Jan 12, 2011, 10:00 AM
Post #1 of 3
By Dr. Michael Gordon
I recently was asked to attend an ethics workshop at a Tel Aviv teaching hospital where I knew many of the staff. Since my Hebrew is just adequate, I at times answered them in a mixture of Hebrew and English.
The discussion was about a conflict between a distraught family receiving “bad news” and their attempt to change the course of nature by making demands that were clinically unreasonable. The ambient level of emotion was extreme and made communication a challenge.
An elderly woman who had lived alone and apparently functioned well was admitted to a geriatric rehabilitation program following a stroke. The goal was to bring her to a level of function to enable her to return home to the care of her son and daughter.
Initially, she seemed to improve, and the family and staff were pleased with her progress. But she then deteriorated, with symptoms not characteristic of a stroke, including loss of appetite, weight loss, fatigue and anemia.
Investigations eventually revealed that she had an underlying cancer of the pancreas, which had spread extensively throughout her abdomen and had reached a point where no treatment options were considered beneficial.
The children, especially the daughter, approached the staff with an initial skepticism and then a degree of concern that became coupled with an intensity bordering on hostility. The daughter had difficulty grasping that her mother, who seemed to be suffering only from the stroke from which she was making progress, could develop a terminal disease while under the care of physicians. The son, who did not have the most amicable relationship with his sister, gradually understood what had happened, but deferred to his sister to interact with staff because of the emotional toll her assertive approach was taking on him.
During the workshop, the responsible physician received incessant calls from the daughter for progress reports and demands for interventions that were untenable, such as transfer to the intensive care unit.
Some staff members suggested taking a hard line, including calling security when she became belligerent. The discussion explored why she was responding as she was, and then considered strategies for dealing with her state of denial, which although extreme, could be understood.
The responsible physician adopted a combination of non-emotionally reactive support, attempts at responding to even marginal requests (such as for a formal intensive care consultation) and engaging the brother in providing support to his sister. Eventually, she accepted the reality of her mother’s situation, no longer sought “miracles” and ceased her conflicts with the staff. I later heard that she ultimately thanked the staff for their exemplary care.
Dealing with bad news anywhere is always a challenge. Those practising medicine and its allied professions have the duty to help distraught families understand and accept the bad outcomes that do occur.
Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto.
Dr. Gordon is the author of the engaging memoir Brooklyn Beginnings: A Geriatrician's Odyssey, published by I-Universe.
Brooklyn Beginnings is available in bookstores and online at: Indigo-Chapters, Amazon.ca, Amazon.com, Barnes and Noble and I-Universe
Moments That Matter: Cases in Ethical Eldercare: A Guide for Family Members, is available online at Amazon.ca.
His latest release is Late-Stage Dementia: providing comfort, compassion and care. It is available at Amazon and Indigo.
Visit Dr. Michael Gordon's website.