My lack of accessing the internet yesterday has put me behind. Saddle-up, we have a lot to discuss.
End of life conversations are so important in the MICU and at our institution and there are many people who do really amazing jobs at it. So yesterday we were rounding on an 87 y/o minimally responsive trached pt who had initially presented with TB meningitis, been put on steroids, later got an upper GI bleed and had been in the ICU for weeks… Not making any progress. Wait, that sounds familiar, right? So I asked about end of life discussions. The attending said that they don’t discuss it with the family and continue to do everything. He added “the ladies figure it out, and then take them home against medical advice eventually.” In a place where they are paying daily for the hospital stay, I guess the family has some motivation to ‘figure it out’ but I wish there was more communication. I asked him if pts can designate themselves as DNR, but they can’t do that either! One pt we saw earlier who came in with a hemmorhagic stroke, her family couldn’t pay for the head CT (only $20-30 in US currency) so they took her home AMA too.
We noticed the other day when we rounded a sign that said “isolation” in the male wards. Yesterday we got to see our first HIV pt, and he was the one in the isolation room! He didn’t have anything infectious, the guy we saw today with leprosy and tb was in the regular ICU.
CaseIndiaTrips 2 