Sunday, June 14, 2009

Palliative Care - A Surgeon Calls It Right

NEW ORLEANS - JANUARY 07:  Detail of Buckeye s...Image by Getty Images via Daylife

Dr. Jeffery Parks is a popular medical blogger from Ohio who writes at Buckeye Surgeon. He has written in the past about end-of-life issues relating to whether or not to extubate a patient for comfort care. He advocated for never extubating a patient, which was in opposition to palliative care standards of care I understood. More recently he published a post about the clinical inertia of the American health care system which would be very familiar to many palliative care clinicians.
I walked into the room and I saw a ninety year old, 100 pound guy who glowed yellow. He looked skeletal. His skin was paper thin, like cellophane wrapped around a chicken breast. He was affable enough. He knew where he was. He said his stomach had been hurting him for months. He'd lost close to fifty pounds since Christmas. He lived alone in an assisted living facility. He had a son in Alabama, but that was it...

...His Ca19-9 was over 20,000. A CT scan had been done at 3AM but there wasn't a read on it yet. I looked at it myself and easily identified a giant mid body pancreatic mass with multiple liver mets. I wrote a note about the findings and recommended a hospice consult.
The next day he came in to find several consultants notified and a full medical workup beginning. Read the rest of his well written post to hear what he did to make this a better situation. Leave some comments in his blog post too, after all we need to support surgeons and other doctors who see these situations.
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