that he would consult the ethics committee and have the patient declared DNR again.

The son was called and refused to allow the patient to be admitted to this doctor. He demanded that we call other doctors to find an alternate.

When we found an alternate, the son refused to allow the patient to be admitted to that physician because he “didn’t know my father’s case.”

Four calls later, there was no other doctor willing to take the patient.

The son demanded transfer to another hospital. Nurses called a couple of other places, but the on-call physician wouldn’t accept the transfer.

Eventually, the patient was admitted to the hospital against his son’s wishes.

In the back of my mind I just kept thinking that this was one fight that the patient probably would have wished he could lose.

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

 

12 Responses to “The Boxer”

  1. hashmd says:

    And the government puts the blame on hospitals and physicians for spending all this money on “futile care”! Like any one doctor could have stopped this particular incident without getting sued?

    • Matt says:

      Yes, one could have. There was nothing to sue for. There were no damages.

      • CodeBlue says:

        Doesn’t mean there won’t be a lawsuit, deposition, lawyering up, paying the lawyer, malpractice premiums, taking time off work, bad press for the doctor and the hospital when some fool from USA today picks it up.

        It won’t go to trial, but it will cause unpleasantness for the doctor who would have done the right thing for the patient if he had any reasonable expectation that the law and/or hospital administration were on his side.

      • Matt says:

        Only if the person is paying out of pocket. Because it makes no sense for any attorney to take it on contingency.

        Don’t know why it would be bad press either. Many, many people would say “thank goodness the doctor had his head on straight” and those that wouldn’t are those inclined to be like the son anyway.

        If the doctor didn’t have an expectation that the law was on his side, then he’s not really on top of the law.

    • WhiteCoat says:

      “Yes, one could have. There was nothing to sue for. There were no damages.”

      Again, Matt, statements like this just show that you have little clue about how medicine and law interact. I’m beginning to question your grasp of the law in general.

      If a doctor stopped the incident … meaning that resuscitation efforts were discontinued and the patient was allowed to die in peace … then the patient death would be considered “damages.” Although that is something taught in the first week of law school, I realize that it may a difficult concept.
      If the defense was that the patient would have died anyway given his medical condition, then the “loss of chance” doctrine comes into play.
      From those “damages” flow medical malpractice and wrongful death actions.

      Now, once the patient has been damaged, his estate – which will likely go largely to the patient’s son – can then sue anyone even tangentially related to the patient’s death to be made whole. As you’ve previously stated in your comments, the value of a human life is immeasurable – except by a jury. So in certain plaintiff-friendly jurisdictions, the value of such a case could be very large. Parade pictures of the patient with his family in front of a jury along with a statements how medical providers “just let him lay there and suffocate when the nursing home called the ambulance” and how the doctor “took it upon himself to play God.” Suddenly there’s a viable case.
      Of course an attorney would take such a case.

      But it doesn’t end with civil lawsuits. Again, your knowledge of medicine and law leaves something to be desired.

      EMTALA is the federal law that requires all emergency departments to provide screening exam and stabilizing treatment to anyone seeking care in the emergency department. Failing to resuscitate the patient without a clear directive not to do so could be considered a statutory violation.

      Then there are criminal lawsuits. With the way society seems to want to criminalize medicine right now, I wouldn’t put it past some overzealous prosecutor wanting to make a name for him/herself to file criminal charges against the physician for failing to resuscitate the patient, then post a press release about it.

      Let’s not forget state medical board action. Complaints from an upset family member would cause a full-blown investigation where physicians are often required to prove their innocence to the board rather than the state being required to prove the physician’s malfeasance. Doctor would have to pay attorneys and experts to defend him/herself in front of the state medical board.

      Enter JCAHO regulators. They come to investigate the hospital about why the patient was allowed to die. After all, death is undoubtedly a patient safety issue. Hospital becomes upset about investigation and blames physician.

      “Don’t know why it would be bad press either.”
      Are you serious? Remember Jim Dwyer? Remember his shining journalistic integrity? All it takes is one rogue journalist with an undisclosed axe to grind to paint a picture of the doctor as a murderer and not a saint.
      Great for readership.
      Some hospital administrators would immediately fire the docs to limit the damages in the press.

      So when you make statements like “there are no damages” and you “don’t know why it would be bad press”, either you are purposely being a troll or you have little insight and even less knowledge of the law you accuse others of failing to “grasp.”

      • Matt says:

        I realize when you practice law based on Law and Order and tort reform propaganda you become quite bitter.

        Under the situation you described, it would be extremely difficult to prove much if any in the way of damages. You have a person hanging on to life by a thread with no meaningful chance of recovery. Your plaintiff is someone who has previously had no relationship with the deceased. While I concede there may be some lawyer somewhere who may take this case, it’s an extremely slim chance and the jury to award damages is even smaller. I realize you believe all juries are made up of incompetent easily led ninnies who swallow whole everything any plaintiff’s lawyer says while the defense attorney hired by the insurer stands there like a potted plant, though.

        As to criminal violations, you’re just engaging in scare tactics. That’s fine if you truly believe it, but it’s like you can find, out of a million doctors, 10 who have ever been charged criminally in the situation you describe. And probably not even that many. But by all means, commence the histrionics!

        Spare me the line about state medical boards. There are too many doctors with multiple paid claims still practicing for that scare tactic to seem very compelling.

        And no, it’s not bad press. I suppose for virtually anything you can find someone who will write an article. That you’ve fixated on one article as proof that anything a doctor does will be spun wrong is just more evidence of your typical sky is falling rhetoric. Rigorous (or any) analysis of percentages has never been your
        strong suit.

        If this Chicken Little stance is truly your worldview, I feel for you. No one should live in the fear you do. If you are that scared of all these bad things, you should probably go ahead and stay inside for awhile. There are umpteen terrible things waiting to happen to you every time you step out of the house. And DEFINITELY don’t drive.

  2. Libby says:

    Pro-life hospice nurse here….poor man…the patient. A son’s guilt. We live only to die, and we are in such denial over it.

  3. Larry Sheldon says:

    And yet, today, children were allowed to die.

  4. ? says:

    I would never want to be a boxer — negative health outcomes.

  5. reese vaughn says:

    Every day I bless my mother who was adamant about dying when her time came. She told me, she told her doctors, she had all the paperwork in place, and I live without guilt, knowing her wishes honored.

  6. Snappz says:

    So unnecessarily cruel. That poor man should have been allowed to pass on, despite the actions and wishes of his son.

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