My experience of ethics at medical school has been patchy, at best.1 Mostly lectures. The definitions of beneficence, non-maleficence, autonomy, and justice learned by rote for exams and then ignored again. Holistic care mentioned once or twice. Maybe in a joke about orthopaedic surgeons. No one can really remember.
And then reality. My grandfather coughing blood. Losing weight. He smoked for 60 years. What did we expect?
Almost a year later my grandfather was on a syringe driver at home. He was becoming increasingly confused and agitated. It had been a long road. He had been so tired. He had said more than once he was ready to go.
It was clear to everyone that this was the end of his life, yet I was left fending off frequent requests for blood taking from the palliative team, carers, and district nurses. What if his sodium was low? Did I not want to know why he was confused? Maybe he had liver mets too. Maybe we should keep checking his LFTs?
It seemed irrelevant. And my overwhelming instinct was to tuck him up in bed and hold his hand.
My saving grace came with a GP home visit later one afternoon, coinciding with the nurses and palliative care team. It was very crowded.
He simply asked: ‘Will any of this change your management?’
I never saw the palliative care team again. More morphine and some midazolam, and he passed away peacefully a few days later surrounded by family.
Of course there is a place for investigations in medicine. But I quickly learned something we aren’t taught: that there is a place for standing back and letting things be.
Six months later on an A&E placement I was digging around in a 90-year-old’s arm desperately trying to fill an arterial blood gas bottle. She was septic and clearly minutes from passing away.
I wish I had asked how it would change her management. I wish I had tucked her in and called her family. Instead, her last few minutes were spent with me, bright strip lighting, and a needle.
- © British Journal of General Practice 2017
REFERENCE
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